1
|
Hägg L, Ehrs F, Lind M, Johansson M. Cancer incidence and mortality after a first-ever venous thrombosis: a cohort study in northern Sweden. Thromb J 2024; 22:77. [PMID: 39169417 DOI: 10.1186/s12959-024-00646-z] [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: 05/02/2024] [Accepted: 08/14/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) has a high mortality rate and can be the first manifestation of cancer. We investigated the incidence of cancer after first-ever VTE and the association between VTE and all-cause mortality. METHODS A Swedish cohort study that included 105,997 participants without previous cancer who underwent a health examination from 1985-2014 was conducted. Manually validated first-ever VTE events, incident cancer according to the Swedish cancer registry, and mortality were registered. Participants were followed until September 5, 2014. RESULTS The mean age at inclusion was 46.2 years, and 50.3% of participants were female. We identified 1303 persons in the cohort with a VTE and no previous cancer. Among these, 179 (13.7%) were diagnosed with cancer after the VTE event, resulting in a cancer incidence of 26.4 (95% CI 22.8-30.6) cases per 1000 person-years. The incidence was highest during the first 6 months after the VTE. In the study population, VTE was associated with an increased risk of cancer (HR 1.95 [95% CI 1.67-2.29] in a multivariable model). VTE was also associated with an increased risk of death (HR 6.30 [95% CI 5.82-6.81]) in a multivariable model). There was an interaction between sex and VTE in relation to both risk of cancer and mortality, with a stronger association in women. CONCLUSIONS The incidence of cancer is high after first-ever VTE, especially close to the VTE event. VTE seems to be a stronger risk marker in women than in men for both cancer and death.
Collapse
Affiliation(s)
- Lovisa Hägg
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Umeå, Sweden.
| | - Felicia Ehrs
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Umeå, Sweden
| | - Marcus Lind
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Umeå, Sweden
| | - Magdalena Johansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Umeå, Sweden
| |
Collapse
|
2
|
Kakuwa T, Watanabe T, Niino M, Kawata A, Satoh T, Matsumura N, Yokoyama Y, Kawana K, Hirashima Y, Kyo S, Yasuda M, Harano K, Machida H, Tokunaga H, Kaneuchi M, Tabata T, Kobayashi Y, Nagase S, Katabuchi H, Mikami M, Yamamoto Y, Rikitake R, Ichinose Y, Higashi T. Quality of care measurement for patients with ovarian cancer in Japan. J Obstet Gynaecol Res 2024; 50:1182-1191. [PMID: 38697202 DOI: 10.1111/jog.15961] [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: 12/11/2023] [Accepted: 04/21/2024] [Indexed: 05/04/2024]
Abstract
AIM Quality of care is important to reduce disease progression, and improve both survival and quality of life. The Japan Society of Gynecologic Oncology has published treatment guidelines to promote standardized high-quality care for ovarian cancer in Japan. We developed quality indicators based on the guideline recommendations and used them on large datasets of health service use to examine the quality of ovarian cancer care. METHODS A panel of experts developed the indicators using a modified Delphi method. Adherence to each indicator was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2018. All patients receiving first-line treatment at participating facilities were included. The adherence rates were returned to participating hospitals, and reasons for nonadherence were collected. A total of 580 hospitals participated, and the study examined the care received by 6611 patients with ovarian cancer and 1879 with borderline tumors using 11 measurable quality indicators. RESULTS The adherence rate ranged from 22.6% for "Estrogen replacement within 6 months of operation" to 93.5% for "Bleomycin, etoposide, and cisplatin for germ cell tumor more than Stage II." Of 580 hospitals, 184 submitted the reasons for nonadherence. CONCLUSIONS The quality of ovarian cancer care should be continuously assessed to encourage the use of best practices. These indicators may be a useful tool for this purpose.
