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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2017

01-02-2017 | Gastrointestinal Oncology

Proposal of the Coagulation Score as a Predictor for Short-Term and Long-Term Outcomes of Patients with Resectable Gastric Cancer

Authors: Mitsuro Kanda, MD, PhD, FACS, Chie Tanaka, MD, PhD, Daisuke Kobayashi, MD, PhD, Akira Mizuno, MD, Yuri Tanaka, MD, Hideki Takami, MD, PhD, Naoki Iwata, MD, PhD, Masamichi Hayashi, MD, PhD, Yukiko Niwa, MD, PhD, Suguru Yamada, MD, PhD, FACS, Tsutomu Fujii, MD, PhD, FACS, Hiroyuki Sugimoto, MD, PhD, Kenta Murotani, PhD, Michitaka Fujiwara, MD, PhD, Yasuhiro Kodera, MD, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 2/2017

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Abstract

Background

Systemic hemostasis and thrombosis activation has been implicated in tumor progression and metastasis. This study aimed to investigate the use of coagulation factors as a novel prediction method for postoperative outcomes after curative gastrectomy in patients with stage II/III gastric cancer (GC).

Methods

Overall, 126 patients with stage II/III GC who underwent gastrectomy between May 2003 and February 2016 were eligible for inclusion in the study. We retrospectively evaluated the predictive value of preoperative platelet count and plasma fibrinogen and d-dimer levels, and coagulation score (0: fibrinogen and d-dimer both below upper limits; 1: either fibrinogen or d-dimer over upper limits; 2: both fibrinogen and d-dimer over upper limits) for short- and long-term outcomes.

Results

Postoperative complications were significantly more frequent in patients with elevated preoperative d-dimer levels compared with those with normal d-dimer levels (26 vs. 10 %; p = 0.032). The prevalence of postoperative complications showed a stepwise increase in proportion to the coagulation score. Patients with a coagulation score of 2 had significantly larger tumors (p = 0.013) and significantly greater intraoperative blood loss (p = 0.004) than those who scored 0 or 1. Coagulation score showed the highest values distinguished high-risk patients in overall and disease-free survival, and a coagulation score of 2 was an independent prognostic factor for recurrence. Patients with a coagulation score of 2 experienced a significantly higher prevalence of liver metastasis as an initial recurrence than those who scored 0 or 1 (p = 0.019).

Conclusions

The coagulation score is a simple and promising predictor for postoperative complications and recurrence after gastrectomy in stage II/III GC patients.
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Metadata
Title
Proposal of the Coagulation Score as a Predictor for Short-Term and Long-Term Outcomes of Patients with Resectable Gastric Cancer
Authors
Mitsuro Kanda, MD, PhD, FACS
Chie Tanaka, MD, PhD
Daisuke Kobayashi, MD, PhD
Akira Mizuno, MD
Yuri Tanaka, MD
Hideki Takami, MD, PhD
Naoki Iwata, MD, PhD
Masamichi Hayashi, MD, PhD
Yukiko Niwa, MD, PhD
Suguru Yamada, MD, PhD, FACS
Tsutomu Fujii, MD, PhD, FACS
Hiroyuki Sugimoto, MD, PhD
Kenta Murotani, PhD
Michitaka Fujiwara, MD, PhD
Yasuhiro Kodera, MD, PhD, FACS
Publication date
01-02-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5544-1

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