From the Guidelines
D-dimer levels are often elevated in patients with metastatic disease, as evidenced by the association between cancer-associated venous thromboembolism and metastatic disease 1. The relationship between D-dimer levels and metastatic disease can be attributed to the activation of the coagulation cascade by tumor cells, release of procoagulant substances, and the creation of a systemic inflammatory state that promotes clotting. Key points to consider include:
- The risk for cancer-associated venous thromboembolism (VTE) is higher in patients with metastatic disease, with an annual incidence ranging from 0.5% to 20% depending on cancer type and other risk factors 1.
- Validated risk scoring models for cancer-associated VTE include factors such as tumor type, body mass index, hemoglobin levels, thrombocyte counts, and biomarkers like soluble P-selectin and D-dimer 1.
- Elevated D-dimer levels have been correlated with tumor burden, stage, and prognosis in various cancer types, with higher levels typically seen in more advanced or metastatic disease.
- While D-dimer testing is not specific enough to be used as a cancer screening tool on its own, persistently elevated levels in cancer patients may indicate disease progression or metastasis.
- Clinicians should interpret elevated D-dimer values in the context of the patient's overall clinical picture, considering other potential causes of increased levels such as infections, recent surgery, or cardiovascular events.
From the Research
D-Dimer Levels in Metastatic Disease
- D-dimer levels are frequently elevated in patients with metastatic disease, as observed in studies on sarcoma 2, breast cancer 3, 4, and colorectal cancer 5.
- Elevated D-dimer levels have been associated with poor prognosis, increased mortality risk, and tumor progression in cancer patients 2, 3, 6.
- The level of D-dimer has been correlated with tumor load, number of metastatic sites, and progression kinetics in patients with metastatic breast cancer 3.
- D-dimer levels have been shown to decrease in response to chemotherapy in patients with metastatic breast cancer 4 and colorectal cancer 5, suggesting its potential as a predictive and monitoring marker for chemotherapy response.
Association with Tumor Progression and Metastasis
- Activation of the extrinsic coagulation system and the fibrinolytic cascade within a tumor is thought to be related to growth, invasion, and metastasis 3.
- D-dimer levels have been positively correlated with tumor markers, such as CEA, CA19-9, and CA72-4, in patients with metastatic colorectal cancer 5.
- High D-dimer levels have been associated with poor overall survival and increased mortality risk in cancer patients, including those with metastatic disease 6.
Clinical Implications
- D-dimer levels may be a useful prognostic marker for identifying high-risk patients with metastatic disease 2, 3, 6.
- Monitoring D-dimer levels may help predict response to chemotherapy and disease progression in patients with metastatic cancer 4, 5.
- Further studies are needed to fully understand the clinical implications of D-dimer levels in metastatic disease and to explore its potential as a therapeutic target 2, 3, 4, 6, 5.