Novel high-sensitive D-dimer determination predicts chemotherapy-associated venous thromboembolism in intermediate risk lung cancer patients

Clin Lung Cancer. 2012 Nov;13(6):482-7. doi: 10.1016/j.cllc.2012.03.005. Epub 2012 May 15.


Introduction: We hypothesized that the use of a novel high sensitivity (HS) assay for D-dimer determination might ameliorate venous thromboembolism (VTE) risk prediction in intermediate risk lung cancer patients in whom chemotherapy could act as a trigger for VTE onset.

Patients and methods: Pretreatment HS D-dimer levels were retrospectively evaluated in 108 lung cancer outpatients using a novel automated latex enhanced turbidimetric immunoassay. All patients were at the start of a new platinum-based chemotherapy regimen and were classified as intermediate risk according to Khorana's assessment model. Patients were followed-up for a median period of 6.9 months.

Results: Receiver operating characteristic (ROC) curves and corresponding Bayesian analysis showed that the best performance was obtained at a cutoff level of 1500 ng/mL, which resulted in a sensitivity of 81%, a specificity of 69%, a positive predictive value (PPV) of 31%, a negative predictive value (NPV) of 96%, and an accuracy of 70%. Patients with HS D-dimer levels above the cutoff had a worse VTE-free survival (60%) compared with those with levels below the cutoff (95%; P = .0001). Multivariate Cox proportional hazards survival analysis confirmed that pretreatment HS D-dimer levels were able to significantly predict VTE with a hazard ratio of 11 (95% confidence interval, 2.62-46.2; P = .001), independently of classic VTE risk factors.

Conclusions: The use of HS D-dimer determination prior to chemotherapy might allow for VTE risk stratification of intermediate risk cancer patients, helping in identifying those individuals who could benefit from thromboprophylaxis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Automation, Laboratory
  • Bayes Theorem
  • Female
  • Fibrin Fibrinogen Degradation Products / metabolism*
  • Follow-Up Studies
  • Humans
  • Immunoassay
  • Lung Neoplasms / drug therapy*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Nephelometry and Turbidimetry / methods
  • Outpatients
  • Platinum Compounds / administration & dosage
  • Predictive Value of Tests
  • Proportional Hazards Models
  • ROC Curve
  • Retrospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Survival Rate
  • Venous Thromboembolism / chemically induced
  • Venous Thromboembolism / diagnosis*


  • Fibrin Fibrinogen Degradation Products
  • Platinum Compounds
  • fibrin fragment D