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Wen X, Bai S, Fang Z, Zhu W. Integrated pan-cancer and scRNA-seq analyses identify a prognostic coagulation-related gene signature associated with tumor microenvironment in lower-grade glioma. Discov Oncol 2024; 15:256. [PMID: 38955935 PMCID: PMC11219639 DOI: 10.1007/s12672-024-01114-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/20/2024] [Indexed: 07/04/2024] Open
Abstract
Cancer-associated thrombosis is a significant complication in cancer patients, leading to increased morbidity and mortality. The expression of coagulation/fibrinolysis genes, termed the "coagulome", plays a critical role in this process. Using the single-sample gene set enrichment analysis (ssGSEA), we identified seven cancer types with significantly activated coagulation pathways, focusing on lower-grade glioma (LGG) and stomach adenocarcinoma due to their predictive value for overall survival. Through 1000 iterations of the Least Absolute Shrinkage and Selection Operator (LASSO), we selected prognostic genes and constructed effective Cox regression models, particularly for LGG. Incorporating clinical characteristics, we constructed a nomogram for LGG, achieving an impressive area under the curve (AUCs) of 0.79, 0.82, and 0.81 at 1, 3, and 5 years in the test dataset, indicating strong potential for clinical application. Functional enrichment analysis between high-risk and low-risk LGG groups revealed significant enrichment of genes involved in the inflammatory response, interferon-gamma response, and epithelial-mesenchymal transition pathways. Combined with CIBERSORT and single-cell RNA sequencing analysis of LGG, our results demonstrated that the interplay between coagulation and the tumor microenvironment, particularly involving gliomas and myeloid cells, significantly influences tumor progression and patient outcomes.
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Affiliation(s)
- Xuehuan Wen
- Department of Oncology, The Affiliated Cangnan Hospital, Wenzhou Medical University, Wenzhou, 325800, Zhejiang, China
| | - Songjie Bai
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Zuochun Fang
- Department of Critical Care Medicine, Longgang People's Hospital, Wenzhou, 325800, Zhejiang, China
| | - Weiguo Zhu
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, People's Republic of China.
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Aloss K, Hamar P. Augmentation of the EPR effect by mild hyperthermia to improve nanoparticle delivery to the tumor. Biochim Biophys Acta Rev Cancer 2024; 1879:189109. [PMID: 38750699 DOI: 10.1016/j.bbcan.2024.189109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
The clinical translation of the nanoparticle (NP)-based anticancer therapies is still unsatisfactory due to the heterogeneity of the enhanced permeability and retention (EPR) effect. Despite the promising preclinical outcome of the pharmacological EPR enhancers, their systemic toxicity can limit their clinical application. Hyperthermia (HT) presents an efficient tool to augment the EPR by improving tumor blood flow (TBF) and vascular permeability, lowering interstitial fluid pressure (IFP), and disrupting the structure of the extracellular matrix (ECM). Furthermore, the HT-triggered intravascular release approach can overcome the EPR effect. In contrast to pharmacological approaches, HT is safe and can be focused to cancer tissues. Moreover, HT conveys direct anti-cancer effects, which improve the efficacy of the anti-cancer agents encapsulated in NPs. However, the clinical application of HT is challenging due to the heterogeneous distribution of temperature within the tumor, the length of the treatment and the complexity of monitoring.
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Affiliation(s)
- Kenan Aloss
- Institute of Translational Medicine - Semmelweis University - 1094, Tűzoltó utca, 37-49, Budapest, Hungary
| | - Péter Hamar
- Institute of Translational Medicine - Semmelweis University - 1094, Tűzoltó utca, 37-49, Budapest, Hungary.
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3
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Chong S, Mu G, Cen X, Xiang Q, Cui Y. Effects of PCSK9 on thrombosis and haemostasis in a variety of metabolic states: Lipids and beyond (Review). Int J Mol Med 2024; 53:57. [PMID: 38757360 PMCID: PMC11093556 DOI: 10.3892/ijmm.2024.5381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors are widely recognised as being able to induce a potent reduction in low‑density lipoprotein‑cholesterol. An increasing number of studies have suggested that PCSK9 also influences the haemostatic system by altering platelet function and the coagulation cascade. These findings have significant implications for anti‑PCSK9 therapy in patients with specific coagulation conditions, including expanded indications, dose adjustments and drug interactions. The present review summarises the changes in PCSK9 levels in individuals with liver diseases, chronic kidney diseases, diabetes mellitus, cancer and other disease states, and discusses their impact on thrombosis and haemostasis. Furthermore, the structure, effects and regulatory mechanisms of PCSK9 on platelets, coagulation factors, inflammatory cells and endothelial cells during coagulation and haemostasis are described.
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Affiliation(s)
- Shan Chong
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing 100191, P.R. China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, P.R. China
| | - Guangyan Mu
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing 100191, P.R. China
- Department of Pharmacy, Peking University First Hospital, Beijing 100034, P.R. China
| | - Xinan Cen
- Department of Hematology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Qian Xiang
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing 100191, P.R. China
- Department of Pharmacy, Peking University First Hospital, Beijing 100034, P.R. China
| | - Yimin Cui
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing 100191, P.R. China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, P.R. China
- Department of Pharmacy, Peking University First Hospital, Beijing 100034, P.R. China
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Tran HCM, Mbemba E, Mourot N, Faltas B, Rousseau A, Lefkou E, Sabbah M, van Dreden P, Gerotziafas G. The procoagulant signature of cancer cells drives fibrin network formation in tumor microenvironment and impacts its quality. Implications in cancer cell migration and the resistance to anticancer agents. Thromb Res 2024; 238:172-183. [PMID: 38723522 DOI: 10.1016/j.thromres.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/02/2024] [Accepted: 04/15/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Cancer cells induce hypercoagulability in the tumoral microenvironment by expressing Tissue Factor (TF). We aimed to study the impact of the procoagulant signature of cancer cells on the quality and structure of fibrin network. We also studied the impact of fibrin clot shield (FCS) on the efficiency of anticancer agents and the migration of cancer cells. MATERIALS AND METHODS Pancreatic cancer cells BXPC3 and breast cancer cells MDA-MB231 and MCF7, were cultured in the presence of normal Platelet Poor Plasma (PPP), diluted 10 % in conditioning media. Their potential to induce thrombin generation and their fibrinolytic activity were assessed. The structure of fibrin network was analyzed with Scanning Electron Microscopy (SEM). Cancer cells' mobility with fibrin clot and their interactions with fibrin were observed. Cancer cells were treated with paclitaxel (PTX) or 4-hydroxy-tamoxifen (4OHTam) in the presence or absence of FCS. RESULTS Cancer cells, in presence of PPP, induced fibrin network formation. High TF-expressing cancer cells (BXPC3 and MDA-MB23 cells), led to dense fibrin network with fine fibers. Low TF expressing cells MCF7 led to thick fibers. Exogenous TF enhanced the density of fibrin network formed by MCF7 cells. Cancer cells through their inherent profibrinolytic potential migrated within the fiber scaffold. The BXPC3 and MCF7 cells moved in clusters whereas the MDA-MB231 cells moved individually within the fibrin network. FCS decreased the efficiency of PTX and 4OHTam on the viability of cancer cells. CONCLUSIONS The procoagulant signature of cancer cells is determinant for the quality and structure of fibrin network in the microenvironment. Original SEM images show the architecture of "bird's nest"-like fibrin network being in touch with the cell membranes and surrounding cancer cells. Fibrin network constructed by triggering thrombin generation by cancer cells, provides a scaffold for cell migration. Fibrin clot shields protect cancer cells against PTX and 4OHTam.
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Affiliation(s)
- Huong Chi Mai Tran
- Sorbonne University, INSERM UMR_S_938, Saint-Antoine Research Center (CRSA), Team "Cancer Biology and Therapeutics", Group "Cancer - Angiogenesis - Thrombosis", University Institute of Cancerology (UIC), 34 Rue du Crozatier, F-75012 Paris, France; Clinical Research Department, Diagnostica Stago, 125 Avenue Louis Roche, 92230 Gennevilliers, France
| | - Elisabeth Mbemba
- Sorbonne University, INSERM UMR_S_938, Saint-Antoine Research Center (CRSA), Team "Cancer Biology and Therapeutics", Group "Cancer - Angiogenesis - Thrombosis", University Institute of Cancerology (UIC), 34 Rue du Crozatier, F-75012 Paris, France
| | - Noémie Mourot
- Sorbonne University, INSERM UMR_S_938, Saint-Antoine Research Center (CRSA), Team "Cancer Biology and Therapeutics", Group "Cancer - Angiogenesis - Thrombosis", University Institute of Cancerology (UIC), 34 Rue du Crozatier, F-75012 Paris, France
| | - Beshoy Faltas
- Sorbonne University, INSERM UMR_S_938, Saint-Antoine Research Center (CRSA), Team "Cancer Biology and Therapeutics", Group "Cancer - Angiogenesis - Thrombosis", University Institute of Cancerology (UIC), 34 Rue du Crozatier, F-75012 Paris, France
| | - Aurélie Rousseau
- Clinical Research Department, Diagnostica Stago, 125 Avenue Louis Roche, 92230 Gennevilliers, France
| | - Elmina Lefkou
- Sorbonne University, INSERM UMR_S_938, Saint-Antoine Research Center (CRSA), Team "Cancer Biology and Therapeutics", Group "Cancer - Angiogenesis - Thrombosis", University Institute of Cancerology (UIC), 34 Rue du Crozatier, F-75012 Paris, France
| | - Michèle Sabbah
- Sorbonne University, INSERM UMR_S_938, Saint-Antoine Research Center (CRSA), Team "Cancer Biology and Therapeutics", Group "Cancer - Angiogenesis - Thrombosis", University Institute of Cancerology (UIC), 34 Rue du Crozatier, F-75012 Paris, France
| | - Patrick van Dreden
- Sorbonne University, INSERM UMR_S_938, Saint-Antoine Research Center (CRSA), Team "Cancer Biology and Therapeutics", Group "Cancer - Angiogenesis - Thrombosis", University Institute of Cancerology (UIC), 34 Rue du Crozatier, F-75012 Paris, France; Clinical Research Department, Diagnostica Stago, 125 Avenue Louis Roche, 92230 Gennevilliers, France
| | - Grigoris Gerotziafas
- Sorbonne University, INSERM UMR_S_938, Saint-Antoine Research Center (CRSA), Team "Cancer Biology and Therapeutics", Group "Cancer - Angiogenesis - Thrombosis", University Institute of Cancerology (UIC), 34 Rue du Crozatier, F-75012 Paris, France; Thrombosis Center, Tenon - Saint Antoine University Hospital,Hôpitaux Universitaires Est Parisien, Assitance Publique Hôpitaix de Paris (AP-HP), 4 Rue de la Chine, 75020 Paris, France.
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Tsantes AG, Petrou E, Tsante KA, Sokou R, Frantzeskaki F, Domouchtsidou A, Chaldoupis AE, Fortis SP, Piovani D, Nikolopoulos GK, Iacovidou N, Bonovas S, Samonis G, Tsantes AE. Cancer-Associated Thrombosis: Pathophysiology, Laboratory Assessment, and Current Guidelines. Cancers (Basel) 2024; 16:2082. [PMID: 38893201 PMCID: PMC11171168 DOI: 10.3390/cancers16112082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Dysregulated hemostasis in cancer patients is associated with various clinical conditions, from thromboembolic complications to disseminated intravascular coagulation. Despite the well-established association between cancer and thromboembolic complications, the mechanisms involved are not completely elucidated. There are several predisposing factors in cancer for increased thrombus generation, such as immobilization and chemotherapy. The term cancer-associated thrombosis (CAT) has been introduced to describe the close bidirectional relationship between cancer and thromboembolic events. Conventional coagulation tests (PT/aPTT) are more accurate in detecting a hypocoagulable rather than a hypercoagulable state; thus, their contribution to CAT management is limited. Traditionally, D-dimer levels have been the most common laboratory study for the evaluation of thrombotic risk. However, D-dimer levels only display a snapshot of the coagulation cascade, and they cannot provide a dynamic evaluation of evolving clot formation. Non-conventional assays, such as viscoelastic methods and microparticle formation are promising tools for the identification of patients at risk for developing CAT. Recent guidelines from the American Society of Clinical Oncology counsel against the estimation of thrombotic risk through a single test and recommend the use of scoring systems that take into account several risk factors. The present review outlines the current insights into the pathophysiological mechanisms of CAT and provides a comprehensive review of the latest advances in the laboratory assessment of CAT and the recent guidelines for the management of patients at risk for developing thromboembolic complications.
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Affiliation(s)
- Andreas G. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.P.); (K.A.T.); (A.E.C.); (A.E.T.)
- Microbiology Department, “Saint Savvas” Oncology Hospital, 11522 Athens, Greece;
| | - Eleni Petrou
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.P.); (K.A.T.); (A.E.C.); (A.E.T.)
| | - Konstantina A. Tsante
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.P.); (K.A.T.); (A.E.C.); (A.E.T.)
| | - Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 18454 Piraeus, Greece;
| | - Frantzeska Frantzeskaki
- 2nd Department of Critical Care, Attikon Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Aglaia Domouchtsidou
- Microbiology Department, “Saint Savvas” Oncology Hospital, 11522 Athens, Greece;
| | - Anastasios E. Chaldoupis
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.P.); (K.A.T.); (A.E.C.); (A.E.T.)
| | - Sotirios P. Fortis
- Laboratory of Reliability and Quality Control in Laboratory Hematology (HemQcR), Department of Biomedical Sciences, Section of Medical Laboratories, School of Health & Caring Sciences, University of West Attica (UniWA), 12243 Egaleo, Greece;
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | | | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - George Samonis
- Department of Medicine, University of Crete, 71500 Heraklion, Greece;
- Department of Oncology, Metropolitan Hospital, 18547 Athens, Greece
| | - Argyrios E. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.P.); (K.A.T.); (A.E.C.); (A.E.T.)
