Gastric cancer, one of the most aggressive tumors affecting the digestive tract, has seen a rise in both incidence and mortality rates in recent years, with a lack of clear prognostic indicators. D‑dimer, a byproduct of fibrin degradation, is a conventional coagulation biomarker that has been investigated as a potential adverse prognostic factor for postoperative cancer patients. However, conflicting results exist, with some studies suggesting that D‑dimer is an independent risk factor for the postoperative prognosis of gastric cancer, and others suggesting that there is no significant association between D‑dimer level and gastric cancer prognosis. This controversy underscores the need for further research to determine the true influence of D‑dimer level on the prognosis of postoperative cancer patients, including exploring the linear and non‑linear associations, and identifying optimal critical values before surgery. The present study aimed to assess the association between preoperative D‑dimer levels and 5‑year overall survival (OS) rate in patients undergoing radical surgery for gastric cancer. Data was analyzed from patients diagnosed with gastric cancer who underwent a radical gastrectomy at Shanxi Cancer Hospital (Taiyuan, China) in 2017 and were followed up for 5 years until December 2022. Preoperative D‑dimer levels and tumor‑related indicators were collected as covariates from hospital records, with patient follow‑up information obtained from the hospital's tracking system. Utilizing multivariate Cox regression, curve fitting and inflection point analysis, the present study sought to investigate the link between preoperative D‑dimer levels and 5‑year OS rate following radical surgery for gastric cancer. After strict admission and exclusion procedures, a total of 133 patients were included in the study and were then classified based on D‑dimer level. Based on the mean value, the D‑dimer levels were segregated into two distinct cohorts: The D‑dimer_high group (n=66) and the D‑dimer_low group (n=67). Cox multiple regression analysis was conducted using both continuous and binary variables. The results showed no effect in terms of the continuous variables, but higher preoperative D‑dimer levels were significantly associated with a higher 5‑year overall survival compared with lower preoperative D‑dimer levels in the categorical variables. Therefore, curve fitting was performed, which indicated that the association between D‑dimer level and 5‑year survival rate after radical gastrectomy for cancer showed a U‑shaped curve, with P<0.001, high and low D‑dimer levels both indicated poorer prognosis. A curvilinear correlation was demonstrated between preoperative D‑dimer levels and the 5‑year survival rate following radical gastrectomy for cancer. Subsequently, an inflection point analysis found that the inflection point was located at 100‑200 ng/ml. In conclusion, in patients undergoing radical gastrectomy for gastric cancer, preoperative D‑dimer can be used to indicate the current state of the tumor to some extent through blood coagulation status. Notably, a U‑shaped association exists between D‑dimer levels and 5‑year postoperative survival rate in gastric cancer. This association demonstrates varying effects across different intervals. Specifically, D‑dimer levels <100 ng/ml are associated with a worse prognosis, whereas levels >200 ng/ml are associated with a better prognosis.

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