Collapse
Affiliation(s)
- Tamaki Kakuwa
- Division of Health Services Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
- Department of Public Health and Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomone Watanabe
- Division of Health Services Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
- Department of Public Health and Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Mariko Niino
- Center for Cancer Registry, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Akira Kawata
- Division of Health Services Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
- Department of Gynecology, Saitama Cancer Center, Saitama, Japan
| | - Toyomi Satoh
- Department of Obstetrics and Gynecology, University of Tsukuba, Institute of Medicine, Tsukuba, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka-sayama, Osaka, Japan
| | - Yoshihito Yokoyama
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Kei Kawana
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | | | - Satoru Kyo
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Shimane, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kenichi Harano
- Department of Experimental Therapeutics/Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hiroko Machida
- Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan
| | - Hideki Tokunaga
- Department of Gynecology, Tohoku University Hospital, Miyagi, Japan
| | | | - Tsutomu Tabata
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoichi Kobayashi
- Department of Obstetrics and Gynecology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan
| | - Yoko Yamamoto
- Division of Health Services Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Ryoko Rikitake
- Division of Health Services Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
- Department of Public Health and Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yuichi Ichinose
- Division of Health Services Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Takahiro Higashi
- Division of Health Services Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
- Department of Public Health and Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Center for Cancer Registry, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| |
Collapse
|
3
|
Ogura S, Seo K, Ichihara M, Ichizuka K, Nagatsuka M. Clinical Utility of the Geriatric Nutritional Risk Index Before Surgical Intervention for Epithelial Ovarian Cancer Patients: A Retrospective Study. J Clin Med Res 2022; 14:409-415. [PMID: 36406943 PMCID: PMC9635807 DOI: 10.14740/jocmr4816] [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: 08/27/2022] [Accepted: 10/06/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The aim of the study is to analyze the impact of the geriatric nutritional risk index (a patient nutritional assessment item) on the prognoses of epithelial ovarian cancer patients. METHODS In this retrospective study conducted at a single hospital, we retrospectively analyzed 75 epithelial ovarian cancer patients who underwent surgical treatment at our hospital from 2010 to 2015. The geriatric nutritional risk index cut-off value was calculated using the receiver operating characteristic curve. Patients were divided into two groups on the basis of the calculated value. Kaplan-Meier curves were prepared for each group, and the difference in survival rates was calculated using the log-rank test. Cox proportional hazards regression analysis was used to compare other factors that affect prognosis. RESULTS The geriatric nutritional risk index was calculated to be 97.3. The survival rate was 61.9% for the group of patients with an index value > 97.3, and 39.4% for patients with an index value < 97.3 at 48 months (P < 0.001). A univariate analysis was performed with the following variables: age > 60 years, albumin level < 3.5 g/dL, body mass index < 22, presence of ascites, cancer antigen 125 level > 35 U/mL, type of tumor tissue, residual lesion, and geriatric nutritional risk index < 97.3. Albumin level, residual lesion, and geriatric nutritional risk index showed significant differences. A multivariate analysis was also performed, and only the geriatric nutritional risk index showed a significant difference (P = 0.0481). CONCLUSIONS The geriatric nutritional risk index may have a strong influence on the prognoses of epithelial ovarian cancer patients. We recommend utilizing these findings in daily clinical practice and incorporating them into treatment strategies for epithelial ovarian cancer.
Collapse
Affiliation(s)
- Shinji Ogura
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Kohei Seo
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan,Corresponding Author: Kohei Seo, Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Tsuzuki- ku, Yokohama-shi, Kanagawa 224-8503, Japan.
| | - Mitsuyoshi Ichihara
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Kiyotake Ichizuka
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Masaaki Nagatsuka
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| |
Collapse
|
4
|
Kurt G, Nagy D, Troelsen FS, Skajaa N, Erichsen R, Farkas DK, Sørensen HT. Venous Thromboembolism and Risk of Cancer in Users of Low-Dose Aspirin: A Danish Population-Based Cohort Study. TH OPEN 2022; 6:e257-e266. [PMID: 36299805 PMCID: PMC9467693 DOI: 10.1055/s-0042-1755606] [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: 03/03/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background
Aspirin may reduce the risk of cancer, particularly gastrointestinal cancer, and venous thromboembolism (VTE). VTE can be the first symptom of occult cancer, but whether it is also a marker of occult cancer in aspirin users remains unknown. Therefore, we investigated the risk of cancer subsequent to VTE among users of low-dose aspirin.
Methods
We conducted a population-based cohort study using data from Danish health registries for the years 2001 to 2018. We identified all patients with a first-time diagnosis of VTE who also redeemed a prescription for low-dose aspirin (75–150mg) within 90 days prior to the first-time VTE. We categorized aspirin users by the number of prescriptions filled as new users (<5 prescriptions), short-term users (5–19 prescriptions), and long-term users (>19 prescriptions). We computed the absolute cancer risks and standardized incidence ratios (SIRs) for cancer using national cancer incidence rates.
