Plasma D-dimer measurement as a marker of gynecologic tumors: comparison with Ca 125

Fibrin is formed and degraded intra-abdominally in ovarian cancer, and the cross-linked fibrin degradation product, D-dimer (D-D), has been found in increased concentrations in the plasma of these patients.

D-dimer and Ca 125 levels were determined simultaneously in 110 patients with gynecologic neoplasms. D-dimer and Ca 125 assays were performed using the Dimertest Stripwell EIA Kit (Ortho) and CA 125-II EIA assay (Roche), respectively.

D-dimer plasma and Ca 125 serum levels were significantly higher in patients with ovarian cancer (mean +/- SE = 894.2 +/- 173.7 ng/ml and 760.5 +/- 292.7 U/ml, respectively) than in those with uterine cancer (mean DD +/- SE = 109.7 +/- 23.5 ng/ml and mean Ca 125 +/- SE = 50.0 +/- 23.1 U/ml) or those with benign disease (mean D-D +/- SE = 70.5 +/- 5.5 ng/ml and mean Ca 125 +/- SE = 6.6 +/- 2.8 U/ml). The levels of both markers increased with regard to ovarian cancer disease status. Mean D-D +/- SE was 90.0 +/- 22.8 ng/ml and mean Ca 125 +/- SE was 2.1 +/- 1.2 U/ml in patients with complete remission; mean D-D +/- SE was 143.3 +/- 33.5 ng/ml and mean Ca 125 +/- SE was 26.2 +/- 13.6 U/ml in patients with partial remission. In active disease, both markers had very high levels: D-D mean +/- SE = 1021.6 +/- 173.0 ng/ml and Ca 125 mean +/- SE = 1154.7 +/- 458.1 U/ml. In all groups of ovarian cancer patients, D-dimer sensitivity was better than that of Ca 125. In advanced ovarian cancer patients, the D-dimer concentration in ascites was up to 100 fold that in plasma.

Our results suggest that D-dimer can serve as a sensitive indicator to monitor the extent and course of the disease in ovarian cancer patients. The patient follow-up is ongoing to establish the predictive value of D-dimer measurement with respect to prognosis.