Plasma D-dimer levels in operable breast cancer patients correlate with clinical stage and axillary lymph node status

Purpose: To investigate the relationship between preoperative plasma D-dime r levels and extent of tumor involvement in operable breast cancer patients . Patients and Methods: A total Of 140 preoperative plasma specimens were obt ained from women scheduled to undergo diagnostic breast biopsies. Ninety-fi ve patients in the initial group went on to undergo axillary lymph node dis section. Of the 140 patients from whom plasma samples were obtained, 102 we re subsequently diagnosed with invasive breast carcinoma, nine were subsequ ently diagnosed with ductal carcinoma-in-situ, and 20 were subsequently dia gnosed with benign breast disease. Plasma D-dimer levels were quantitated u sing a commercially available immunoassay kit (DIMERTEST; American Diagnost ica, Greenwich, CT). The relationships between plasma D-dimer and other pro gnostic variables (tumor size, estrogen receptor, progesterone receptor, nu clear grade, histologic grade, lymphovascular invasion, and clinical stage grouping) were then examined using univariate and multivariate linear and l ogistic regression analyses. Results: Median plasma D-dimer levels were significantly higher in patients with invasive carcinoma than those patients with either benign breast dise ase or carcinoma-in-situ (P = .0001). A significant relationship existed be tween the presence of elevated D-dimer (> 100 ng/mL) and involved axillary lymph nodes (chi(2) test; P = .001). Elevated D-dimer levels predicted posi tive lymph node involvement in both univariate regression (P = .0035) and m ultivariate linear regression (P = .012) models. In addition, elevated D-di mer levels predicted the presence of lymphovascular invasion in univariate logistic regression (P = .0025) and multivariate logistic regression analys is (P = .0053). Quantitative D-dimer levels were highly correlated with cli nical stage grouping (analysis of variance test; P = .002). Conclusion: Plasma D-dimer levels were markers of lymphovascular invasion, clinical stage, and lymph node involvement in operable breast cancer. This correlation suggests that detectable fibrin degradation, as measured by pla sma D-dimer, is a clinically important marker for lymphovascular invasion a nd early tumor metastasis in operable breast cancer. J Clin Oncol 18:600-60 8. (C) 2000 by American Society of Clinical Oncology.