Results
We followed-up 11,759 users of low-dose aspirin with VTE. Long-term users comprised 50% of aspirin users. The 1-year absolute risk of cancer was 6.0% for new users and 6.7% for short-term and long-term users, with corresponding SIRs of 3.3 (95% confidence interval [CI]: 2.8–4.0), 3.2 (95% CI: 2.9–3.7), and 2.8 (95% CI: 2.6–3.2), respectively. After the first year of follow-up, the SIR decreased to 1.2 (95% CI: 1.1–1.4) for new users, 1.1 (95% CI: 1.1–1.3) for short-term users, and 1.1 (95% CI: 1.0–1.2) for long-term users.
Conclusion
VTE may be a harbinger of cancer, even in users of low-dose aspirin, regardless of duration of use.
Collapse
Affiliation(s)
- Gencer Kurt
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
| | - Dávid Nagy
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
| | - Frederikke S. Troelsen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
| | - Nils Skajaa
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
| | - Dóra K. Farkas
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
| | - Henrik T. Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
| |
Collapse
|
5
|
Yamanaka S, Miyake R, Yamada Y, Kawaguchi R, Ootake N, Myoba S, Kobayashi H. Tissue Factor Pathway Inhibitor 2: A Novel Biomarker for Predicting Asymptomatic Venous Thromboembolism in Patients with Epithelial Ovarian Cancer. Gynecol Obstet Invest 2022; 87:133-140. [PMID: 35613543 DOI: 10.1159/000524804] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Patients with asymptomatic venous thromboembolism (VTE) are associated with an increased risk of pulmonary thromboembolism events. However, due to low specificity and high false-positive rates, D-dimer testing cannot be used alone to diagnose VTE. Tissue factor pathway inhibitor 2 (TFPI2), a new serodiagnostic marker for ovarian cancer, plays a role in blood coagulation system regulation. We hypothesized that combining D-dimer and TFPI2 would improve its utility in diagnosing VTE. This study aimed to look into the clinical utility of serum D-dimer and TFPI2 levels in detecting asymptomatic VTE in patients with epithelial ovarian cancer (EOC). DESIGN From January 2008 to December 2015, researchers at Nara Medical University Hospital's Department of Gynecology conducted a single-center retrospective study. The receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic value of preoperative D-dimer, TFPI2, and D-dimer combined with TFPI2 in distinguishing VTE patients from those who did not have VTE. PARTICIPANTS This study included 122 patients with EOC who met the inclusion and exclusion criteria out of 223 admitted to the hospital with EOC. The patients were divided into two groups: VTE (n = 25) and non-VTE (n = 97). RESULTS There were significant differences in D-dimer, TFPI2, and CA125 levels and residual tumor between the VTE and non-VTE groups. The D-dimer level was found to be significantly related to age, body mass index, VTE, massive ascites, residual tumor, histology, and Federation of Gynecology and Obstetrics stage, whereas the TFPI2 level was only related to VTE. Multivariate analysis revealed that D-dimer (the optimal cutoff value, 3.5 μg/mL) and TFPI2 (the optimal cutoff value, 400 pg/mL) are independent risk factors for preoperative VTE. ROC analysis revealed that the area under the curve was 0.8266 for D-dimer, 0.7963 for TFPI2, and 0.8495 for the combination of D-dimer and TFPI2. When compared to the D-dimer test alone, the combination of D-dimer and TFPI2 had higher specificity (77.3-96.9%) and positive predictive value (48.8-81.2%) for the diagnosis of VTE. LIMITATIONS This is a single-center retrospective study. CONCLUSION The combination of D-dimer and TFPI2 may be useful to safely exclude VTE and select patients at high risk of VTE.