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Peseski AM, Kapoor S, Kuchibhatla M, Adamski A, Abe K, Beckman MG, Reyes NL, Richardson LC, Saber I, Schulteis R, Singh BP, Sitlinger A, Thames EH, Ortel TL. An epidemiologic study comparing cancer- and noncancer-associated venous thromboembolism in a racially diverse Southeastern United States county. Res Pract Thromb Haemost 2024; 8:102420. [PMID: 38817950 PMCID: PMC11137544 DOI: 10.1016/j.rpth.2024.102420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 06/01/2024] Open
Abstract
Background Cancer-associated venous thromboembolism (CA-VTE) represents a major cause of morbidity and mortality in patients with cancer. Despite poor outcomes, there is an ongoing knowledge gap in epidemiologic data related to this association. Objectives To compare venous thromboembolism (VTE) characteristics, risk factors, and outcomes between patients with and without active cancer in a racially diverse population. Methods Our surveillance project occurred at the 3 hospitals in Durham County, North Carolina, from April 2012 through March 2014. Electronic and manual methods were used to identify unique Durham County residents with VTE. Results We identified 987 patients with VTE during the surveillance period. Of these, 189 patients had active cancer at the time of their VTE event. Patients with CA-VTE were older (median age: 69 years vs 60 years, P < .0001) and had a lower body mass index (median body mass index: 26.0 kg/m2 vs 28.4 kg/m2, P = .0001) than noncancer patients. The most common cancers in our cohort were gastrointestinal, breast, genitourinary, and lung. The proportion of VTE cases with pulmonary embolism (PE) was greater in the cancer cohort compared with that in the noncancer cohort (58.2% vs 44.0%, P = .0004). Overall survival was lower in the CA-VTE group than in patients without cancer (P < .0001). Black patients with CA-VTE had lower proportion of PE (52.3% vs 67.1%, P = .05) but had decreased survival (P < .0003) in comparison with White patients. Conclusion Future studies may be needed to continue to evaluate local and national VTE data to improve VTE prevention strategies and CA-VTE outcomes.
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Affiliation(s)
- Andrew M. Peseski
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Sargam Kapoor
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Alys Adamski
- Division of Blood Disorders and Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karon Abe
- Division of Blood Disorders and Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michele G. Beckman
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nimia L. Reyes
- Division of Blood Disorders and Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa C. Richardson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ryan Schulteis
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Bhavana Pendurthi Singh
- Division of Hematology Oncology, Lehigh Valley Hospital Pocono, East Stroudsburg, Pennsylvania, USA
| | - Andrea Sitlinger
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina, USA
| | - Elizabeth H. Thames
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Thomas L. Ortel
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Department of Pathology, Duke University, Durham, North Carolina, USA
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7
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Charles-Schoeman C, Fleischmann R, Mysler E, Greenwald M, Ytterberg SR, Koch GG, Bhatt DL, Wang C, Mikuls TR, Chen AS, Connell CA, Woolcott JC, Menon S, Chen Y, Lee K, Szekanecz Z. Risk of Venous Thromboembolism With Tofacitinib Versus Tumor Necrosis Factor Inhibitors in Cardiovascular Risk-Enriched Rheumatoid Arthritis Patients. Arthritis Rheumatol 2024. [PMID: 38481002 DOI: 10.1002/art.42846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/19/2024] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The ORAL Surveillance trial found a dose-dependent increase in venous thromboembolism (VTE) and pulmonary embolism (PE) events with tofacitinib versus tumor necrosis factor inhibitors (TNFi). We aimed to assess VTE incidence over time and explore risk factors of VTE, including disease activity, in ORAL Surveillance. METHODS Patients with rheumatoid arthritis (RA) aged 50 years or older with at least one additional cardiovascular risk factor received tofacitinib 5 or 10 mg twice daily (BID) or TNFi. Post hoc, cumulative probabilities and incidence rates (patients with first events/100 patient-years) by 6-month intervals were estimated for adjudicated VTE, deep vein thrombosis, and PE. Cox regression models identified risk factors. Clinical Disease Activity Index leading up to the event was explored in patients with VTE. RESULTS Cumulative probabilities for VTE and PE were higher with tofacitinib 10 mg BID, but not 5 mg BID, versus TNFi. Incidence rates were consistent across 6-month intervals within treatments. Across treatments, risk factors for VTE included prior VTE, body mass index greater than or equal to 35 kg/m2, older age, and history of chronic lung disease. At the time of the event, most patients with VTE had active disease as defined by Clinical Disease Activity Index. CONCLUSION Incidences of VTE and PE were higher with tofacitinib (10 > 5 mg BID) versus TNFi and were generally consistent over time. Across treatments, VTE risk factors were aligned with previous studies in the general RA population. These data highlight the importance of assessing VTE risk factors, including age, body mass index, and VTE history, when considering initiation of tofacitinib or TNFi in patients with active RA.
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Affiliation(s)
| | - Roy Fleischmann
- Metroplex Clinical Research Center and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Eduardo Mysler
- Organización Médica de Investigación, Buenos Aires, Argentina
| | | | | | - Gary G Koch
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Ted R Mikuls
- University of Nebraska Medical Center and Veterans Affairs Nebraska Western Iowa Health Care System, Omaha, Nebraska
| | | | | | | | | | - Yan Chen
- Pfizer Inc, Collegeville, Pennsylvania
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8
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Popovich SM, Vetter TR. Preoperative Management of the Adult Oncology Patient. Anesthesiol Clin 2024; 42:145-158. [PMID: 38278586 DOI: 10.1016/j.anclin.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Anesthesiologists are experiencing first-hand the aging population, given older patients more frequently presenting for surgery, often with geriatric syndromes influencing their anesthetic management. The overall incidence and health burden of cancer morbidity and mortality are also rapidly increasing worldwide. This growth in the cancer population, along with the associated risk factors and comorbidities often accompanying a cancer diagnosis, underscores the need for anesthesiologists to become well versed in the preoperative evaluation and management of the adult patient with cancer. This article will focus on the unique challenges and opportunities for the anesthesiologist caring for the adult oncology patient presenting for surgery.
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Affiliation(s)
- Shannon M Popovich
- Department of Anesthesiology and Perioperative Medicine, Division of Anesthesiology, Critical Care Medicine and Pain Medicine, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA.
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9
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Zlotnikov ID, Ezhov AA, Dobryakova NV, Kudryashova EV. Disulfide Cross-Linked Polymeric Redox-Responsive Nanocarrier Based on Heparin, Chitosan and Lipoic Acid Improved Drug Accumulation, Increased Cytotoxicity and Selectivity to Leukemia Cells by Tumor Targeting via "Aikido" Principle. Gels 2024; 10:157. [PMID: 38534575 DOI: 10.3390/gels10030157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 03/28/2024] Open
Abstract
We have developed a micellar formulation of anticancer drugs based on chitosan and heparin grafted with lipoic and oleic acids that can release the cytotoxic cargo (doxorubicin) in response to external stimuli, such as increased glutathione concentration-a hallmark of cancer. Natural polysaccharides (heparin and chitosan) provide the pH sensitivity of the nanocarrier: the release of doxorubicin (Dox) is enhanced in a slightly acidic environment (tumor microenvironment). Fatty acid residues are necessary for the formation of nanoparticles (micelles) and solubilization of cytostatics in a hydrophobic core. Lipoic acid residues provide the formation of a labile S-S cross-linking between polymer chains (the first variant) or covalently attached doxorubicin molecules through glutathione-sensitive S-S bridges (the second variant)-both determine Redox sensitivity of the anticancer drugs carriers stable in blood circulation and disintegrate after intracellular uptake in the tumor cells. The release of doxorubicin from micelles occurs slowly (20%/6 h) in an environment with a pH of 7.4 and the absence of glutathione, while in a slightly acidic environment and in the presence of 10 mM glutathione, the rate increases up to 6 times, with an increase in the effective concentration up to 5 times after 7 h. The permeability of doxorubicin in micellar formulations (covalent S-S cross-linked and not) into Raji, K562, and A875 cancer cells was studied using FTIR, fluorescence spectroscopy and confocal laser scanning microscopy (CLSM). We have shown dramatically improved accumulation, decreased efflux, and increased cytotoxicity compared to doxorubicin control with three tumor cell lines: Raji, K562, and A875. At the same time, cytotoxicity and permeability for non-tumor cells (HEK293T) are significantly lower, increasing the selectivity index against tumor cells by several times.
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Affiliation(s)
- Igor D Zlotnikov
- Faculty of Chemistry, Lomonosov Moscow State University, Leninskie Gory, 1/3, 119991 Moscow, Russia
| | - Alexander A Ezhov
- Faculty of Physics, Lomonosov Moscow State University, Leninskie Gory, 1/2, 119991 Moscow, Russia
| | - Natalia V Dobryakova
- Faculty of Chemistry, Lomonosov Moscow State University, Leninskie Gory, 1/3, 119991 Moscow, Russia
| | - Elena V Kudryashova
- Faculty of Chemistry, Lomonosov Moscow State University, Leninskie Gory, 1/3, 119991 Moscow, Russia
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10
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Paffenholz P. [Venous thromboembolism: risk factors and prophylaxis]. Aktuelle Urol 2024; 55:44-49. [PMID: 37339669 DOI: 10.1055/a-2099-8233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Venous thromboembolism is an important complication in tumour patients as it occurs frequently in these patients and causes relevant morbidity. The risk of thromboembolic complications in tumour patients is 3-9 times higher than in non-tumour patients and is the second most common cause of death in tumour patients. The risk of thrombosis depends on tumour-induced coagulopathy and on individual factors, type and stage of cancer, time since cancer diagnosis as well as type of systemic cancer therapy. Thromboprophylaxis in tumour patients is effective but can be associated with increased bleeding. Even though there are currently no dedicated recommendations for individual tumour entities, international guidelines recommend prophylactic measures in high-risk patients. A thrombosis risk of >8-10% can be considered an indication for thromboprophylaxis, which is indicated by a Khorana score ≥2, and should be calculated individually using nomograms. In particular, patients with a low risk of bleeding should receive thromboprophylaxis. Risk factors and symptoms of a thromboembolic event should also be intensively discussed with the patient and materials for patient information should be handed out.
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Chen R, Petrazzini BO, Malick W, Rosenson R, Do R. Prediction of Venous Thromboembolism in Diverse Populations Using Machine Learning and Structured Electronic Health Records. Arterioscler Thromb Vasc Biol 2024; 44:491-504. [PMID: 38095106 PMCID: PMC10872966 DOI: 10.1161/atvbaha.123.320331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major cause of morbidity and mortality worldwide. Current risk assessment tools, such as the Caprini and Padua scores and Wells criteria, have limitations in their applicability and accuracy. This study aimed to develop machine learning models using structured electronic health record data to predict diagnosis and 1-year risk of VTE. METHODS We trained and validated models on data from 159 001 participants in the Mount Sinai Data Warehouse. We then externally tested them on 401 723 participants in the UK Biobank and 123 039 participants in All of Us. All data sets contain populations of diverse ancestries and clinical histories. We used these data sets to develop small, medium, and large models with increasing features on a range of optimizing portability to maximizing performance. We make trained models publicly available in click-and-run format at https://doi.org/10.17632/tkwzysr4y6.6. RESULTS In the holdout and external test sets, respectively, models achieved areas under the receiver operating characteristic curve of 0.80 to 0.83 and 0.72 to 0.82 for VTE diagnosis prediction and 0.76 to 0.78 and 0.64 to 0.69 for 1-year risk prediction, significantly outperforming the Padua score. Models also demonstrated robust performance across different VTE types and patient subsets, including ethnicity, age, and surgical and hospitalization status. Models identified both established and novel clinical features contributing to VTE risk, offering valuable insights into its underlying pathophysiology. CONCLUSIONS Machine learning models using structured electronic health record data can significantly improve VTE diagnosis and 1-year risk prediction in diverse populations. Model probability scores exist on a continuum, affecting mortality risk in both healthy individuals and VTE cases. Integrating these models into electronic health record systems to generate real-time predictions may enhance VTE risk assessment, early detection, and preventative measures, ultimately reducing the morbidity and mortality associated with VTE.
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Affiliation(s)
- Robert Chen
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ben Omega Petrazzini
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Genomic Data Analytics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Waqas Malick
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Rosenson
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ron Do
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Genomic Data Analytics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Pavlovic D, Niciforovic D, Markovic M, Papic D. Cancer-Associated Thrombosis: Epidemiology, Pathophysiological Mechanisms, Treatment, and Risk Assessment. Clin Med Insights Oncol 2023; 17:11795549231220297. [PMID: 38152726 PMCID: PMC10752082 DOI: 10.1177/11795549231220297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
Cancer patients represent a growing population with drastically difficult care and a lowered quality of life, especially due to the heightened risk of vast complications. Thus, it is well established so far that one of the most prominent complications in individuals with cancer is venous thromboembolism. Since there are various improved methods for screening and diagnosing cancer and its complications, the incidence of cancer-associated thrombosis has been on the rise in recent years. Therefore, the high mortality and morbidity rates among these patients are not a surprise. Consequently, there is an excruciating need for understanding the mechanisms behind this complex process, as well as the imperative for adequate analysis and application of the most suitable steps for cancer-associated thrombosis prevention. There are various and numerous mechanisms offering potential answers to cancer-associated thrombosis, some of which have already been elucidated in various preclinical and clinical scenarios, yet further and more elaborate studies are crucial to understanding and preventing this complex and harsh clinical entity. This article elaborates on the growing incidence, mortality, morbidity, and risk factors of cancer-associated thrombosis while emphasizing the pathophysiological mechanisms in the light of various types of cancer in patients and summarizes the most novel therapy and prevention guidelines recommendations.
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Affiliation(s)
- Dragica Pavlovic
- Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Danijela Niciforovic
- Center for Internal Oncology, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Marina Markovic
- Center for Internal Oncology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Dragana Papic
- Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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13
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Marques IS, Tavares V, Savva-Bordalo J, Rei M, Liz-Pimenta J, de Melo IG, Assis J, Pereira D, Medeiros R. Long Non-Coding RNAs: Bridging Cancer-Associated Thrombosis and Clinical Outcome of Ovarian Cancer Patients. Int J Mol Sci 2023; 25:140. [PMID: 38203310 PMCID: PMC10778953 DOI: 10.3390/ijms25010140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Ovarian cancer (OC) and venous thromboembolism (VTE) have a close relationship, in which tumour cells surpass the haemostatic system to drive cancer progression. Long non-coding RNAs (lncRNAs) have been implicated in VTE pathogenesis, yet their roles in cancer-associated thrombosis (CAT) and their prognostic value are unexplored. Understanding how these lncRNAs influence venous thrombogenesis and ovarian tumorigenesis may lead to the identification of valuable biomarkers for VTE and OC management. Thus, this study evaluated the impact of five lncRNAs, namely MALAT1, TUG1, NEAT1, XIST and MEG8, on a cohort of 40 OC patients. Patients who developed VTE after OC diagnosis had worse overall survival compared to their counterparts (log-rank test, p = 0.028). Elevated pre-chemotherapy MEG8 levels in peripheral blood cells (PBCs) predicted VTE after OC diagnosis (Mann-Whitney U test, p = 0.037; Χ2 test, p = 0.033). In opposition, its low levels were linked to a higher risk of OC progression (adjusted hazard ratio (aHR) = 3.00; p = 0.039). Furthermore, low pre-chemotherapy NEAT1 levels in PBCs were associated with a higher risk of death (aHR = 6.25; p = 0.008). As for the remaining lncRNAs, no significant association with VTE incidence, OC progression or related mortality was observed. Future investigation with external validation in larger cohorts is needed to dissect the implications of the evaluated lncRNAs in OC patients.
