This preprint is under consideration at World Journal of Surgical Oncology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Baiyong Shen
Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital
Corresponding Author
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Background: Elevated plasma D-dimer levels have been reported as an unfavorable prognostic indicator in many solid tumors. However, there are limited relevant studies in pancreatic cancer patients following radical surgery, and the clinical significance remains controversial. The aim of this study was to investigate the clinical and prognostic significance of preoperative plasma D-dimer in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing resection.
Methods: A retrospective analysis was performed of all patients who consecutively underwent radical surgery for PDAC by laparotomy or robotic surgery from December 2011 to December 2018. Baseline clinicopathologic characteristics, preoperative laboratory parameters and follow-up information were collected. Univariate and multivariate analyses were performed to analyze the prognostic value of preoperative plasma D-dimer.
Results: Among 1351 patients, elevated preoperative plasma D-dimer levels (≥ 0.55 ng/mL) were found in 417 (30.9%) patients. 312 (23.09%) underwent minimally invasive robotic pancreatectomy. The median overall survival (OS) of patients with elevated D-dimer levels was 6.3 months shorter than that of patients with normal D-dimer levels (15.0 months vs 21.3 months, p < 0.001). Multivariate analysis showed that elevated D-dimer levels independently predicted poorer OS (hazard ratio: 1.33, 95% confidence interval: 1.17-1.51, p < 0.001). Subgroup analysis demonstrated that D-dimer was a reliable prognostic factor in patients who underwent R0 resection. In addition, integration of D-dimer, carbohydrate antigen 19-9 (CA19-9) and NLR provided a better prognostic model for PDAC patients before operation.
Conclusion: An elevated preoperative plasma D-dimer level was a reliable independent prognostic factor for OS in patients with PDAC undergoing resection. Combination of D-dimer, CA19-9 and NLR can enhance the prognostic accuracy before operation.
Keywords
D-dimer, pancreatic ductal adenocarcinoma (PDAC), pancreatic surgery, prognostic factors
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CURRENT STATUS: Under Review
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Posted 13 May, 2021
Editorial decision: Minor Revision
On 13 May, 2021
Reviewer #2 agreed
On 12 May, 2021
Reviewers invited
Invitations sent on 12 May, 2021
Reviewer #1 agreed
On 12 May, 2021
Review #1 received
Received 12 May, 2021
Review #2 received
Received 12 May, 2021
Editor assigned
On 08 May, 2021
Submission checks complete
On 08 May, 2021
Editor invited
On 08 May, 2021
This version was not preprinted
Version (no preprint)
Posted 13 May, 2021
Reviews received
Received 13 May, 2021
Reviewers invited
Invitations sent on 12 May, 2021
Editor assigned
On 09 May, 2021
First submitted
On 06 May, 2021
Editorial decision: Minor Revision
On 23 Apr, 2021
This version was not preprinted
Version 1
Posted 16 Mar, 2021
No community comments so far
Review #2 received
Received 12 Apr, 2021
Reviewer #3 agreed
On 04 Apr, 2021
Reviewer #2 agreed
On 02 Apr, 2021
Review #1 received
Received 13 Mar, 2021
Reviews received
Received 11 Mar, 2021
Reviewer #1 agreed
On 11 Mar, 2021
Reviewers invited
Invitations sent on 11 Mar, 2021
Editor assigned
On 09 Mar, 2021
Submission checks complete
On 09 Mar, 2021
Editor invited
On 09 Mar, 2021
First submitted
On 07 Mar, 2021
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This preprint is under consideration at World Journal of Surgical Oncology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Baiyong Shen
Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version (no preprint)
Posted 13 May, 2021
Editorial decision: Minor Revision
On 13 May, 2021
Reviewer #2 agreed
On 12 May, 2021
Reviewers invited
Invitations sent on 12 May, 2021
Reviewer #1 agreed
On 12 May, 2021
Review #1 received
Received 12 May, 2021
Review #2 received
Received 12 May, 2021
Editor assigned
On 08 May, 2021
Submission checks complete
On 08 May, 2021
Editor invited
On 08 May, 2021
This version was not preprinted
Version (no preprint)
Posted 13 May, 2021
Reviews received
Received 13 May, 2021
Reviewers invited
Invitations sent on 12 May, 2021
Editor assigned
On 09 May, 2021
First submitted
On 06 May, 2021
Editorial decision: Minor Revision
On 23 Apr, 2021
This version was not preprinted
Version 1
Posted 16 Mar, 2021
No community comments so far
Review #2 received
Received 12 Apr, 2021
Reviewer #3 agreed
On 04 Apr, 2021
Reviewer #2 agreed
On 02 Apr, 2021
Review #1 received
Received 13 Mar, 2021
Reviews received
Received 11 Mar, 2021
Reviewer #1 agreed
On 11 Mar, 2021
Reviewers invited
Invitations sent on 11 Mar, 2021
Editor assigned
On 09 Mar, 2021
Submission checks complete
On 09 Mar, 2021
Editor invited
On 09 Mar, 2021
First submitted
On 07 Mar, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Elevated plasma D-dimer levels have been reported as an unfavorable prognostic indicator in many solid tumors. However, there are limited relevant studies in pancreatic cancer patients following radical surgery, and the clinical significance remains controversial. The aim of this study was to investigate the clinical and prognostic significance of preoperative plasma D-dimer in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing resection.
Methods: A retrospective analysis was performed of all patients who consecutively underwent radical surgery for PDAC by laparotomy or robotic surgery from December 2011 to December 2018. Baseline clinicopathologic characteristics, preoperative laboratory parameters and follow-up information were collected. Univariate and multivariate analyses were performed to analyze the prognostic value of preoperative plasma D-dimer.
Results: Among 1351 patients, elevated preoperative plasma D-dimer levels (≥ 0.55 ng/mL) were found in 417 (30.9%) patients. 312 (23.09%) underwent minimally invasive robotic pancreatectomy. The median overall survival (OS) of patients with elevated D-dimer levels was 6.3 months shorter than that of patients with normal D-dimer levels (15.0 months vs 21.3 months, p < 0.001). Multivariate analysis showed that elevated D-dimer levels independently predicted poorer OS (hazard ratio: 1.33, 95% confidence interval: 1.17-1.51, p < 0.001). Subgroup analysis demonstrated that D-dimer was a reliable prognostic factor in patients who underwent R0 resection. In addition, integration of D-dimer, carbohydrate antigen 19-9 (CA19-9) and NLR provided a better prognostic model for PDAC patients before operation.
Conclusion: An elevated preoperative plasma D-dimer level was a reliable independent prognostic factor for OS in patients with PDAC undergoing resection. Combination of D-dimer, CA19-9 and NLR can enhance the prognostic accuracy before operation.
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
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