Collapse
Affiliation(s)
- Shoichiro Yamanaka
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Japan
| | - Ryuta Miyake
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Japan
| | - Yuki Yamada
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Japan
| | - Ryuji Kawaguchi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Japan
| | - Norihisa Ootake
- Bioscience Division, Research and Development Department, Tosoh Corporation, Ayase-shi, Japan
| | - Shohei Myoba
- Bioscience Division, Research and Development Department, Tosoh Corporation, Ayase-shi, Japan
| | - Hiroshi Kobayashi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Japan.,Department of Gynecology, Ms.Clinic MayOne, Kashihara, Japan
| |
Collapse
|
6
|
Vestergaard SV, Birn H, Darvalics B, Nitsch D, Sørensen HT, Christiansen CF. Risk of Arterial Thromboembolism, Venous Thromboembolism, and Bleeding in Patients with Nephrotic Syndrome: A Population-Based Cohort Study. Am J Med 2022; 135:615-625.e9. [PMID: 34979093 DOI: 10.1016/j.amjmed.2021.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although venous thromboembolism is a well-known complication of nephrotic syndrome, the long-term absolute and relative risks of arterial thromboembolism, venous thromboembolism, and bleeding in adults with nephrotic syndrome remain unclarified. METHODS In this matched cohort study, we identified every adult with first-time recorded nephrotic syndrome from admissions, outpatient clinics, or emergency department visits in Denmark during 1995-2018. Each patient was matched by age and sex with 10 individuals from the general population. We estimated the 10-year cumulative risks of recorded arterial thromboembolism, venous thromboembolism, and bleeding accounting for the competing risk of death. Using Cox models, we computed crude and adjusted hazard ratios (HRs) of the outcomes in patients with nephrotic syndrome versus comparators. RESULTS Among 3967 adults with first-time nephrotic syndrome, the 1-year risk of arterial thromboembolism was 4.2% (95% confidence interval [CI] 3.6-4.8), of venous thromboembolism was 2.8% (95% CI 2.3-3.3), and of bleeding was 5.2% (95% CI 4.5-5.9). The 10-year risk of arterial thromboembolism was 14.0% (95% CI 12.8-15.2), of venous thromboembolism 7.7% (95% CI 6.8-8.6), and of bleeding 17.0% (95% CI 15.7-18.3), with highest risks of ischemic stroke (8.1%), myocardial infarction (6.0%), and gastrointestinal bleeding (8.2%). During the first year, patients with nephrotic syndrome had increased rates of both arterial thromboembolism (adjusted HR [HRadj] = 3.11 [95% CI 2.60-3.73]), venous thromboembolism (HRadj = 7.11 [5.49-9.19]), and bleeding (HRadj = 4.02 [3.40-4.75]) compared with the general population comparators after adjusting for confounders. CONCLUSION Adults with nephrotic syndrome have a high risk of arterial thromboembolism, venous thromboembolism, and bleeding compared with the general population. The mechanisms and consequences of this needs to be clarified.
Collapse
Affiliation(s)
- Søren Viborg Vestergaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Henrik Birn
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Renal Medicine, Aarhus University Hospital, Aarhus , Denmark
| | - Bianka Darvalics
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
7
|
Sardiña González C, Martínez Vivero C, López Castro J. PARANEOPLASTIC SYNDROMES REVIEW: THE GREAT FORGOTTEN ONES. Crit Rev Oncol Hematol 2022; 174:103676. [PMID: 35378267 DOI: 10.1016/j.critrevonc.2022.103676] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/14/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022] Open
Abstract
Paraneoplastic syndromes (PNS) are a group of disorders that can affect the oncologic patient, and which are not directly attributable to tumour invasion, tumour compression or metastasis. In fact, they are due to tumour secretion of functional hormones or peptides or are related to immune cross-reactivity with the host tissue. These syndromes are called paraneoplastic because the components that cause them do not derive from the organ or tissue of origin, but from the neoplasm suffered by the patient. It is estimated that 10-15% of people with cancer suffer from a PNS.(1) PNS is the second direct cause of death (27% of cases) in cancer patients, after cancer itself. Consequently, it is of remarkable importance to recognize and treat SPNs specifically.(2) In view of the above, the aim of this article is to review the state of the art in neurological, haematological, endocrine, and dermatological paraneoplastic syndromes. It is a review in which the most relevant PNS and their symptomatology are described, inquiring into their diagnosis and treatment.
