The study examined if preoperative plasma D-dimer level was associated with the postoperative cumulative incidence of deep venous thrombosis in patients with colorectal cancer admitted for intended curative surgery. In 176 consecutive patients with newly-diagnosed colorectal cancer and absence of preoperative deep venous thrombosis, we measured the preoperative plasma D-dimer levels and performed compression ultrasonography for deep venous thrombosis prior to surgery, as well as one week, one month, and one year after surgery. The cumulative incidence of deep venous thrombosis up to one year after surgery was 20 percent (95 percent confidence interval, 12 to 31 percent) in the positive D-dimer group compared with 5 percent (95 percent confidence interval, 2 to 12 percent) in the negative D-dimer group. The adjusted hazard ratio of deep venous thrombosis in the positive vs. the negative D-dimer group was 6.53 (95 percent confidence interval, 1.58 to 27.0). A positive preoperative D-dimer was associated with a higher cumulated incidence of postoperative deep venous thrombosis. D-dimer might be useful in identifying those colorectal cancer patients who fail to respond to standard prophylaxis for deep venous thrombosis.

In the western world, colorectal cancer (CRC) is the third most common cause of cancer-related deaths. Survival is closely related to the stage of cancer at diagnosis striking the clinical need for biomarkers capable of early detection. To search for possible biological parameters for early diagnosis of CRC we evaluated protein expression for three CREC (acronym: Cab45, reticulocalbin, ERC-55, calumenin) proteins: reticulocalbin, calumenin, and ERC-55 in a cellular model consisting of a normal derived colon mucosa cell line, NCM460, and a primary adenocarcinoma cell line of the colon, SW480. Furthermore, this cellular model was analyzed by a top-down proteomic approach, 2-dimensional polyacrylamide gel electrophoresis (2D-PAGE) and liquid chromatography–tandem mass spectrometry (LC–MS/MS) for novel putative diagnostic markers by identification of differentially expressed proteins between the two cell lines. A different colorectal carcinoma cell line, HCT 116, was used in a bottom-up proteomic approach with label-free quantification (LFQ) LC–MS/MS. The two cellular models gave sets of putative diagnostic CRC biomarkers. Various of these novel putative markers were verified with increased expression in CRC patient neoplastic tissue compared to the expression in a non-involved part of the colon, including reticulocalbin, calumenin, S100A6 and protein SET. Characterization of these novel identified biological features for CRC patients may have diagnostic potential and therapeutic relevance in this malignancy characterized by a still unmet clinical need.

To examine the impact of plasma D-dimer levels in predicting 3-year survival and nonresectability in pancreatic cancer patients. Ninety-five patients were divided into three groups according to plasma D-dimer levels. Kaplan–Meier survival curves and hazard ratios were computed, and diagnostic indices of D-dimer in the prediction of resectability were assessed. The median survival among patients with low, medium and high D-dimer levels was 13.7 [95% confidence interval (CI): 10.2–19.6], 6.2 (95% CI: 2.0–15.1) and 2.4 months (95% CI: 1.4–3.3), respectively. The adjusted hazard ratio of death in the group of patients with high D-dimer levels was 2.2 (95% CI: 1.1–4.2). The positive and negative predictive values of D-dimer in the prediction of nonresectability were 89% (95% CI: 77–96%) and 48% (95% CI: 33– 63%), respectively. An elevated D-dimer level is associated with reduced survival in pancreatic cancer and predicts nonresectability.

Deep venous thrombosis (DVT) is a major complication of cancer and a predictor of reduced survival. The postoperative prevalence of DVT in colorectal cancer surgery is high, but the preoperative prevalence is unknown. The aim of this observational study was to estimate the preoperative prevalence of DVT in patients with colorectal cancer. Some 193 consecutive patients with newly diagnosed colorectal cancer admitted for intended curative surgery were examined with compression ultrasonography for DVT before surgery. DVT was detected in 15 (7·8 per cent) of the 193 patients, with a prevalence of 16 per cent in women (12 of 76) versus 2·6 per cent in men (three of 117 (adjusted odds ratio (OR) 5·8 (95 per cent confidence interval (c.i.) 1·4 to 23·2)). The risk of DVT was strongly correlated with increasing American Society of Anesthesiologists (ASA) risk score: adjusted OR 6·8 (95 per cent c.i. 1·6 to 28·7 for ASA group III or IV versus ASA group I or II). Pulmonary embolism was detected in two patients (1·0 per cent). A high preoperative prevalence of DVT was observed in patients with colorectal cancer, especially among women and patients in ASA groups III and IV.

Summary: The preoperative prevalence of deep venous thrombosis (DVT) in patients with colorectal cancer may be as high as 8%. In order to minimize the risk of pulmonary embolism, it is important to rule out preoperative DVT. A large study has confirmed that a negative D-dimer test in combination with a low clinical pre-test probability (PTP) can be safely used to rule out the tentative diagnosis of DVT in cancer patients. However, the accuracy in colorectal cancer patients is uncertain. This study assessed the diagnostic accuracy of a quantitative D-dimer assay in combination with the PTP score in ruling out preoperative DVT in colorectal cancer patients admitted for surgery. Preoperative D-dimer test and compression ultrasonography for DVT were performed in 193 consecutive patients with newly diagnosed colorectal cancer. Diagnostic accuracy indices of the D-dimer test were assessed according to the PTP score. The negative predictive value, positive predictive value, sensitivity and specificity were 99% (95% confidence interval (CI), 95–100%), 17% (95% CI, 9–26), 93% (95% CI, 68–100%) and 61% (95% CI, 53–68%), respectively. In conclusion, the combined use of pre-test probability and D-dimer test may be useful in ruling out preoperative DVT in colorectal cancer patients admitted for surgery.