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Affiliation(s)
- Inês Soares Marques
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/Pathology and Laboratory Medicine Department, Clinical Pathology SV/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; (I.S.M.); (V.T.); (I.G.d.M.)
- Faculty of Sciences of the University of Porto (FCUP), 4169-007 Porto, Portugal
| | - Valéria Tavares
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/Pathology and Laboratory Medicine Department, Clinical Pathology SV/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; (I.S.M.); (V.T.); (I.G.d.M.)
- Faculty of Medicine of the University of Porto (FMUP), 4200-072 Porto, Portugal;
- Abel Salazar Institute for the Biomedical Sciences (ICBAS), University of Porto, 4050-313 Porto, Portugal
| | - Joana Savva-Bordalo
- Department of Medical Oncology, Portuguese Institute of Oncology of Porto (IPO Porto), 4200-072 Porto, Portugal; (J.S.-B.); (D.P.)
| | - Mariana Rei
- Department of Gynaecology, Portuguese Institute of Oncology of Porto (IPO Porto), 4200-072 Porto, Portugal;
| | - Joana Liz-Pimenta
- Faculty of Medicine of the University of Porto (FMUP), 4200-072 Porto, Portugal;
- Department of Medical Oncology, Centro Hospitalar de Trás-os-Montes e Alto Douro (CHTMAD), 5000-508 Vila Real, Portugal
| | - Inês Guerra de Melo
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/Pathology and Laboratory Medicine Department, Clinical Pathology SV/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; (I.S.M.); (V.T.); (I.G.d.M.)
- Faculty of Medicine of the University of Porto (FMUP), 4200-072 Porto, Portugal;
| | - Joana Assis
- Clinical Research Unit, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal;
| | - Deolinda Pereira
- Department of Medical Oncology, Portuguese Institute of Oncology of Porto (IPO Porto), 4200-072 Porto, Portugal; (J.S.-B.); (D.P.)
| | - Rui Medeiros
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/Pathology and Laboratory Medicine Department, Clinical Pathology SV/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; (I.S.M.); (V.T.); (I.G.d.M.)
- Faculty of Medicine of the University of Porto (FMUP), 4200-072 Porto, Portugal;
- Abel Salazar Institute for the Biomedical Sciences (ICBAS), University of Porto, 4050-313 Porto, Portugal
- Faculty of Health Sciences, Fernando Pessoa University, 4200-150 Porto, Portugal
- Research Department, Portuguese League Against Cancer (NRNorte), 4200-172 Porto, Portugal
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Zhifei L, Yuexiang L, Shaofei C, Shuo L, Hongwei W, Chuntao G. Elevated preoperative plasma D-dimer level was an independent prognostic factor for patients with PDAC after curative resection: a retrospective analysis. Jpn J Clin Oncol 2023; 53:1058-1067. [PMID: 37539583 DOI: 10.1093/jjco/hyad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/11/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE In this study, the relationship between preoperative plasma D-dimer level and overall survival and recurrence free survival were evaluated in patients with curative resection of pancreatic ductal adenocarcinoma. METHODS Preoperative plasma D-dimer level of 573 patients with pancreatic ductal adenocarcinoma were collected. The univariate and multivariate Cox hazard models were used to identify independent variables associated with overall survival and recurrence free survival in this study. The Kaplan-Meier method was used to evaluate overall survival and recurrence free survival, and the differences between survival curves were analyzed using the Log-rank test. Continuous variables were presented as $\overline{x}\pm s$, parametric analysis was performed using t-test. Categorical variables were analyzed by means of the chi-square or Fisher's exact test. RESULTS Based on the analysis for the whole study, the results showed that patients in the elevated plasma D-dimer levels had a tendency to have an elder mean age (58.69 ± 8.32 years vs. 63.05 ± 8.44 years, P < 0.001), larger tumour size ≥4 cm (P = 0.006), advanced T stage (P = 0.024), N stage (P = 0.041), Tumor, Node and Metastasis (TNM) stage (P = 0.029) and postoperative complications (P = 0.042) was more likely occurred. Besides, according to the results of Cox multivariate analysis, elevated preoperative plasma D-dimer level was an independent prognostic factor not only for overall survival (Hazard Ratio (HR):1.430, 95% Confidence Interval (CI) (1.163-1.759), P = 0.001) but also for recurrence free survival (HR:1.236, 95% CI (1.018-1.500), P = 0.032). CONCLUSION In our study, the elevated preoperative plasma D-dimer level may act as an independent prognostic factor for overall survival and recurrence free survival in patients with pancreatic ductal adenocarcinoma after curative resection. Pancreatic ductal adenocarcinoma patients with elevated preoperative plasma D-dimer level had a worse prognosis than those with normal plasma D-dimer level; and the elevated preoperative plasma D-dimer level may imply heavy tumour burden and provide supplementary information regarding disease status.
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Affiliation(s)
- Li Zhifei
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Hexi District, Tianjin, China
- Department of Hepatobiliary-Pancreatic-Splenic Surgery, Inner Mongolia Autonomous Region People's Hospital, Hohhot, China
| | - Liang Yuexiang
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Hexi District, Tianjin, China
| | - Chang Shaofei
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Hexi District, Tianjin, China
| | - Li Shuo
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Hexi District, Tianjin, China
| | - Wang Hongwei
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Hexi District, Tianjin, China
| | - Gao Chuntao
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Hexi District, Tianjin, China
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15
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Guan C, Ma F, Chang S, Zhang J. Interpretable machine learning models for predicting venous thromboembolism in the intensive care unit: an analysis based on data from 207 centers. Crit Care 2023; 27:406. [PMID: 37875995 PMCID: PMC10598960 DOI: 10.1186/s13054-023-04683-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a severe complication in critically ill patients, often resulting in death and long-term disability and is one of the major contributors to the global burden of disease. This study aimed to construct an interpretable machine learning (ML) model for predicting VTE in critically ill patients based on clinical features and laboratory indicators. METHODS Data for this study were extracted from the eICU Collaborative Research Database (version 2.0). A stepwise logistic regression model was used to select the predictors that were eventually included in the model. The random forest, extreme gradient boosting (XGBoost) and support vector machine algorithms were used to construct the model using fivefold cross-validation. The area under curve (AUC), accuracy, no information rate, balanced accuracy, kappa, sensitivity, specificity, precision, and F1 score were used to assess the model's performance. In addition, the DALEX package was used to improve the interpretability of the final model. RESULTS This study ultimately included 109,044 patients, of which 1647 (1.5%) had VTE during ICU hospitalization. Among the three models, the Random Forest model (AUC: 0.9378; Accuracy: 0.9958; Kappa: 0.8371; Precision: 0.9095; F1 score: 0.8393; Sensitivity: 0.7791; Specificity: 0.9989) performed the best. CONCLUSION ML models can be a reliable tool for predicting VTE in critically ill patients. Among all the models we had constructed, the random forest model was the most effective model that helps the user identify patients at high risk of VTE early so that early intervention can be implemented to reduce the burden of VTE on the patients.
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Affiliation(s)
- Chengfu Guan
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, #18 Daoshan Road, Fuzhou, 350001, China
| | - Fuxin Ma
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, #18 Daoshan Road, Fuzhou, 350001, China
| | - Sijie Chang
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, #18 Daoshan Road, Fuzhou, 350001, China
| | - Jinhua Zhang
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, #18 Daoshan Road, Fuzhou, 350001, China.
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Felix G, Ferreira E, Ribeiro A, Guerreiro I, Araújo E, Ferreira S, Coelho S, Magalhães H, Almeida J, Lourenço P. Predictors of cancer in patients with acute pulmonary embolism. Thromb Res 2023; 230:11-17. [PMID: 37598636 DOI: 10.1016/j.thromres.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/05/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Acute pulmonary embolism (PE) can occur as a manifestation of an underlying cancer and be of paraneoplastic aetiology. A previously unknown cancer is sometimes diagnosed after the acute PE diagnosis. The identification of a group of patients with elevated probability of having an occult cancer underlying PE was never performed. We aimed to determine predictors of occult cancer in acute PE. Our hypothesis was that the D-dimer levels would be a predictor of cancer. PATIENTS AND METHODS We retrospectively analysed a cohort of patients hospitalized with acute PE. EXCLUSION CRITERIA <18 years, venous embolism only of veins other than pulmonary territory or when the embolism was considered chronic, and no image confirmation of acute PE. Patients were grouped according to the timing of cancer diagnosis: 1) known concomitant active cancer, 2) cancer diagnosed during acute PE admission or in the following 2 years and, 3) no known cancer during the 2-year follow-up since PE diagnosis. Predictors of concomitant cancer were determined using a logistic regression analysis. Multivariate models were built. RESULTS We studied 562 patients; median age was 72 years and 219 (39.0 %) were men. In 223 (39.7 %) of the patients the PE was of central arteries and 61.4 % presented with bilateral PE. PE was considered unprovoked at time of discharge in 47.7 %. Median (interquartile range) D-dimer level was 7.98 (3.30-14.99) μg/mL. A total of 126 (22.4 %) patients were in group 1, 47 in group 2 (cancer diagnosed after the diagnosis of acute PE and up to 2 years) and 389 patients were in group 3. Elevated D-dimer levels were independently associated with already known cancer. D-dimer were independent predictors of future cancer diagnosis: OR = 1.07 ((95 % CI: 1.01-1.14) per each 5 ng/mL increase; for patients with D-dimer >15.0 μg/mL the OR of future cancer was 2.10 (1.05-4.18). If only patients with unprovoked PE upon admission (n = 307) were to be considered results were similar considering D-dimer; anaemia also predicted unknown cancer [OR = 2.13 (1.08-4.16)]. CONCLUSIONS Patients with D-dimer >15 μg/mL presented a >2-fold higher risk of being diagnosed with a cancer condition in the upcoming 2 years. D-dimer may help clinicians in identifying which patients are at higher risk of occult cancer.
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Affiliation(s)
- Gonçalo Felix
- Faculdade de Medicina da Universidade do Porto, Portugal
| | - Ester Ferreira
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal; Departamento de Medicina da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Ana Ribeiro
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal; Departamento de Medicina da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Inês Guerreiro
- Serviço de Oncologia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Emanuel Araújo
- Unidade de Cuidados Agudos Polivalente do Centro Hospitalar de Leiria, Leiria, Portugal
| | - Sara Ferreira
- Serviço de Cuidados Paliativos do Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Sara Coelho
- Serviço de Oncologia do Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Helena Magalhães
- Serviço de Oncologia, Unidade Local Saúde Matosinhos, Matosinhos, Portugal
| | - Jorge Almeida
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal; Departamento de Medicina da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Patrícia Lourenço
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal; Departamento de Medicina da Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
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Poenou G, Heestermans M, Lafaie L, Accassat S, Moulin N, Rodière A, Petit B, Duvillard C, Mismetti P, Bertoletti L. Inhibition of Factor XI: A New Era in the Treatment of Venous Thromboembolism in Cancer Patients? Int J Mol Sci 2023; 24:14433. [PMID: 37833881 PMCID: PMC10572808 DOI: 10.3390/ijms241914433] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 10/15/2023] Open
Abstract
Direct oral anticoagulants against activated factor X and thrombin were the last milestone in thrombosis treatment. Step by step, they replaced antivitamin K and heparins in most of their therapeutic indications. As effective as the previous anticoagulant, the decreased but persistent risk of bleeding while using direct oral anticoagulants has created space for new therapeutics aiming to provide the same efficacy with better safety. On this basis, drug targeting factor XI emerged as an option. In particular, cancer patients might be one of the populations that will most benefit from this technical advance. In this review, after a brief presentation of the different factor IX inhibitors, we explore the potential benefit of this new treatment for cancer patients.
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Affiliation(s)
- Géraldine Poenou
- Therapeutic and Vascular Medecine Department, Saint-Etienne Universitary Hospital Center, F-42270 Saint-Priest en Jarez, France (C.D.)
- INSERM, U 1059 SAINBIOSE, Jean Monnet University, Mines Saint-Étienne, F-42023 Saint Priest en Jarez, France
| | - Marco Heestermans
- INSERM, U 1059 SAINBIOSE, Jean Monnet University, Mines Saint-Étienne, F-42023 Saint Priest en Jarez, France
- French Blood Establishement Auvergne-Rhône-Alpes, Research Department, F-42023 Saint-Etienne, France
| | - Ludovic Lafaie
- INSERM, U 1059 SAINBIOSE, Jean Monnet University, Mines Saint-Étienne, F-42023 Saint Priest en Jarez, France
- Geriatry Department, Saint-Etienne Universitary Hospital Center, F-42000 Saint-Etienne, France
| | - Sandrine Accassat
- Therapeutic and Vascular Medecine Department, Saint-Etienne Universitary Hospital Center, F-42270 Saint-Priest en Jarez, France (C.D.)
- INSERM, CIC-1408, Saint-Etienne Universitary Hospital Center, F-42055 Saint Priest en Jarez, France
| | - Nathalie Moulin
- Therapeutic and Vascular Medecine Department, Saint-Etienne Universitary Hospital Center, F-42270 Saint-Priest en Jarez, France (C.D.)
| | - Alexandre Rodière
- Therapeutic and Vascular Medecine Department, Saint-Etienne Universitary Hospital Center, F-42270 Saint-Priest en Jarez, France (C.D.)
| | - Bastien Petit
- Therapeutic and Vascular Medecine Department, Saint-Etienne Universitary Hospital Center, F-42270 Saint-Priest en Jarez, France (C.D.)
| | - Cécile Duvillard
- Therapeutic and Vascular Medecine Department, Saint-Etienne Universitary Hospital Center, F-42270 Saint-Priest en Jarez, France (C.D.)
| | - Patrick Mismetti
- Therapeutic and Vascular Medecine Department, Saint-Etienne Universitary Hospital Center, F-42270 Saint-Priest en Jarez, France (C.D.)
- INSERM, U 1059 SAINBIOSE, Jean Monnet University, Mines Saint-Étienne, F-42023 Saint Priest en Jarez, France
- INSERM, CIC-1408, Saint-Etienne Universitary Hospital Center, F-42055 Saint Priest en Jarez, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
| | - Laurent Bertoletti
- Therapeutic and Vascular Medecine Department, Saint-Etienne Universitary Hospital Center, F-42270 Saint-Priest en Jarez, France (C.D.)