Collapse
Affiliation(s)
| | | | - José López Castro
- Internal Medicine Dept. Hospital Público de Monforte de Lemos (Lugo, SPAIN)
| |
Collapse
|
8
|
Fuglsang CH, Nagy D, Troelsen FS, Farkas DK, Henderson VW, Srensen HT. Venous Thromboembolism and Risk of Cancer in Patients with Dementia: A Danish Population-Based Cohort Study. J Alzheimers Dis 2021; 82:1601-1608. [PMID: 34219709 PMCID: PMC8461660 DOI: 10.3233/jad-201530] [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] [Indexed: 11/24/2022]
Abstract
Background: Venous thromboembolism (VTE) may be the first manifestation of occult cancer. Dementia has been linked to reduced cancer risk. Objective: We examined the risk of cancer following VTE in people with dementia in comparison to the risk in the general population. Methods: We conducted a population-based Danish registry-based cohort study following patients with a first-time VTE and a previous or concurrent diagnosis of dementia during the period 1 April 1996 –31 December 2017. We followed the study participants from date of VTE until diagnosis of cancer, death, emigration, or end of study period, whichever came first. The absolute risk of cancer within one year after VTE was computed, treating death as a competing risk. We calculated gender, age, and calendar-period standardized incidence ratios (SIRs) of cancer based on national cancer rates. Results: We followed 3,552 people with dementia and VTE for a median of 1.3 years. Within the first year after VTE, they had a 90% increased risk of cancer in comparison with the general population [SIR: 1.9 (95% confidence interval: 1.6–2.4)]. During subsequent follow-up years, the SIR fell to 0.7 (95% confidence interval: 0.5–0.8). Findings for Alzheimer’s disease and VTE were similar. Conclusion: People with dementia have an increased risk of a cancer diagnosis during the first year following VTE, perhaps related to increased surveillance, and a lower risk thereafter. Overall risk is similar to that of the general population.
Collapse
Affiliation(s)
- Cecilia H Fuglsang
- Department of Clinical Epidemiology, Aarhus University/Aarhus University Hospital, Aarhus, Denmark
| | - David Nagy
- Department of Clinical Epidemiology, Aarhus University/Aarhus University Hospital, Aarhus, Denmark
| | - Frederikke S Troelsen
- Department of Clinical Epidemiology, Aarhus University/Aarhus University Hospital, Aarhus, Denmark
| | - Dora K Farkas
- Department of Clinical Epidemiology, Aarhus University/Aarhus University Hospital, Aarhus, Denmark
| | - Victor W Henderson
- Department of Clinical Epidemiology, Aarhus University/Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology & Population Health, Stanford University, Stanford, CA, USA.,Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Henrik T Srensen
- Department of Clinical Epidemiology, Aarhus University/Aarhus University Hospital, Aarhus, Denmark.,Center for Population Health Sciences, Stanford, CA, USA
| |
Collapse
|
9
|
Alam AU, Karkhaneh M, Sun HL, Wu C. Survival patterns among venous thromboembolism patients with hematologic malignancies in Alberta, Canada from 2003 to 2015. Thromb Res 2020; 199:59-66. [PMID: 33429125 DOI: 10.1016/j.thromres.2020.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hematologic malignancies are at increased risk of developing venous thromboembolism (VTE). OBJECTIVES We aimed to identify the prevalence of hematologic malignancy in VTE patients and compare the survival with or without VTE. METHODS Using linked administrative data and a validated algorithm we identified VTE cases in Alberta, Canada from 2003 to 2015. Subjects having International Classification of Diseases code for hematologic malignancies, solid tumors and both cancers within 1 year before and after the VTE index event were defined as cancer associated VTE cases. We also identified patients with no VTE. Cox proportional hazards model was applied to estimate the hazard ratio (HR) of death. Kaplan Meier analysis was performed to compare survival rate between different groups. RESULTS We identified 5157 cancer associated VTE patients and 24,932 cancer patients with no VTE. Among the cancer associated VTE patients 697 (13.5%), 4376 (84.9%) and 84 (1.6%) had hematologic malignancies, solid tumors and both cancers, respectively. The median survival (in months) was significantly shorter in myelodysplastic syndrome (MDS), myeloproliferative neoplasm (MPN) and plasma cell dyscrasia patients with VTE than those without (16.6 vs 27.1, p = 0.004; 70.6 vs 99.2, p = 0.023 and 32.9 vs 55.5, p = 0.007 respectively). Occurrence of pulmonary embolism in MDS and MPN patients and deep vein thrombosis in plasma cell dyscrasia patients were significantly associated with increased risk of death (adjusted HR: 3.0, 95% CI: 1. 46-6.16; adjusted HR 1.60, 95% CI:1.01-2.51 and adjusted HR: 1.40, 95% CI: 1.03-1.89 respectively). CONCLUSIONS VTE adversely affects the survival among patients with hematologic malignancies.
