Baton Rouge General Medical Center Baton Rogue, LA
Lakshmi Sai Meghana Kodali, MBBS, MPH1, Rineetha Tandra, MD, MBBS2, Arshad Ali Mohd, MBBS3, Diksha Sanjana Pasnoor, MBBS4, Swathi Nimmala, MD5, Sudhir Pasham, MD6, Rishabh Vashisht, MBBS7, Naga Sai Akhil Reddy Gogula, MBBS8, Sandeep Kotnani, MBBS9, Devangi Upadhyay, MBBS10, Rupak Desai, MBBS11 1University of Michigan-Flint, Flint, MI; 2Baton Rouge General Medical Center, Baton Rogue, LA; 3Deccan College of Medical Sciences, Hyderabad, Telangana, India; 4Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, Telangana, India; 5Cape Fear Valley Hospital, Fayetteville, NC; 6Sanford Bemidji Medical Center, Bemidji, MN; 7NRI Medical College and General Hospital, Guntur, Andhra Pradesh, India; 8Duke University, Durham, NC; 9Rutgers Monmouth Medical Center, Long Branch, NJ; 10Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Orissa, India; 11Independent Outcomes Researcher, Atlanta, GA Introduction: Despite advances in diagnosis and treatment, colorectal cancer remains a significant public health challenge, contributing to high mortality rates worldwide. Among potential biomarkers, D-dimer, a widely used indicator of activated coagulation and fibrinolysis, has been proposed as a valuable prognostic biomarker in operable CRC. However, its prognostic value in metastatic colorectal cancer (mCRC) patients remains understudied. This meta-analysis evaluates the prognostic significance of D-dimer levels, offering insights into overall survival (OS) and progression-free survival (PFS) in mCRC patients. Methods: A comprehensive literature search was conducted using PubMed and Google Scholar, and the snowballing technique was used to identify relevant studies. Eligible studies included those evaluating baseline D-dimer levels in mCRC patients and their impact on OS and/or PFS published between 2004 and 2020. Data extraction focused on study design, sample size, D-dimer cut-off levels, and statistical outcomes. Binary random-effects models were used to estimate pooled hazard ratios (HR) and 95% confidence intervals (CI). Heterogeneity was assessed using I² statistics. Subgroup and sensitivity analyses were conducted to explore potential variations across study designs. Results: A total of 6 studies, encompassing 554 mCRC patients with a median age range of 23-85 years, in which males represented 56% of the cohort, were analyzed. Elevated D-dimer levels were significantly associated with poor OS, with a pooled HR of 1.46 (95% CI: 1.16-1.84, p < 0.01) and moderate heterogeneity (I² = 50.46%). Subgroup analysis demonstrated consistent associations in prospective cohort studies (HR: 1.41, 95% CI: 1.20-1.65, I² = 0%) and retrospective observational studies (HR: 2.83, 95% CI: 1.58-5.07, I²=0%). In contrast, the association between elevated D-dimer levels and PFS was not statistically significant, with a pooled HR of 1.13 (95% CI: 0.98-1.30, p = 0.10) and no heterogeneity (I² = 0%). Sensitivity analyses confirmed the robustness of the OS findings. Discussion: Our meta-analysis highlights the prognostic utility of elevated plasma D-dimer levels in mCRC patients, demonstrating their significant association with poor overall survival. The findings underscore the potential of D-dimer as a valuable biomarker in mCRC. However, no statistically significant association was observed with progression-free survival, highlighting the need for further research to clarify its role in predicting disease progression.
Figure: Figure 1. Association of D-dimer levels with overall survival and progression-free survival in metastatic colorectal cancer: a meta-analysis
Disclosures: Lakshmi Sai Meghana Kodali indicated no relevant financial relationships. Rineetha Tandra indicated no relevant financial relationships. Arshad Ali Mohd indicated no relevant financial relationships. Diksha Sanjana Pasnoor indicated no relevant financial relationships. Swathi Nimmala indicated no relevant financial relationships. Sudhir Pasham indicated no relevant financial relationships. Rishabh Vashisht indicated no relevant financial relationships. Naga Sai Akhil Reddy Gogula indicated no relevant financial relationships. Sandeep Kotnani indicated no relevant financial relationships. Devangi Upadhyay indicated no relevant financial relationships. Rupak Desai indicated no relevant financial relationships.
Lakshmi Sai Meghana Kodali, MBBS, MPH1, Rineetha Tandra, MD, MBBS2, Arshad Ali Mohd, MBBS3, Diksha Sanjana Pasnoor, MBBS4, Swathi Nimmala, MD5, Sudhir Pasham, MD6, Rishabh Vashisht, MBBS7, Naga Sai Akhil Reddy Gogula, MBBS8, Sandeep Kotnani, MBBS9, Devangi Upadhyay, MBBS10, Rupak Desai, MBBS11. P2635 - Prognostic Role of D-Dimer in Predicting Survival Outcomes in Metastatic Colorectal Cancer: A Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