- INSERM, U 1059 SAINBIOSE, Jean Monnet University, Mines Saint-Étienne, F-42023 Saint Priest en Jarez, France
- INSERM, CIC-1408, Saint-Etienne Universitary Hospital Center, F-42055 Saint Priest en Jarez, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
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18
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Bucciol R, Othman M. Tissue factor positive microparticles as a biomarker for increased risk of breast cancer-associated thrombosis: a mini review. Curr Opin Hematol 2023; 30:180-185. [PMID: 37522480 DOI: 10.1097/moh.0000000000000774] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
PURPOSE OF REVIEW Cancer-associated thrombosis (CAT), such as venous thromboembolism (VTE), is a frequent complication in cancer patients, resulting in poor prognosis. Breast cancer is not highly thrombogenic but is highly prevalent, resulting in increased VTE cases. Many cancers express tissue factor (TF), a glycoprotein that triggers coagulation. The cancer cells were shown to express and release substantial amounts of TF-positive microparticles (MPTF), associated with a prothrombotic state. This narrative review evaluated the current use of the procoagulant MPTF as a biomarker for thrombosis risk in breast cancer. RECENT FINDINGS Tumors of epithelial origin with elevated TF expression have been associated with increased VTE incidence. Thus, studies have affirmed the use of MPTF biomarkers for VTE risk in many cancers. Patients with metastatic breast cancer and CAT were found to exhibit elevated procoagulant microparticles in vitro, due to TF expression. The silencing of TF was associated with decreased microparticle release in breast carcinoma cell lines, associated with decreased coagulation. SUMMARY CAT is a multifactorial condition, with several various underlying diseases. It is proposed that MPTF may be an effective biomarker for thrombosis risk in breast cancer patients but requires a more systemic evaluation utilizing standardized quantification methods.
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Affiliation(s)
- Regan Bucciol
- Department of Biomedical and Molecular Sciences, Queen's University
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, Queen's University
- School of Baccalaureate Nursing, St Lawrence College, Kingston, Ontario, Canada
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Masini M, Toma M, Spallarossa P, Porto I, Ameri P. Direct Oral Anticoagulants for Cancer-Associated Venous Thromboembolism. Curr Oncol Rep 2023; 25:979-987. [PMID: 37278934 PMCID: PMC10474987 DOI: 10.1007/s11912-023-01428-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE OF REVIEW To present the randomized controlled trial (RCT) evidence and highlight the areas of uncertainty regarding direct oral anticoagulants (DOAC) for cancer-associated venous thromboembolism (CAT). RECENT FINDINGS In the last years, four RCTs have shown that rivaroxaban, edoxaban, and apixaban are at least as effective as low-molecular-weight heparin (LMWH) for the treatment of both incidental and symptomatic CAT. On the other hand, these drugs increase the risk of major gastrointestinal bleeding in patients with cancer at this site. Another two RCTs have demonstrated that apixaban and rivaroxaban also prevent CAT in subjects at intermediate-to-high risk commencing chemotherapy, albeit at the price of higher likelihood of bleeding. By contrast, data are limited about the use DOAC in individuals with intracranial tumors or concomitant thrombocytopenia. It is also possible that some anticancer agents heighten the effects of DOAC via pharmacokinetic interactions, up to making their effectiveness-safety profile unfavorable. Leveraging the results of the aforementioned RCTS, current guidelines recommend DOAC as the anticoagulants of choice for CAT treatment and, in selected cases, prevention. However, the benefit of DOAC is less defined in specific patient subgroups, in which the choice of DOAC over LMWH should be carefully pondered.
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Affiliation(s)
- Marta Masini
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6 - 16132, Genoa, Italy
| | - Matteo Toma
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Spallarossa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Italo Porto
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6 - 16132, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6 - 16132, Genoa, Italy.
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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20
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Muse O, Patell R, Peters CG, Yang M, El-Darzi E, Schulman S, Falanga A, Marchetti M, Russo L, Zwicker JI, Flaumenhaft R. The unfolded protein response links ER stress to cancer-associated thrombosis. JCI Insight 2023; 8:e170148. [PMID: 37651191 PMCID: PMC10629814 DOI: 10.1172/jci.insight.170148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023] Open
Abstract
Thrombosis is a common complication of advanced cancer, yet the cellular mechanisms linking malignancy to thrombosis are poorly understood. The unfolded protein response (UPR) is an ER stress response associated with advanced cancers. A proteomic evaluation of plasma from patients with gastric and non-small cell lung cancer who were monitored prospectively for venous thromboembolism demonstrated increased levels of UPR-related markers in plasma of patients who developed clots compared with those who did not. Release of procoagulant activity into supernatants of gastric, lung, and pancreatic cancer cells was enhanced by UPR induction and blocked by antagonists of the UPR receptors inositol-requiring enzyme 1α (IRE1α) and protein kinase RNA-like endoplasmic reticulum kinase (PERK). Release of extracellular vesicles bearing tissue factor (EVTFs) from pancreatic cancer cells was inhibited by siRNA-mediated knockdown of IRE1α/XBP1 or PERK pathways. Induction of UPR did not increase tissue factor (TF) synthesis, but rather stimulated localization of TF to the cell surface. UPR-induced TF delivery to EVTFs was inhibited by ADP-ribosylation factor 1 knockdown or GBF1 antagonism, verifying the role of vesicular trafficking. Our findings show that UPR activation resulted in increased vesicular trafficking leading to release of prothrombotic EVTFs, thus providing a mechanistic link between ER stress and cancer-associated thrombosis.
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Affiliation(s)
- Oluwatoyosi Muse
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Rushad Patell
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian G. Peters
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Moua Yang
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Emale El-Darzi
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sol Schulman
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Falanga
- Immunohematology and Transfusion Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marina Marchetti
- Immunohematology and Transfusion Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Russo
- Immunohematology and Transfusion Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Jeffrey I. Zwicker
- Hematology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert Flaumenhaft
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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21
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Schuderer JG, Dinh HT, Spoerl S, Taxis J, Fiedler M, Gottsauner JM, Maurer M, Reichert TE, Meier JK, Weber F, Ettl T. Risk Factors for Flap Loss: Analysis of Donor and Recipient Vessel Morphology in Patients Undergoing Microvascular Head and Neck Reconstructions. J Clin Med 2023; 12:5206. [PMID: 37629249 PMCID: PMC10455344 DOI: 10.3390/jcm12165206] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
In microvascular head and neck reconstruction, various factors such as diabetes, alcohol consumption, and preoperative radiation hold a risk for flap loss. The primary objective of this study was to examine the vessel morphology of both recipient and donor vessels and to identify predictors for changes in the diameters of H.E.-stained specimens associated with flap loss in a prospective setting. Artery and vein samples (N = 191) were collected from patients (N = 100), with sampling from the recipient vessels in the neck area and the donor vessels prior to anastomosis. External vessel diameter transverse (ED), inner vessel diameter transverse (ID), thickness vessel intima (TI), thickness vessel media (TM), thickness vessel wall (TVW), and intima-media ratio (IMR) for the recipient (R) and transplant site (T) in arteries (A) and veins (V) were evaluated using H.E. staining. Flap loss (3%) was associated with increased ARED (p = 0.004) and ARID (p = 0.004). Preoperative radiotherapy led to a significant reduction in the outer diameter of the recipient vein in the neck (p = 0.018). Alcohol consumption (p = 0.05), previous thrombosis (p = 0.007), and diabetes (p = 0.002) were associated with an increase in the total thickness of venous recipient veins in the neck. Diabetes was also found to be associated with dilation of the venous media in the neck vessels (p = 0.007). The presence of cardiovascular disease (CVD) was associated with reduced intimal thickness (p = 0.016) and increased total venous vessel wall thickness (p = 0.017) at the transplant site. Revision surgeries were linked to increased internal and external diameters of the graft artery (p = 0.04 and p = 0.003, respectively), while patients with flap loss showed significantly increased artery diameters (p = 0.004). At the transplant site, alcohol influenced the enlargement of arm artery diameters (p = 0.03) and the intima-media ratio in the radial forearm flap (p = 0.013). In the anterolateral thigh, CVD significantly increased the intimal thickness and the intima-media ratio of the graft artery (p = 0.01 and p = 0.02, respectively). Patients with myocardial infarction displayed increased thickness in the A. thyroidea and artery media (p = 0.003). Facial arteries exhibited larger total vessel diameters in patients with CVD (p = 0.03), while facial arteries in patients with previous thrombosis had larger diameters and thicker media (p = 0.01). The presence of diabetes was associated with a reduced intima-media ratio (p < 0.001). Although the presence of diabetes, irradiation, and cardiovascular disease causes changes in vessel thickness in connecting vessels, these alterations did not adversely affect the overall success of the flap.
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Affiliation(s)
- Johannes G. Schuderer
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (J.T.); (M.F.)
| | - Huong T. Dinh
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (J.T.); (M.F.)
| | - Steffen Spoerl
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (J.T.); (M.F.)
| | - Jürgen Taxis
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (J.T.); (M.F.)
| | - Mathias Fiedler
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (J.T.); (M.F.)
| | - Josef M. Gottsauner
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (J.T.); (M.F.)
| | - Michael Maurer
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (J.T.); (M.F.)
| | - Torsten E. Reichert
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (J.T.); (M.F.)
| | - Johannes K. Meier
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (J.T.); (M.F.)
| | - Florian Weber
- Institute of Pathology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Tobias Ettl
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (J.T.); (M.F.)
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22
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Verzeroli C, Giaccherini C, Russo L, Bolognini S, Gamba S, Tartari CJ, Schieppati F, Ticozzi C, Vignoli A, Masci G, Sarmiento R, Spinelli D, Malighetti P, Tondini C, Petrelli F, Giuliani F, D'Alessio A, Gasparini G, Minelli M, De Braud F, Santoro A, Labianca R, Marchetti M, Falanga A. Utility of the Khorana and the new-Vienna CATS prediction scores in cancer patients of the HYPERCAN cohort. J Thromb Haemost 2023; 21:1869-1881. [PMID: 37054917 DOI: 10.1016/j.jtha.2023.03.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/24/2023] [Accepted: 03/16/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Risk assessment models (RAMs) are relevant approaches to identify cancer outpatients at high risk of venous thromboembolism (VTE). Among the proposed RAMs, the Khorana (KRS) and the new-Vienna CATS risk scores have been externally validated in ambulatory patients with cancer. OBJECTIVES To test KRS and new-Vienna CATS scores in 6-month VTE prediction and mortality in a large prospective cohort of metastatic cancer outpatients during chemotherapy. PATIENTS/METHODS Newly diagnosed patients with metastatic non-small cell lung, colorectal, gastric, or breast cancers were analyzed (n = 1286). The cumulative incidence of objectively confirmed VTE was estimated with death as a competing risk and multivariate Fine and Gray regression. RESULTS Within 6 months, 120 VTE events (9.7%) occurred. The KRS and the new-Vienna CATS scores showed comparable c-stat. Stratification by KRS provided VTE cumulative incidences of 6.2%, 11.4%, and 11.5% in the low-, intermediate-, and high-risk categories, respectively (p = ns), and of 8.5% vs. 11.8% (p = ns) in the low- vs. high-risk group by the single 2-point cut-off value stratification. Using a pre-defined 60-point cut-off by the new-Vienna CATS score, 6.6% and 12.2% cumulative incidences were obtained in the low- and high-risk groups, respectively (p < 0.001). Furthermore, having a KRS ≥2 = or a new-Vienna CATS score >60 points was also an independent risk factor for mortality. CONCLUSION In our cohort, the 2 RAMs showed a comparable discriminating potential; however, after the application of cut-off values, the new-Vienna CATS score provided statistically significant stratification for VTE. Both RAMs proved to be effective in identifying patients at increased risk of mortality.
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Affiliation(s)
- Cristina Verzeroli
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Cinzia Giaccherini
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Russo
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Silvia Bolognini
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Sara Gamba
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Carmen J Tartari
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Schieppati
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Ticozzi
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Alfonso Vignoli
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Giovanna Masci
- Oncology Unit, Istituti di Ricovero e Cura a Carattere Scientifico Humanitas Institute, Rozzano, Italy
| | | | - Daniele Spinelli
- Department of Statistics, University of Milan Bicocca, Milan, Italy
| | - Paolo Malighetti
- Department of Management Engineering, University of Bergamo, Italy
| | - Carlo Tondini
- Oncology Unit, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Fausto Petrelli
- Oncology Unit, Hospital Treviglio-Caravaggio, Treviglio, Italy
| | - Francesco Giuliani
- Oncology Unit, Istituti di Ricovero e Cura a Carattere Scientifico Cancer Institute Giovanni Paolo II, Bari, Italy
| | - Andrea D'Alessio
- Medical Oncology and Internal Medicine, Policlinico San Marco, Gruppo San Donato Zingonia-Bergamo, Italy
| | | | - Mauro Minelli
- Oncology Unit, Hospital San Giovanni Addolorata, Rome, Italy
| | - Filippo De Braud
- Oncology Unit, Istituti di Ricovero e Cura a Carattere Scientifico National Cancer Institute, Milan, Italy
| | - Armando Santoro
- Oncology Unit, Istituti di Ricovero e Cura a Carattere Scientifico Humanitas Institute, Rozzano, Italy
| | | | - Marina Marchetti
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy; University of Milan Bicocca, School of Medicine, Milan, Italy
| | - Anna Falanga
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy; University of Milan Bicocca, School of Medicine, Milan, Italy.
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23
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Mitchell A, Frontini M, Islam S, Sivapalaratnam S, Krishnan A. Increased bleeding and thrombosis in myeloproliferative neoplasms mediated through altered expression of inherited platelet disorder genes. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.23.541977. [PMID: 37292725 PMCID: PMC10245891 DOI: 10.1101/2023.05.23.541977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
An altered thrombo-hemorrhagic profile has long been observed in patients with myeloproliferative neoplasms (MPNs). We hypothesized that this observed clinical phenotype may result from altered expression of genes known to harbor genetic variants in bleeding, thrombotic, or platelet disorders. Here, we identify 32 genes from a clinically validated gene panel that were also significantly differentially expressed in platelets from MPN patients as opposed to healthy donors. This work begins to unravel previously unclear mechanisms underlying an important clinical reality in MPNs. Knowledge of altered platelet gene expression in MPN thrombosis/bleeding diathesis opens opportunities to advance clinical care by: (1) enabling risk stratification, in particular, for patients undergoing invasive procedures, and (2) facilitating tailoring of treatment strategies for those at highest risk, for example, in the form of antifibrinolytics, desmopressin or platelet transfusions (not current routine practice). Marker genes identified in this work may also enable prioritization of candidates in future MPN mechanistic as well as outcome studies.
