Correlation of Thrombosis and Prothrombotic Markers with Outcome in Lung Adenocarcinoma Patients: A Prospective Study.

Background: It is largely accepted that cancer patients have a high incidence of thrombosis which is strictly related to prognosis of cancer. Aim: We prospectively evaluated 81 consecutively lung adenocarcinoma patients in order to identify prothrombotic factors and thrombosis incidence.

Methods: Patients were submitted to Doppler examination of arms and limbs every three months or in case of thrombosis suspicion. Additional image evaluations were made in case of inconclusive diagnosis. Levels of C protein, platelets, and fibrinogen, factor VIII and IX, D-dimmer, antitrombin and apoptotic microparticles were evaluated each six months. Samples were also tested for lupus anticoagulant (LA) antibodies and levels of IL-1, IL-6 and Tumor Necrosis Factor (TNF). A group of 30 healthy blood donors was used as control.

Results: From the studied patients 21% had thrombosis, 38% had fibrinogen above 500 mg/dl, 42% had FVIII activity above 200%, 63% had increased D-dimmer, 60% had more than 1x106 microparticles/ml serum, and none of them have decreased levels of C protein or antitrombin. A small fraction of patients had increase of platelet counts. At immunological evaluation 52% of patients had LA detection and 63% showed increased leves of IL-6. Patients with at least one of the variables thrombosis, high levels of IL-6 (p<0.001), FVIII (p=0.05) and LA p=0.02) detection had a worst prognostic. Patients with increased FVIII levels (p=0,05) or LA detection (p=0,028) showed a significant increase in the thrombosis risk, whereas patients with more than 1x106 microparticles/ml showed only a tendency to increased risk of thrombosis (p=0,09).

Conclusion: There is a high incidence of thrombosis in lung adenocarcinoma patients, on which FVIII and LA significantly influenced and microparticles only showed a tendency. However, presence of LA, thrombosis or increased levels of IL-6 or FVIII showed directly interfered with patient’s survival.