The Hemostatic State in Cancer Patients: The Relationship between Hypercoagulable Markers and Cancer Prognostic Markers.

Background: The most common abnormalities described in cancer patients are the elevation of the clotting factors V, VIII, IX, and XI; increased fibrinogen/fibrin degradation products; hyperfibrinogenemia; and thrombocytosis. We performed a prospective study to evaluate the relationship between changes in hemostatic parameters and cancer prognostic markers.

Methods: We enrolled patients who were diagnosed as having different types of nonhematological, solid organ tumor. The most important natural inhibitors of abnormal coagulation (protein C, protein S, and antithrombin) and D-dimer and prothrombin activation peptide F 1 + 2 as markers of the status of coagulation system were studied in these groups of patients prior to any form of therapy. These markers were repeatedly measured with each treatment course and their results were correlated with other markers of tumor prognosis. These parameters were also studied before and after any surgical intervention for the tumor. The main aim of the study was to assess the changes in hemostatic parameters and to see if these changes can be used as markers for tumor prognosis.

Results: Fifty-two patients were enrolled in this study. Two patients had esophageal adenocarcinoma, 6 had gastric cancer, 16 had colorectal cancer, 4 had exocrine pancreatic carcinoma, 2 had adenocarcinoma of gallbladder, 6 had adenocarcinomatous type of non-small cell lung cancer, 2 had small cell lung cancer, 12 had infiltrating breast carcinoma, and 2 had ovarian cancer. In all cases, the elevation of the levels of hypercoaguable markers was directly correlated with tumor stage, tumor markers, and radiological findings of cancer state. Additionally, the level of naturally occurring coagulation inhibitors were all decreased with progression of tumor. These hypercoaguable parameters were also raised after surgical resection of these tumors.

Conclusions: Based on our findings, determination of D-dimer, F1 + 2, protein C, protein S, and antithrombin levels can be used as markers to assess the tumor prognosis.