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Affiliation(s)
- Alan Mitchell
- Department of Clinical Haematology, Barts Health NHS Trust, University of Exeter Medical School, Faculty of Health and Life Sciences, RILD Building, Barrack Road, Exeter, EX2 5DW
| | - Mattia Frontini
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, RILD Building, Barrack Road, Exeter, EX2 5DW
| | | | - Suthesh Sivapalaratnam
- Department of Clinical Haematology, Barts Health NHS Trust, University of Exeter Medical School, Faculty of Health and Life Sciences, RILD Building, Barrack Road, Exeter, EX2 5DW
- Blizard Institute, Queen Mary University London
| | - Anandi Krishnan
- Department of Pathology, Stanford University School of Medicine
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24
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Zhang B, Jiang X. Magnetic Nanoparticles Mediated Thrombolysis-A Review. IEEE OPEN JOURNAL OF NANOTECHNOLOGY 2023; 4:109-132. [PMID: 38111792 PMCID: PMC10727495 DOI: 10.1109/ojnano.2023.3273921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Nanoparticles containing thrombolytic medicines have been developed for thrombolysis applications in response to the increasing demand for effective, targeted treatment of thrombosis disease. In recent years, there has been a great deal of interest in nanoparticles that can be navigated and driven by a magnetic field. However, there are few review publications concerning the application of magnetic nanoparticles in thrombolysis. In this study, we examine the current state of magnetic nanoparticles in the application of in vitro and in vivo thrombolysis under a static or dynamic magnetic field, as well as the combination of magnetic nanoparticles with an acoustic field for dual-mode thrombolysis. We also discuss four primary processes of magnetic nanoparticles mediated thrombolysis, including magnetic nanoparticle targeting, magnetic nanoparticle trapping, magnetic drug release, and magnetic rupture of blood clot fibrin networks. This review will offer unique insights for the future study and clinical development of magnetic nanoparticles mediated thrombolysis approaches.
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Affiliation(s)
- Bohua Zhang
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695 USA
| | - Xiaoning Jiang
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695 USA
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25
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Falanga A, Ay C, Di Nisio M, Gerotziafas G, Jara-Palomares L, Langer F, Lecumberri R, Mandala M, Maraveyas A, Pabinger I, Sinn M, Syrigos K, Young A, Jordan K. Venous thromboembolism in cancer patients: ESMO Clinical Practice Guideline. Ann Oncol 2023; 34:452-467. [PMID: 36638869 DOI: 10.1016/j.annonc.2022.12.014] [Citation(s) in RCA: 74] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- A Falanga
- Division of Immunohaematology and Transfusion Medicine, Haemostasis and Thrombosis Center, Department of Oncology and Haematology, Hospital Papa Giovanni XXIII, Bergamo, Italy; University of Milan Bicocca, Department of Medicine and Surgery, Monza, Italy
| | - C Ay
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - M Di Nisio
- Department of Medicine and Ageing Sciences, G. d'Annunzio University, Chieti, Italy
| | - G Gerotziafas
- Sorbonne University, INSERM UMRS-938, Team "Cancer Vessels, Biology and Therapeutics", Group "Cancer-Hemostasis-Angiogenesis", Institut Universitaire de Cancérologie, Consultation Thrombosis in Oncology (COTHON), Tenon-Saint Antoine Hospital, AP-HP, Paris, France
| | - L Jara-Palomares
- Respiratory Department, Medical Surgical Unit of Respiratory Diseases, Hospital Virgen del Rocio, Sevilla; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - F Langer
- Centre for Oncology, University Cancer Centre Hamburg (UCCH), II Medical Clinic and Polyclinic, University Medical Centre Eppendorf, Hamburg, Germany
| | - R Lecumberri
- Servicio de Hematología, Clínica Universidad de Navarra, Pamplona (Navarra); CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - M Mandala
- University of Perugia, Unit of Medical Oncology, Santa Maria Misericordia Hospital, Perugia, Italy
| | - A Maraveyas
- Queen's Centre for Oncology and Haematology, Faculty of Health Sciences, Hull York Medical School and Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - I Pabinger
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - M Sinn
- Centre for Oncology, University Cancer Centre Hamburg (UCCH), II Medical Clinic and Polyclinic, University Medical Centre Eppendorf, Hamburg, Germany
| | - K Syrigos
- Oncology Unit, 3rd Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Young
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - K Jordan
- Department of Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital, Potsdam, Germany; Department of Rheumatology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
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26
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Liz-Pimenta J, Tavares V, Neto BV, Santos JMO, Guedes CB, Araújo A, Khorana AA, Medeiros R. Thrombosis and cachexia in cancer: two partners in crime? Crit Rev Oncol Hematol 2023; 186:103989. [PMID: 37061076 DOI: 10.1016/j.critrevonc.2023.103989] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023] Open
Abstract
Among cancer patients, thrombosis and cachexia are major causes of morbidity and mortality. Although the two may occur together, little is known about their possible relationship. Thus, a literature review was conducted by screening the databases PubMed, Scopus, SciELO, Medline and Web of Science. To summarize, cancer-associated thrombosis (CAT) and cancer-associated cachexia (CAC) seem to share several patient-, tumour- and treatment-related risk factors. Inflammation alongside metabolic and endocrine derangement is the potential missing link between CAT, CAC and cancer. Many key players, including specific pro-inflammatory cytokines, immune cells and hormones, appear to be implicated in both thrombosis and cachexia, representing attractive predictive markers and potential therapeutic targets. Altogether, the current evidence suggests a link between CAT and CAC, however, epidemiological studies are required to explore this potential relationship. Given the high incidence and negative impact of both diseases, further studies are needed for the better management of cancer patients.
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Affiliation(s)
- Joana Liz-Pimenta
- Department of Medical Oncology, Centro Hospitalar de Trás-os-Montes e Alto Douro, 5000-508 Vila Real, Portugal; FMUP, Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal
| | - Valéria Tavares
- FMUP, Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal; ICBAS, Abel Salazar Institute for the Biomedical Sciences, 4050-313 Porto, Portugal; Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP) / Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
| | - Beatriz Vieira Neto
- FMUP, Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal; Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP) / Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
| | - Joana M O Santos
- FMUP, Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal; Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP) / Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
| | - Catarina Brandão Guedes
- Department of Imunohemotherapy, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - António Araújo
- Department of Medical Oncology, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Alok A Khorana
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio 44106, United States of America
| | - Rui Medeiros
- FMUP, Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal; ICBAS, Abel Salazar Institute for the Biomedical Sciences, 4050-313 Porto, Portugal; Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP) / Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal; Research Department, Portuguese League Against Cancer - Regional Nucleus of the North, 4200-172 Porto, Portugal; Biomedical Research Center, Faculty of Health Sciences of the Fernando Pessoa University, 4249-004 Porto, Portugal.
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27
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Nipu MAI, Kundu S, Alam SS, Dina AN, Hasan MA, Khan M, Khalil MI, Hossan T, Islam MA. Anticardiolipin Antibodies in Patients with Cancer: A Case–Control Study. Cancers (Basel) 2023; 15:cancers15072087. [PMID: 37046748 PMCID: PMC10093391 DOI: 10.3390/cancers15072087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Antiphospholipid antibodies are highly prevalent in autoimmune diseases and mainly associated with thromboembolic events, which is one of the major reasons for cancer-related mortality. Confirmed adult cancer patients were included (n = 40) with an equal number of age- and sex-matched healthy controls. The presence and concentration of anticardiolipin antibodies were investigated by the enzyme-linked immunosorbent assay using the venous blood samples. aCL antibodies were detected in 60.0% (n = 24) of the cancer patients compared to none in the healthy controls (p < 0.001). The serum concentration of aCL antibodies was significantly higher in cancer patients than controls (p < 0.001) and ranged from 89.0 U/mL to 133.0 U/mL among the aCL-positive patients. All the lung cancer patients (n = 6) were diagnosed with positive aCL, and a borderline significant association of aCL antibody positivity was observed in colon cancer patients (p = 0.051). About 72.7% of the advanced-stage cancer individuals and 81.8% of the cancer patients who underwent surgery were diagnosed with positive aCL antibodies. A significant association of aCL antibody positivity was observed with cancer patients comorbid with heart diseases (p = 0.005). The prevalence and serum levels of aCL antibodies were significantly higher in cancer patients compared to healthy controls. Cancer patients (i.e., lung, liver, and colon), at advanced-stage, comorbid with heart diseases, who underwent surgery, were more likely to be diagnosed with aCL antibodies.
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Jing H, Wu X, Xiang M, Wang C, Novakovic VA, Shi J. Microparticle Phosphatidylserine Mediates Coagulation: Involvement in Tumor Progression and Metastasis. Cancers (Basel) 2023; 15:cancers15071957. [PMID: 37046617 PMCID: PMC10093313 DOI: 10.3390/cancers15071957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 04/14/2023] Open
Abstract
Tumor progression and cancer metastasis has been linked to the release of microparticles (MPs), which are shed upon cell activation or apoptosis and display parental cell antigens, phospholipids such as phosphatidylserine (PS), and nucleic acids on their external surfaces. In this review, we highlight the biogenesis of MPs as well as the pathophysiological processes of PS externalization and its involvement in coagulation activation. We review the available evidence, suggesting that coagulation factors (mainly tissue factor, thrombin, and fibrin) assist in multiple steps of tumor dissemination, including epithelial-mesenchymal transition, extracellular matrix remodeling, immune escape, and tumor angiogenesis to support the formation of the pre-metastatic niche. Platelets are not just bystander cells in circulation but are functional players in primary tumor growth and metastasis. Tumor-induced platelet aggregation protects circulating tumor cells (CTCs) from the blood flow shear forces and immune cell attack while also promoting the binding of CTCs to endothelial cells and extravasation, which activates tumor invasion and sustains metastasis. Finally, in terms of therapy, lactadherin can inhibit coagulation by competing effectively with coagulation factors for PS binding sites and may similarly delay tumor progression. Furthermore, we also investigate the therapeutic potential of coagulation factor inhibitors within the context of cancer treatment. The development of multiple therapies targeting platelet activation and platelet-tumor cell interactions may not only reduce the lethal consequences of thrombosis but also impede tumor growth and spread.
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Affiliation(s)
- Haijiao Jing
- Department of Hematology, The First Hospital, Harbin Medical University, Harbin 150001, China
| | - Xiaoming Wu
- Department of Hematology, The First Hospital, Harbin Medical University, Harbin 150001, China
| | - Mengqi Xiang
- Department of Hematology, The First Hospital, Harbin Medical University, Harbin 150001, China
| | - Chengyue Wang
- Department of Hematology, The First Hospital, Harbin Medical University, Harbin 150001, China
| | - Valerie A Novakovic
- Department of Research, VA Boston Healthcare System, Harvard Medical School, Boston, MA 02132, USA
| | - Jialan Shi
- Department of Hematology, The First Hospital, Harbin Medical University, Harbin 150001, China
- Department of Research, VA Boston Healthcare System, Harvard Medical School, Boston, MA 02132, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02132, USA
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Kramme K, Sarraf P, Shebrain S, Munene G. Safety and Efficacy of Prophylactic Enoxaparin Adjusted by Anti-Factor Xa Peak Levels in Pancreatic Surgery. Am Surg 2023; 89:300-308. [PMID: 34078133 DOI: 10.1177/00031348211023438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Recommended prophylactic doses of enoxaparin (Lovenox) are associated with subprophylactic anti-Factor Xa (anti-Xa) levels. This study examines the safety and efficacy of anti-Xa-guided dosing of enoxaparin in pancreatic surgery. METHODS Prospectively enrolled patients undergoing pancreatic surgery received enoxaparin dosing adjusted based on peak anti-Xa levels and were compared to a historical cohort of patients. RESULTS Baseline characteristics were similar between the intervention and control groups. In the intervention group, 73.9% initially had subprophylactic peak anti-Xa levels. There were no differences in the venous thromboembolism (VTE) rates between the intervention and control groups (0% vs. 7.69%; P = .084), major bleeding events (4.35% vs. 2.56%; P = .627), RBC transfusion (15.2% vs. 25.6%; P = .257), or Hgb on discharge (9.82 vs. 9.44 g/dL; P = .244). Subtherapeutic anti-Xa levels were correlated with a higher BMI (P = .033), longer OR time (P = .011), and length of stay (P = .018). CONCLUSIONS Enoxaparin 40 mg once daily is associated with subprophylactic peak anti-Xa levels. Dose adjustment based on anti-Xa levels trended toward a lower rate of in-hospital VTE without an increase in bleeding or transfusion requirement.
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Affiliation(s)
- Katherine Kramme
- Department of Surgery, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Paya Sarraf
- Department of Epidemiology and Biostatistics, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Saad Shebrain
- Department of Surgery, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Gitonga Munene
- Department of Surgery, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.,Western Michigan Cancer Center, Kalamazoo, MI, USA
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Akinbo DB, Ajayi OI. Thrombotic Pathogenesis and Laboratory Diagnosis in Cancer Patients, An Update. Int J Gen Med 2023; 16:259-272. [PMID: 36711430 PMCID: PMC9879027 DOI: 10.2147/ijgm.s385772] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/04/2023] [Indexed: 01/23/2023] Open
Abstract
Cancer-associated thrombosis (CAT) is a leading cause of mortality in cancer patients and its incidence varies in different parts of the world. Venous thromboembolism (VTE) is a prominent manifestation of CAT, and significantly impacts morbidity and survival compared to arterial thrombosis in cancer patients. Several risk factors for developing VTE such as chemotherapy and immobilization have also been found co-existing with cancer patients and contributing to the increased risk of VTE in cancer patients than in non-cancer patients. This review highlights recent mechanisms in the pathogenesis of hypercoagulable syndromes associated with cancer, multiple mechanisms implicated in promoting cancer-associated thrombosis and their diagnostic approaches. Cancer cells interact with every part of the hemostatic system; generating their own procoagulant factors, through stimulation of the prothrombotic properties of other blood cell components or the initiation of clotting by cancer therapies which can all directly activate the coagulation cascade and contribute to the VTE experienced in CAT. It is our hope that the multiple interconnections between the hemostatic system and cancer biology and the improved biomarkers reported in this study can be relevant in establishing a predictive model for VTE, optimize early detection of asymptomatic microthrombosis for more personalized prophylactic strategies and incorporate effective therapeutic options and patient management to reduce mortality and morbidity, and improve the quality of life of affected cancer patients.
