Purpose: Elevated plasma D-dimer levels were thought to be associated with decreasing survival in various cancers. The relationship between plasma D-dimer levels and clinicopathology and the optimal D-dimer cutoff as a prognostic predictor has not been determined in patients with upper tract urothelial carcinoma (UTUC). We aimed to investigate the prognostic value of preoperative plasma D-dimer levels as a predictor of patient outcomes in UTUC following radical nephroureterectomy.
Patients and Methods: We retrospectively reviewed data for 232 patients. The D-dimer cutoff value was set at 0.36 mg/L, and we used the Kaplan–Meier method and Cox’s proportional hazards regression models to analyze the association between D-dimer levels and oncological outcomes. Multivariate Cox regression was used to develop a nomogram, which we evaluated for accuracy using a receiver operating characteristic curve, calibration plot, and decision curve analysis.
Results: Plasma D-dimer levels ≥ 0.36 mg/L were significantly associated with advanced tumor status regarding size, location, hydronephrosis, tumor grade, lymph node involvement, grade, and stage (all p < 0.05). The Kaplan–Meier analysis showed that plasma D-dimer levels ≥ 0.36 mg/L predicted worse oncological outcomes vs levels < 0.36 mg/L (all p < 0.001). Univariate and multivariate analyses showed that elevated preoperative plasma D-dimer level was an independent predictor of recurrence-free survival (hazard ratio (HR): 1.67, 95% confidence interval (CI): 1.07– 2.63; p = 0.025), cancer-specific survival (HR: 2.34, 95% CI: 1.30– 4.19; p = 0.004), and overall survival (HR: 1.98, 95% CI: 1.18– 3.34; p = 0.010). We also developed a nomogram predicting 3- and 5-year overall survival probability.
Conclusion: D-dimer levels may be a useful prognostic predictor of survival and improve risk stratification and precisely individualize treatment for patients with UTUC.
Keywords: urothelial carcinoma, upper urinary tract, prognosis, predictors, D-dimer, nomogram