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Affiliation(s)
- David Bolaji Akinbo
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Afe Babalola University, Ado – Ekiti, Ekiti State, Nigeria,Department of Food, Nutrition, Dietetics and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA,Correspondence: David Bolaji Akinbo, Email
| | - Olutayo Ifedayo Ajayi
- Department of Physiology, School of Basic Medical Sciences, College of Medical Sciences, University of Benin, Benin City, Edo State, Nigeria
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31
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Neto BV, Tavares V, Santos JMO, Cerqueira F, Pereira D, Medeiros R. Map of thrombogenesis in viral infections and viral-driven tumours. Discov Oncol 2023; 14:3. [PMID: 36617364 PMCID: PMC9826626 DOI: 10.1007/s12672-022-00610-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023] Open
Abstract
Viruses are pathogenic agents responsible for approximately 10% of all human cancers and significantly contribute to the global cancer burden. Until now, eight viruses have been associated with the development of a broad range of malignancies, including solid and haematological tumours. Besides triggering and promoting oncogenesis, viral infections often go hand-in-hand with haemostatic changes, representing a potential risk factor for venous thromboembolism (VTE). Conversely, VTE is a cardiovascular condition that is particularly common among oncological patients, with a detrimental impact on patient prognosis. Despite an association between viral infections and coagulopathies, it is unclear whether viral-driven tumours have a different incidence and prognosis pattern of thromboembolism compared to non-viral-induced tumours. Thus, this review aims to analyse the existing evidence concerning the association of viruses and viral tumours with the occurrence of VTE. Except for hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection, which are associated with a high risk of VTE, little evidence exists concerning the thrombogenic potential associated with oncoviruses. As for tumours that can be induced by oncoviruses, four levels of VTE risk are observed, with hepatocellular carcinoma (HCC) and gastric carcinoma (GC) associated with the highest risk and nasopharyngeal carcinoma (NPC) associated with the lowest risk. Unfortunately, the incidence of cancer-related VTE according to tumour aetiology is unknown. Given the negative impact of VTE in oncological patients, research is required to better understand the mechanisms underlying blood hypercoagulability in viral-driven tumours to improve VTE management and prognosis assessment in patients diagnosed with these tumours.
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Affiliation(s)
- Beatriz Vieira Neto
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/ Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC), 4200-072, Porto, Portugal
- FMUP, Faculty of Medicine, University of Porto, 4200-072, Porto, Portugal
| | - Valéria Tavares
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/ Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC), 4200-072, Porto, Portugal
- FMUP, Faculty of Medicine, University of Porto, 4200-072, Porto, Portugal
- ICBAS, Abel Salazar Institute for the Biomedical Sciences, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
| | - Joana M O Santos
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/ Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC), 4200-072, Porto, Portugal
- FMUP, Faculty of Medicine, University of Porto, 4200-072, Porto, Portugal
| | - Fátima Cerqueira
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/ Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC), 4200-072, Porto, Portugal
- FP-I3ID, FP-ENAS, FP-BHS, University Fernando Pessoa, Praça 9 de Abril, 349, 4249-004, Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Rua Carlos da Maia, 296, 4200-150, Porto, Portugal
| | - Deolinda Pereira
- Oncology Department, Portuguese Institute of Oncology of Porto (IPOP), 4200-072, Porto, Portugal
| | - Rui Medeiros
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/ Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC), 4200-072, Porto, Portugal.
- FMUP, Faculty of Medicine, University of Porto, 4200-072, Porto, Portugal.
- ICBAS, Abel Salazar Institute for the Biomedical Sciences, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal.
- FP-I3ID, FP-ENAS, FP-BHS, University Fernando Pessoa, Praça 9 de Abril, 349, 4249-004, Porto, Portugal.
- Faculty of Health Sciences, University Fernando Pessoa, Rua Carlos da Maia, 296, 4200-150, Porto, Portugal.
- Research Department, Portuguese League Against Cancer (NRNorte), 4200-172, Porto, Portugal.
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Bentsen KK, Hojbjerg JA, Vinholt PJ, Hansen O, Hvas AM, Jeppesen SS. Impact of Stereotactic Body Radiotherapy on Thrombin Generation and Platelet Aggregation in Patients with Non-Small Cell Lung Cancer. Clin Appl Thromb Hemost 2023; 29:10760296231216962. [PMID: 38009051 PMCID: PMC10683386 DOI: 10.1177/10760296231216962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
Patients with localized non-small cell lung cancer (NSCLC) considered unfit for surgery are at substantially increased risk of venous thromboembolism. Radiotherapy may further increase this risk. We aim to investigate the impact of stereotactic body radiotherapy (SBRT) on thrombin generation and platelet aggregation. We included 110 patients with localized NSCLC treated with SBRT. Blood samples were obtained prior to SBRT, immediately after SBRT completion, and 4-6 weeks following SBRT. Ex vivo and in vivo thrombin generations were analyzed using a calibrated automated thrombogram and commercial enzyme-linked immunosorbent assays. Platelet aggregation was evaluated using multiple electrode aggregometry. No significant differences were found in ex vivo or in vivo thrombin generation between blood samples before and immediately after SBRT treatment. Platelet aggregation was lower immediately after SBRT than before SBRT (TRAP: P = 0.04 and ASPI: P = 0.02) but remained within the reference interval. SBRT did not affect in vivo and ex vivo thrombin generation or platelet aggregation. SBRT did not cause prothrombotic changes in the coagulation in this study population of SBRT-treated patients with localized NSCLC.
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Affiliation(s)
- Kristian Kirkelund Bentsen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Johanne Andersen Hojbjerg
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pernille Just Vinholt
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | - Olfred Hansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stefan Starup Jeppesen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
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Li Y, Liu Z, Chen C, Li D, Peng H, Zhao P, Wang J. Risk factors and potential predictors of pulmonary embolism in cancer patients undergoing thoracic and abdominopelvic surgery: a case control study. Thromb J 2022; 20:80. [PMID: 36550497 PMCID: PMC9783998 DOI: 10.1186/s12959-022-00442-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Postoperative pulmonary embolism (PE) is a severe complication leading to death and poor prognosis. The present study investigated the risk factors and potential predictors of PE in cancer patients undergoing thoracic and abdominopelvic surgery. METHODS A retrospective study was conducted on the patients with cancer who underwent thoracic and abdominopelvic surgery in Sichuan Cancer Hospital from December 2016 to January 2022. A total of 189 patients were included, in which 63 patients diagnosed PE after operation were collected as PE group, and 126 patients matched by age, type of cancer and cancer location were enrolled as control group. Conditional logistic regression was conducted to analyze the association between PE and risk factors. Predictive values of key factors were compared by the area under the curve (AUC) in receiver operating characteristic curve (ROC) curve. RESULTS Conditional multivariate logistic regression showed that BMI (odds ratio [OR] 4.065, 95% confidence interval [CI] 1.138-14.527; p = 0.031), intraoperative hypotension time (OR 4.095, 95% CI 1.367-12.266; p = 0.009), same day fluid balance (OR 0.245, 95% CI 0.061-0.684; p = 0.048), and postoperative D-Dimer (OR 1.693, 95% CI 1.098-2.611; p = 0.017) were significantly related to the occurrence of postoperative PE. Postoperative D-Dimer had the maximal AUC value 0.8014 (95% CI: 0.7260-0.8770) for predicting PE, with a cutoff value of 1.505 μg/ml. CONCLUSIONS BMI, intraoperative hypotension time, lower same day fluid balance and postoperative D-dimer are independent risk factors associated with PE in cancer patients undergoing thoracic and abdominopelvic surgery. Postoperative D-Dimer seems to be a good indicator to predict postoperative PE for cancer patients.
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Affiliation(s)
- Yi Li
- grid.415880.00000 0004 1755 2258Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Surgical Building, No. 55 4th section of South Renmin Road, Chengdu, Sichuan China
| | - Zhenjun Liu
- grid.415880.00000 0004 1755 2258Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Surgical Building, No. 55 4th section of South Renmin Road, Chengdu, Sichuan China
| | - Chen Chen
- grid.415880.00000 0004 1755 2258Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Surgical Building, No. 55 4th section of South Renmin Road, Chengdu, Sichuan China
| | - Dan Li
- grid.415880.00000 0004 1755 2258Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Surgical Building, No. 55 4th section of South Renmin Road, Chengdu, Sichuan China
| | - Huan Peng
- grid.415880.00000 0004 1755 2258Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Surgical Building, No. 55 4th section of South Renmin Road, Chengdu, Sichuan China
| | - Pei Zhao
- grid.415880.00000 0004 1755 2258Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Surgical Building, No. 55 4th section of South Renmin Road, Chengdu, Sichuan China
| | - Jiuhui Wang
- grid.415880.00000 0004 1755 2258Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Surgical Building, No. 55 4th section of South Renmin Road, Chengdu, Sichuan China
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Jin K, Brennan PM, Poon MTC, Figueroa JD, Sudlow CLM. Impact of tumour characteristics and cancer treatment on cerebrovascular mortality after glioma diagnosis: Evidence from a population-based cancer registry. Front Oncol 2022; 12:1025398. [PMID: 36568237 PMCID: PMC9780584 DOI: 10.3389/fonc.2022.1025398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Objective We aimed to examine brain tumour grade, a marker of biological aggressiveness, tumour size and cancer treatment are associated with cerebrovascular mortality among patients with malignant glioma, the most common and aggressive type of brain tumour. Methods We conducted a retrospective, observational cohort study using the US National Cancer Institute's state and regional population-based cancer registries. We identified adult patients with glioma in 2000 to 2018 (N=72,916). The primary outcome was death from cerebrovascular disease. Cox regression modelling was used to estimate the associations with cerebrovascular mortality of tumour grade, tumour size and treatment (surgery, radiotherapy, chemotherapy), calculating hazard ratios (HR) adjusted for these factors as well as for age, sex, race, marital status and calendar year. Results Higher grade (Grade IV vs Grade II: HR=2.47, 95% CI=1.69-3.61, p<0.001) and larger brain tumours (size 3 to <6 cm: HR=1.40, 95% CI=1.03 -1.89, p<0.05; size ≥ 6 cm: HR=1.47, 95% CI=1.02-2.13, p<0.05 compared to size < 3cm) were associated with increased cerebrovascular mortality. Cancer treatment was associated with decreased risk (surgery: HR= 0.60, p<0.001; chemotherapy: HR=0.42, p<0.001; radiation: HR= 0.69, p<0.05). However, among patents surviving five years or more from cancer diagnosis radiotherapy was associated with higher risk of cerebrovascular mortality (HR 2.73, 95% CI 1.49-4.99, p<0.01). Conclusion More aggressive tumour characteristics are associated with increased cerebrovascular mortality. Radiotherapy increased risk of cerebrovascular mortality five-year after cancer diagnosis. Further research is needed to better understand the long-term cardiovascular consequences of radiation therapy, and whether the consequent risk can be mitigated.
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Affiliation(s)
- Kai Jin
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Brain Tumour Centre of Excellence, Cancer Research United Kingdom Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Paul M. Brennan
- Brain Tumour Centre of Excellence, Cancer Research United Kingdom Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael T. C. Poon
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Brain Tumour Centre of Excellence, Cancer Research United Kingdom Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonnie D. Figueroa
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Brain Tumour Centre of Excellence, Cancer Research United Kingdom Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Cathie L. M. Sudlow
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Brain Tumour Centre of Excellence, Cancer Research United Kingdom Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
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Jones SR, Patel RB, Rahim MQ, Althouse SK, Batra S. Venous Thromboembolic Events in Adolescent and Young Adult Patients with Acute Lymphoblastic Leukemia. J Adolesc Young Adult Oncol 2022; 11:600-604. [PMID: 35108120 DOI: 10.1089/jayao.2021.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Acute venous thromboembolisms (VTEs) are serious complications that occur during acute lymphoblastic leukemia (ALL) chemotherapy. The data elucidating risk factors for developing VTEs are limited in adolescent and young adult patients being treated per pediatric ALL protocols. In a cohort of 66 patients, 14 (21%) experienced VTEs. The majority of VTEs occurred during induction chemotherapy after the first dose of asparaginase, and in the upper extremities. Five-year relapse-free and overall survival were not impacted by VTEs. Contrary to VTEs in adults, hypoalbuminemia and increased body mass index were not associated with an elevated risk of VTE.
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Affiliation(s)
- Sandra R Jones
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Roshni B Patel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mahvish Q Rahim
- Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Sandra K Althouse
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, SA
| | - Sandeep Batra
- Department of Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA.,Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
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Zhang K, Ma Z, Li S, Zhang W, Foda MF, Zhao Y, Han H. Platelet-Covered Nanocarriers for Targeted Delivery of Hirudin to Eliminate Thrombotic Complication in Tumor Therapy. ACS NANO 2022; 16:18483-18496. [PMID: 36350264 DOI: 10.1021/acsnano.2c06666] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Most patients are at high risk of thrombosis during cancer treatment. However, the major discrepancy in the therapeutic mechanisms and microenvironment between tumors and thrombosis makes it challenging for a panacea to treat cancer while being able to eliminate the risk of thrombosis. Herein, we developed a biomimetic MnOx/Ag2S nanoflower platform with platelet membrane modification (MnOx@Ag2S@hirudin@platelet membrane: MAHP) for the long-term release of anticoagulant drugs to treat thrombosis together with tumor therapy. This MAHP platform could achieve the targeted delivery of hirudin to the thrombus site and perform the controlled release under the irradiation of near-infrared light, demonstrating effective removal of the thrombus. Moreover, MAHP could inhibit tumor progression and prolong the survival time of mice with thromboembolic complications.
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Affiliation(s)
- Kai Zhang
- The State Key Laboratory of Agricultural Microbiology, College of Life Science and Technology, College of Science, Huazhong Agricultural University, Wuhan 430070, Hubei, People's Republic of China
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, 21 Nanyang Link, Singapore, 637371, Singapore
| | - Zhaoyu Ma
- The State Key Laboratory of Agricultural Microbiology, College of Life Science and Technology, College of Science, Huazhong Agricultural University, Wuhan 430070, Hubei, People's Republic of China
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, 21 Nanyang Link, Singapore, 637371, Singapore
| | - Shuting Li
- The State Key Laboratory of Agricultural Microbiology, College of Life Science and Technology, College of Science, Huazhong Agricultural University, Wuhan 430070, Hubei, People's Republic of China
| | - Weiyun Zhang
- The State Key Laboratory of Agricultural Microbiology, College of Life Science and Technology, College of Science, Huazhong Agricultural University, Wuhan 430070, Hubei, People's Republic of China
| | - Mohamed Frahat Foda
- The State Key Laboratory of Agricultural Microbiology, College of Life Science and Technology, College of Science, Huazhong Agricultural University, Wuhan 430070, Hubei, People's Republic of China
- Department of Biochemistry, Faculty of Agriculture, Benha University, Moshtohor, Toukh 13736, Egypt
| | - Yanli Zhao
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, 21 Nanyang Link, Singapore, 637371, Singapore
| | - Heyou Han
- The State Key Laboratory of Agricultural Microbiology, College of Life Science and Technology, College of Science, Huazhong Agricultural University, Wuhan 430070, Hubei, People's Republic of China
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Liu R, Xu B, Ma Z, Ye H, Guan X, Ke Y, Xiang Z, Shi Q. Controlled release of nitric oxide for enhanced tumor drug delivery and reduction of thrombosis risk. RSC Adv 2022; 12:32355-32364. [PMID: 36425712 PMCID: PMC9650582 DOI: 10.1039/d2ra05438h] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/31/2022] [Indexed: 08/28/2023] Open
Abstract
Platelets activation and hypercoagulation induced by tumor cell-specific thrombotic secretions such as tissue factor (TF) and cancer procoagulant (CP), microparticles (MPs), and cytokines not only increase cancer-associated thrombosis but also accelerate cancer progress. In addition, the tumor heterogeneity such avascular areas, vascular occlusion and interstitial fluid pressure still challenges efficient drug delivery into tumor tissue. To overcome these adversities, we herein present an antiplatelet strategy based on a proteinic nanoparticles co-assembly of l-arginine (LA) and photosensitizer IR783 for local NO release to inhibit the activation of tumor-associated platelets and normalize angiogenesis, suppressing thrombosis and increasing tumoral accumulation of the nanoagent. In addition, NIR-controlled release localizes the NO spatiotemporally to tumor-associated platelets and prevents undesirable systemic bleeding substantially. Moreover, NO can transform to more cytotoxic peroxynitrite to destroy cancer cells. Our study describes an antiplatelet-directed cancer treatment, which represents a promising area of targeted cancer therapy.
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Affiliation(s)
- Rui Liu
- Department of VIP Unit, China-Japan Union Hospital of Jilin University Changchun Jilin 130022 China
| | - Baofeng Xu
- Stroke Center and Department of Neurology, First Hospital of Jilin University Changchun Jilin 130022 China
| | - Zhifang Ma
- State Key Laboratory of Polymer Physics and Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences Changchun Jilin 130022 China
| | - Hongbo Ye
- State Key Laboratory of Polymer Physics and Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences Changchun Jilin 130022 China
| | - Xinghua Guan
- State Key Laboratory of Polymer Physics and Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences Changchun Jilin 130022 China
| | - Yue Ke
- State Key Laboratory of Polymer Physics and Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences Changchun Jilin 130022 China
- University of Science and Technology of China Hefei Anhui 230026 China
| | - Zehong Xiang
- State Key Laboratory of Polymer Physics and Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences Changchun Jilin 130022 China
- University of Science and Technology of China Hefei Anhui 230026 China
| | - Qiang Shi
- State Key Laboratory of Polymer Physics and Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences Changchun Jilin 130022 China
- University of Science and Technology of China Hefei Anhui 230026 China
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Lee LH, Danchaivijitr P, Uaprasert N, Gill H, Sacdalan DL, Ho GF, Parakh R, Pai P, Lee JK, Rey N, Cohen AT. Safe and effective treatment of venous Thromboembolism associated with Cancer: focus on direct Oral Anticoagulants in Asian patients. Exp Hematol Oncol 2022; 11:79. [PMID: 36303259 PMCID: PMC9615183 DOI: 10.1186/s40164-022-00331-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
Cancer-associated thrombosis (CAT) poses a significant disease burden and the incidence in Asian populations is increasing. Anticoagulation is the cornerstone of treatment, but can be challenging due to the high bleeding risk in some cancers and the high risk of recurrent venous thromboembolism (VTE) in patients with malignancies. Direct oral anticoagulants (DOACs) are well established as first-choice treatments for VTE in non-cancer patients, offering a more convenient and less invasive treatment option than low-molecular-weight heparin (LMWH). Asian patients have exhibited comparable efficacy and safety outcomes with other races in trials of DOACs for VTE in the general population. Although no specific data are available in Asian patients with CAT, results from randomized controlled trials of apixaban, edoxaban, or rivaroxaban versus the LMWH, dalteparin, indicate that DOACs are a reasonable alternative to LMWH for anticoagulation in Asian patients with CAT. This is further supported by analyses of real-world data in Asian populations demonstrating the efficacy and safety of DOACs in Asian patients with CAT. Apixaban, edoxaban, or rivaroxaban are recommended in the most recently updated international guidelines as first-line therapy for CAT in patients without gastrointestinal or genitourinary cancers and at low risk of bleeding. An increased risk of major gastrointestinal bleeding was evident with edoxaban or rivaroxaban, but not apixaban, versus dalteparin in the clinical trials, suggesting that apixaban could be a safe alternative to LMWH in patients with gastrointestinal malignancies. Determining the optimal anticoagulant therapy for patients with CAT requires careful consideration of bleeding risk, tumor type, renal function, drug-drug interactions, financial costs, and patients' needs and preferences.
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Affiliation(s)
- Lai Heng Lee
- Haematology Department, Singapore General Hospital, Bukit Merah, Singapore
| | - Pongwut Danchaivijitr
- Division of Medical Oncology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Noppacharn Uaprasert
- Research Unit in Translational Hematology, Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Harinder Gill
- Department of Medicine, The University of Hong Kong, 102 Pokfulam Road, Pokfulam Hong Kong, Pokfulam, Hong Kong, China.
| | | | - Gwo Fuang Ho
- Clinical Oncology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Rajiv Parakh
- Division of Peripheral Vascular & Endovascular Service, Medanta-Medicity, Gurgaon, Haryana, India
| | - Paresh Pai
- Vascular and Endovascular Surgery, The Vascular Clinic, Mumbai, India
| | - Jen-Kuang Lee
- Cardiology Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Nannette Rey
- de La Salle Medical and Health Sciences Institute, Dasmarinas Cavite, Philippines
| | - Alexander T Cohen
- Department of Haematological Medicine, Guy's and St Thomas' Hospitals, NHS Trust, King's College, London, UK
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Wang Y, Liu L, Zhou P, Luo X, Liu HQ, Yang H. Activated partial thromboplastin time maybe associated with the prognosis of papillary thyroid carcinoma. OPEN CHEM 2022. [DOI: 10.1515/chem-2022-0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Objective
Hemostasis markers associated with tumors have been widely studied. However, the associations between the coagulation factors and papillary thyroid carcinoma (PTC) prognosis remain unclear. The aim of the present study was to investigate these associations.
Patients and methods
PTC patients treated at Shengjing Hospital between 2013 and 2019 were retrospectively analyzed and divided into three groups. Clinical, ultrasound, and pathological patient characteristics were recorded. The blood routine, coagulation factors, and thyroid function data were compared.
Results
A total of 50 patients were selected and divided into Group 1 [complicated with second primary malignancies (SPMs)], Group 2 (with postoperative cervical lymph node metastasis), and Group 3 (control group). The ages of patients in Group 2 were significantly higher than those in the control group. The neutrophil ratio (%) in Group 1 was significantly higher than that in Groups 2 and 3, while its lymphocyte ratio (%) was significantly lower. The coagulation factor activated partial thromboplastin time (APTT) in the first and second groups was statistically significantly lower than that in the control group. There were no statistical differences in APTT between the first and second groups. Shorter APTT was associated with SPM and postoperative cervical lymph node metastasis.
Conclusions
Coagulation indicators, especially APTT, may be a new biomarker for predicting PTC prognosis and may provide a new molecular target, especially in combination with SPM and postoperative cervical lymph node metastasis.
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Affiliation(s)
- Yanhai Wang
- Ultrasound Department, Shenzhen Samii Medical Center , Shenzhen 518118 , Guangdong Province , China
- Ultrasound Department, ShengJing Hospital of China Medical University , Shenyang , 110004, Liaoning Province , China
| | - Luying Liu
- Ultrasound Department, Shenzhen Samii Medical Center , Shenzhen 518118 , Guangdong Province , China
| | - Pingting Zhou
- Ultrasound Department, Shenzhen Samii Medical Center , Shenzhen 518118 , Guangdong Province , China
| | - Xiaoli Luo
- Ultrasound Department, Shenzhen Samii Medical Center , Shenzhen 518118 , Guangdong Province , China
| | - Han-Qing Liu
- Central Laboratory, Shenzhen Samii Medical Center , No. 1 Jinniu Road, Pingshan District, Shenzhen City , Shenzhen 518118 , Guangdong Province , China
| | - Hua Yang
- Ultrasound Department, ShengJing Hospital of China Medical University , Shenyang , 110004, Liaoning Province , China
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McNamee N, de la Fuente LR, Santos-Martinez MJ, O'Driscoll L. Proteomics profiling identifies extracellular vesicles' cargo associated with tumour cell induced platelet aggregation. BMC Cancer 2022; 22:1023. [PMID: 36171564 PMCID: PMC9520807 DOI: 10.1186/s12885-022-10068-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background Cancer patients have an increased risk of developing venous thromboembolism, with up to 30% dying within a month of their development. Some cancer cells are known to induce platelet aggregation, and this interaction is understood to contribute to thrombosis and haematogenous metastasis. Many researchers have reported on extracellular vesicles (EVs) released from platelets. However, less is known about how cancer cells’ EVs may affect platelet function. Here EVs released by triple-negative breast cancer (TNBC) cell line variants were extensively investigated in this regard. Methods EVs were separated from conditioned media of TNBC Hs578T and Hs578Ts(i)8 cells using filtration and ultracentrifugation and were characterised by nanoparticle tracking analysis, immunoblots, and transmission electron microscopy. Blood samples from consenting donors were procured, and their platelets collected by differential centrifugation. Light transmission aggregometry and optical microscopy evaluated the potential interaction of TNBC cells and their EVs with platelets. Global proteomic analysis was performed on the EVs, by in-solution digestion and mass spectrometry. Data analysis included the use of Perseus, FunRich, and Vesiclepedia. Immunoblotting was used as a secondary method to investigate some key EV cargo proteins identified by the global proteomics approach. Results Both TNBC cell variants induced platelet aggregation. Increasing cell numbers significantly reduced the time taken for platelet aggregation to occur. EVs released by the cells also resulted in platelet aggregation. The time to induce platelet aggregation was EV dose-dependent. Proteomics profiling and immunoblotting of the EVs’ cargo identified candidate proteins (including uPAR and PDGFRβ) that may be involved during this process. Conclusions TNBC cells induce platelet aggregation. Furthermore, the cell-free EVs induced this undesirable effect. A number of EV cargo proteins were identified that may be relevant as therapeutic targets. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10068-7.
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Affiliation(s)
- Niamh McNamee
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.,Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Trinity St. James's Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - Laura Rodriguez de la Fuente
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.,Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Maria Jose Santos-Martinez
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.,Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Lorraine O'Driscoll
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland. .,Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland. .,Trinity St. James's Cancer Institute, Trinity College Dublin, Dublin, Ireland.
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Berthe P, Scailteux LM, Lescoat A, Staumont D, Coiffier G, Guéret P, Dupuy A, Oger E, Droitcourt C. Oral Janus kinase inhibitors and venous thromboembolic events in atopic dermatitis: protocols for a case-time control study and a nested case-control study based on the French national health insurance (SNDS) cohort. BMJ Open 2022; 12:e059979. [PMID: 36130766 PMCID: PMC9494565 DOI: 10.1136/bmjopen-2021-059979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a highly prevalent, chronic, inflammatory skin disease. Several orally administered Janus kinase inhibitors (JAKis, including baricitinib, upadacitinib and abrocitinib) have received a marketing authorisation for AD.Clinical trials in rheumatoid arthritis (RA) have flagged up a potential risk of JAKi-induced venous thromboembolic events (VTEs). Accordingly, the summary of product characteristics for a JAKi must mention VTEs as potential adverse drug reactions. In contrast to RA, AD per se is not associated with an elevated risk of VTEs. Assessing this potential risk among patients with AD would shed further light on the putative underlying relationship between JAKis and VTEs.Our research question is to investigate whether JAKi administration increases the risk of VTEs in adults with AD. Our primary objective is to assess the risk of VTEs in adults with AD exposed to JAKis compared to AD adults not exposed to JAKis, and our secondary objective is to evaluate whether JAKi initiation acts as a trigger of VTEs in adults with AD within 3 months. METHODS AND ANALYSIS Hence, we have designed (1) a nested case-control study and (2) a case-time control study in a cohort of adults with AD with data from the French national health insurance system (2017-2025).Here, we describe the study protocol, our methodological choices and certain novel aspects, including the combined value of the two assumptions and the use of an exhaustive national health insurance database with potentially greater statistical power for studying rare events in the population of patients with AD at a low risk of VTEs (thus limiting the influence of confounding factors). ETHICS AND DISSEMINATION The protocol has been approved by an independent ethics committee and registered with the French National Data Protection Commission. The study's findings will be published in peer-reviewed scientific journals and presented at international conferences.
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Affiliation(s)
| | - Lucie-Marie Scailteux
- Pharmacovigilance and Pharmacoepidemiology, CHU Rennes, Rennes, France
- Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Alain Lescoat
- Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
- Internal Medicine and Clinical Immunology, CHU Rennes, Rennes, France
| | - Delphine Staumont
- Department of Dermatology, Lille University Hospital Center, Lille, France
| | - Guillaume Coiffier
- Department of Rheumatology, CH Dinan, Dinan, France
- INSERM, INRA, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
| | | | - Alain Dupuy
- Department of Dermatology, CHU Rennes, Rennes, France
- Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Emmanuel Oger
- Pharmacovigilance and Pharmacoepidemiology, CHU Rennes, Rennes, France
- Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Catherine Droitcourt
- Department of Dermatology, CHU Rennes, Rennes, France
- Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
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Moore TL, Cook AB, Bellotti E, Palomba R, Manghnani P, Spanò R, Brahmachari S, Di Francesco M, Palange AL, Di Mascolo D, Decuzzi P. Shape-specific microfabricated particles for biomedical applications: a review. Drug Deliv Transl Res 2022; 12:2019-2037. [PMID: 35284984 PMCID: PMC9242933 DOI: 10.1007/s13346-022-01143-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 12/13/2022]
Abstract
The storied history of controlled the release systems has evolved over time; from degradable drug-loaded sutures to monolithic zero-ordered release devices and nano-sized drug delivery formulations. Scientists have tuned the physico-chemical properties of these drug carriers to optimize their performance in biomedical/pharmaceutical applications. In particular, particle drug delivery systems at the micron size regime have been used since the 1980s. Recent advances in micro and nanofabrication techniques have enabled precise control of particle size and geometry-here we review the utility of microplates and discoidal polymeric particles for a range of pharmaceutical applications. Microplates are defined as micrometer scale polymeric local depot devices in cuboid form, while discoidal polymeric nanoconstructs are disk-shaped polymeric particles having a cross-sectional diameter in the micrometer range and a thickness in the hundreds of nanometer range. These versatile particles can be used to treat several pathologies such as cancer, inflammatory diseases and vascular diseases, by leveraging their size, shape, physical properties (e.g., stiffness), and component materials, to tune their functionality. This review highlights design and fabrication strategies for these particles, discusses their applications, and elaborates on emerging trends for their use in formulations.
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Affiliation(s)
- Thomas L Moore
- Laboratory of Nanotechnology for Precision Medicine, Istituto Italiano Di Tecnologia, Via Morego, 30, 16163, Genoa, Italy.
| | - Alexander B Cook
- Laboratory of Nanotechnology for Precision Medicine, Istituto Italiano Di Tecnologia, Via Morego, 30, 16163, Genoa, Italy
| | - Elena Bellotti
- Laboratory of Nanotechnology for Precision Medicine, Istituto Italiano Di Tecnologia, Via Morego, 30, 16163, Genoa, Italy
| | - Roberto Palomba
- Laboratory of Nanotechnology for Precision Medicine, Istituto Italiano Di Tecnologia, Via Morego, 30, 16163, Genoa, Italy
| | - Purnima Manghnani
- Laboratory of Nanotechnology for Precision Medicine, Istituto Italiano Di Tecnologia, Via Morego, 30, 16163, Genoa, Italy
| | - Raffaele Spanò
- Laboratory of Nanotechnology for Precision Medicine, Istituto Italiano Di Tecnologia, Via Morego, 30, 16163, Genoa, Italy
| | - Sayanti Brahmachari
- Laboratory of Nanotechnology for Precision Medicine, Istituto Italiano Di Tecnologia, Via Morego, 30, 16163, Genoa, Italy
| | - Martina Di Francesco
- Laboratory of Nanotechnology for Precision Medicine, Istituto Italiano Di Tecnologia, Via Morego, 30, 16163, Genoa, Italy
| | - Anna Lisa Palange
- Laboratory of Nanotechnology for Precision Medicine, Istituto Italiano Di Tecnologia, Via Morego, 30, 16163, Genoa, Italy
| | - Daniele Di Mascolo
- Laboratory of Nanotechnology for Precision Medicine, Istituto Italiano Di Tecnologia, Via Morego, 30, 16163, Genoa, Italy
| | - Paolo Decuzzi
- Laboratory of Nanotechnology for Precision Medicine, Istituto Italiano Di Tecnologia, Via Morego, 30, 16163, Genoa, Italy
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Wang P, Xu D, Hu Y, Li H, Li A. Correlation between quantitative parameters of CEUS and Ki-67 labeling index in soft-tissue sarcoma. Acta Radiol 2022:2841851221115081. [PMID: 35903876 DOI: 10.1177/02841851221115081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Apart from the immunohistochemical Ki-67 labeling index (LI), clinicians need a non-invasive and convenient way to predict the prognosis of patients with soft-tissue sarcoma (STS). PURPOSE To investigate the correlation between quantitative parameters of contrast-enhanced ultrasound (CEUS) and Ki-67 LI in STS. MATERIAL AND METHODS A total of 25 patients diagnosed with STS who underwent CEUS examination using SonoVue®, between January 2019 to November 2020, were included in the study. They were then divided into a high-proliferation group and low-proliferation group according to 30% Ki-67 positive tumor cells. The quantitative parameters in the semi-automatic time intensity curve analysis software, including arrival time, time to peak, peak intensity, rise time (RT), rise slope, 50% wash-out time, and 50% wash-out intensity, were extracted from the time intensity curve of CEUS by two independent observers. Statistical evaluation of the correlation and difference between CEUS quantitative parameters and Ki-67 LI between the two groups was performed. According to the area under the curve (AUC) analysis, optimal cutoff points of parameters with significant difference were determined. RESULTS CEUS RT of the high-proliferation group in STS was significantly higher than that of the low-proliferation group (ρ = 0.509, P = 0.01). The most reasonable cutoff to distinguish between low- and high-proliferation groups was 10.84 s. The sensitivity, specificity, and the AUC were 86.7%, 80%, and 0.80, respectively. CONCLUSION CEUS RT was correlated with Ki-67 LI of STS, which can be used as a minimally invasive auxiliary tool to predict the prognosis of STS in clinical practice.
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Affiliation(s)
- Pingping Wang
- Department of Ultrasound, 162752Affiliated Zhongda Hospital of Southeast University, Nanjing, PR China
| | - Di Xu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Yu Hu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Hai Li
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Ao Li
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
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Liu XR, Zhou W, Chen F. Severe compression of left iliac vein is a protective factor for the risk of inferior vena cava thrombosis. J Vasc Surg Venous Lymphat Disord 2022; 10:1107-1112. [PMID: 35716997 DOI: 10.1016/j.jvsv.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/12/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the association between left iliac vein (LIV) compression and inferior vena cava thrombosis (IVCT) in patients with LIV involvement of deep vein thrombosis (DVT). METHODS A total of 263 consecutive DVT patients were retrospectively reviewed and divided into group IVCT and non-IVCT. The influences of LIV smallest diameter and percentage compression on the risk of IVCT were investigated using logistic regression analysis. RESULTS The mean age of IVCT patients was significantly younger than that of non-IVCT patients (55.5±1.8 vs. 62.7±1.1, p=0.001). The percentage of provoked DVT in IVCT patients was higher than that in non-IVCT patients (67.1% vs 48.2%, p=0.01). The smallest diameter of LIV in ICVT patients was larger than that in non-IVCT patients (4.1±0.3 vs. 2.5±0.2, p<0.001). Mean percentage compression of LIV in IVCT patients was significantly lower than that in non-IVCT patients (63.5±2.2 vs. 74.3±1.3; P<0.001). Age was associated with decreased odds of ICVT (OR: 0.965, 95% CI: 0.965-0.985, P=0.001). Provoked DVT was associated with increased odds of ICVT (OR:2.011, 95% CI: 1.070-3.782, P=0.03). LIV compression was associated with decreased odds of ICVT for each 1mm decrease in smallest diameter of the LIV (OR, 0.717; 95% CI, 0.627-0.820; P <0.001), and for each 10% increase in percentage compression of the LIV (OR, 0.715; 95% CI, 0.612-0.835; P <0.001). CONCLUSION Among LIV involvement of DVT patients, non-IVCT patients had more severe LIV compression than IVCT patients. Severe LIV compression may be a protective factor for the risk of IVCT.
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Affiliation(s)
- Xin Ran Liu
- Department of Vascular and Interventional Radiology, the second affiliated Hospital, Nanchang University, Nanchang 330006, China;; Queen Mary School, Nanchang University, Nanchang 330006, China
| | - Wei Zhou
- Department of Vascular and Interventional Radiology, the second affiliated Hospital, Nanchang University, Nanchang 330006, China
| | - Feng Chen
- Department of Vascular and Interventional Radiology, the second affiliated Hospital, Nanchang University, Nanchang 330006, China;.
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Cancer associated thrombosis in pediatric patients. Best Pract Res Clin Haematol 2022; 35:101352. [DOI: 10.1016/j.beha.2022.101352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022]
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Cho HJ, Lee IK, Lee YS, Yun SS, Park SC, Kim JY, Lee CS. Application of venous thromboembolism prophylaxis program in patients with colorectal cancer using the enhanced recovery after surgery protocol. Eur J Surg Oncol 2022; 48:1384-1389. [PMID: 35120818 DOI: 10.1016/j.ejso.2022.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 12/28/2021] [Accepted: 01/20/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The incidence of postoperative symptomatic venous thromboembolism (VTE) in western colorectal cancer is 1.1-2.5%. Anticoagulation and mechanical devices are recommended for moderate-to high-risk patients. Hospital stay and immobilization, as risk factors for VTE, are reduced by enhanced recovery after surgery (ERAS). This study aimed to evaluate short- and long-term outcomes for a VTE prophylaxis program after minimally invasive colorectal cancer surgery with ERAS protocol. In addition, predicting factors associated with VTE were investigated. MATERIALS AND METHODS We included 1043 patients diagnosed with colorectal cancer who required surgical treatment between January 2017 and December 2019 at a single institution. The patients enrolled followed the VTE prophylaxis program. RESULTS Five (0.5%) patients developed symptomatic VTE, and the median follow-up period was 21 months. The Caprini score for all VTE patients was ≤8 points; thus, only mechanical prophylaxis was applied. The incidence rate of postoperative symptomatic VTE was only 0.5%. There was no association between variables considered as associated with VTE onset, such as age, perioperative complication, and length of postoperative day. TNM staging (OR 2.44, 95% CI 1.4-4.16, p = 0.001) and the Caprini score (OR 1.75, 95% CI 1.1-2.8, p = 0.001) were associated with VTE onset. CONCLUSION Although pharmacological prophylaxis was only performed for Caprini scores ≥9, the VTE incidence rate of patients with colorectal cancer undergoing VTE prophylaxis program was 0.6%; 0.7% is the incidence criterion of the moderate group recommended for pharmacological prophylaxis. Continuous follow-up is required for patients with advanced-stage colorectal cancer with high-risk Caprini scores.
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Affiliation(s)
- Hyung Jin Cho
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Kyu Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoon Suk Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Seob Yun
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jang Yong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Seung Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Thoppil JJ, Courtney DM, McDonald S, Kabrhel C, Nordenholz KE, Camargo CA, Kline JA. SARS-CoV-2 Positivity in Ambulatory Symptomatic Patients Is Not Associated With Increased Venous or Arterial Thrombotic Events in the Subsequent 30 Days. J Emerg Med 2022; 62:716-724. [PMID: 35177286 PMCID: PMC8761548 DOI: 10.1016/j.jemermed.2021.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/29/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND COVID-19 has been associated with increased risk of thromboembolism in critically ill patients. OBJECTIVE We sought to examine the association of SARS-CoV-2 test positivity and subsequent acute vascular thrombosis, including venous thromboembolism (VTE) or arterial thrombosis (AT), in a large nationwide registry of emergency department (ED) patients tested with a nucleic acid test for suspected SARS-CoV-2. METHODS The RECOVER (Registry of Potential COVID-19 in Emergency Care) registry includes 155 EDs across the United States. We performed a retrospective cohort study to produce odds ratios (ORs) for COVID-19-positive vs. COVID-19-negative status as a predictor of 30-day VTE or AT, adjusting for age, sex, active cancer, intubation, hospital length of stay, and intensive care unit (ICU) care. RESULTS Comparing 14,056 COVID-19-positive patients with 12,995 COVID-19-negative patients, the overall 30-day prevalence of VTE events was 1.4% vs. 1.3%, respectively (p = 0.44, χ2). Multivariable analysis identified that testing positive for SARS-CoV-2 status was negatively associated with both VTE (OR 0.76; 95% confidence interval [CI] 0.61-0.94) and AT (OR 0.51; 95% CI 0.32-0.80), whereas intubation, ICU care, and age 50 years or older were positively associated with both VTE and AT. CONCLUSIONS In contrast to other reports, results from this large, hetereogenous national sample of ED patients tested for SARS-CoV-2, showed no association between vascular thrombosis and COVID-19 test positivity.
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Affiliation(s)
- Joby J. Thoppil
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - D. Mark Courtney
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Samuel McDonald
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher Kabrhel
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston Massachusetts
| | | | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston Massachusetts
| | - Jeffrey A. Kline
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan,Reprint Address: Jeffrey A. Kline, MD, Department of Emergency Medicine, Wayne State University, 4201 St. Antoine, University Health Center – 6G, Detroit, MI 48201
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Tawil N, Rak J. Blood coagulation and cancer genes. Best Pract Res Clin Haematol 2022; 35:101349. [DOI: 10.1016/j.beha.2022.101349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
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Cho H, Choi JH, Kang SY, Lee HW, Choi YW, Kim TH, Ahn MS, Kim CH, Shin YS, Jang JY, Oh YT, Heo J, Sheen SS. Analysis of thromboembolic events in head and neck cancer patients who underwent concurrent chemoradiotherapy with cisplatin. Korean J Intern Med 2022; 37:653-659. [PMID: 35439872 PMCID: PMC9082433 DOI: 10.3904/kjim.2021.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/25/2021] [Accepted: 12/24/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The study investigated the incidence of thromboembolic events (TEE) in head and neck (H&N) cancer patients who received concurrent chemoradiotherapy (CCRT) with cisplatin, and analyzed the factors affecting TEE occurrence. METHODS Two hundred and fifty-seven patients who started CCRT with cisplatin for H&N cancer from January 2005 to December 2019 were analyzed. RESULTS TEE occurred in five patients, an incidence rate of 1.9%. The 2-, 4-, and 6-month cumulative incidences of TEE were 0.8%, 1.6%, and 1.9%, respectively. Khorana score was the only factor associated with TEE occurrence (p = 0.010). CONCLUSION The incidence of TEE in H&N cancer patients who underwent CCRT with cisplatin was relatively low when compared to other types of cancer. However, patients with a high Khorana score require more careful surveillance for possible TEE occurrence.
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Affiliation(s)
- Hundo Cho
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Jin-Hyuk Choi
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Seok Yun Kang
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Hyun Woo Lee
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Yong Won Choi
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Tae-Hwan Kim
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Mi Sun Ahn
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Chul-Ho Kim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon,
Korea
| | - Yoo Seob Shin
- Department of Otolaryngology, Ajou University School of Medicine, Suwon,
Korea
| | - Jeon Yeob Jang
- Department of Otolaryngology, Ajou University School of Medicine, Suwon,
Korea
| | - Young-Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Jaesung Heo
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Seung Soo Sheen
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon,
Korea
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A Glucagonoma Presenting as Cerebral Vein Thrombosis and Diabetes. Case Rep Endocrinol 2022; 2022:7659341. [PMID: 35498123 PMCID: PMC9054441 DOI: 10.1155/2022/7659341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/11/2022] [Indexed: 11/18/2022] Open
Abstract
Glucagonomas are rare pancreatic neuroendocrine tumors (pNETs), malignant in 80% of cases, thus highlighting the importance of early diagnosis and treatment. Primary manifestations are diabetes, dermatosis, depression, weight loss, and deep vein thrombosis. Unlike other pNETs, glucagonomas are associated with a higher incidence of thromboembolic events, often resulting in death. We present the case of a glucagonoma patient whose primary manifestation was cerebral sinus venous thrombosis (CS-VT). Early diagnosis enabled curative resection. The purpose of this paper is to review the underlying mechanisms associated with increased coagulopathy in glucagonomas.
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