Collapse
Affiliation(s)
- Arafat Ul Alam
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Haowei Linda Sun
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Cynthia Wu
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, Canada.
| |
Collapse
|
10
|
Trousseau's syndrome associated with rapidly emerging pancreatic adenocarcinoma soon after esophagectomy: A case report. Int J Surg Case Rep 2020; 77:605-609. [PMID: 33395856 PMCID: PMC7708758 DOI: 10.1016/j.ijscr.2020.11.113] [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: 11/06/2020] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 11/20/2022] Open
Abstract
The first reported case of Trousseau’s syndrome associated with rapidly emerging pancreatic cancer potentially triggered esophagectomy. The aggressively emerging pancreatic cancer with mucin production may be a potential mechanism for cancer-related thrombosis. When a patient with cancer encountered small, multiple cerebral infarctions postoperatively, the body should be checked for occult malignancy.
Introduction Trousseau’s syndrome is characterized as an unexpected, cancer-associated thrombotic event. We describe the first reported case of Trousseau’s syndrome associated with rapidly emerging pancreatic cancer potentially triggered by esophagectomy. Presentation of case A 79-year-old asymptomatic male with clinical stage I esophageal squamous cell carcinoma underwent thoracoscopic subtotal esophagectomy. On postoperative day 46, the patient presented with weakness of his left upper extremity due to multiple cerebral and cerebellar infarctions, with no evidence of atherosclerotic or cardiogenic thrombi. An abdominal computed tomography (CT) showed a pancreatic tumor with multiple liver metastases. Extremely high D-dimer and the CT findings suggested Trousseau’s syndrome associated with a rapidly emerging neoplasm as the etiology of the brain infarction. Although further thrombotic events did not occur, his condition deteriorated rapidly and died on the 31st days of onset. The autopsy revealed multiple small infarctions, with multiple thrombi in the cerebral hemispheres, brain stem, and cerebellum. Histological evaluation revealed pancreatic adenocarcinoma with nodal and liver metastases. Discussion A hypercoagulable state associated with the aggressively emerging pancreatic adenocarcinoma, accompanied by cancer cell production of mucin, may be a potential mechanism for cancer-related thrombosis. Conclusion In patients who received intensive surgical treatment and encountered unexplained brain infarctions in the multi-arterial territory, Trousseau’s syndrome should be considered, and investigation for occult malignancy is required.
Collapse
|
11
|
Pilli VS, Datta A, Dorsey A, Liu B, Majumder R. Modulation of protein S and growth arrest specific 6 protein signaling inhibits pancreatic cancer cell survival and proliferation. Oncol Rep 2020; 44:1322-1332. [PMID: 32945517 PMCID: PMC7448444 DOI: 10.3892/or.2020.7689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 05/08/2020] [Indexed: 12/14/2022] Open
Abstract
Thrombotic complications and hypercoagulopathies are commonly associated with the progression of pancreatic ductal adenocarcinoma (PDAC). Although the mechanistic link between the two phenomena is uncertain, there is evidently an increase in procoagulant proteins and a decrease in anticoagulants in PDAC patients. For example, the anticoagulant protein S (PS) is decreased during the progression of PDAC, a condition that possibly contributes to the hypercoagulopathies. PS is also an important signaling molecule that binds a family of tyrosine kinase receptors known as TAM (Tyro3, Axl and Mer) receptors; TAM receptors are often upregulated in different cancers. Growth Arrest Specific 6 or GAS6 protein, a homolog of PS, is also a TAM receptor family ligand. The downstream signaling pathways triggered by this ligand-receptor interaction perform diverse functions, such as cell survival, proliferation, efferocytosis, and apoptosis. Targeting the TAM receptors to treat cancer has had limited success; side effects are a significant obstacle due to the widespread numerous functions of TAM receptors. In the present study, it was revealed that PS-TAM interaction was pro-apoptotic, whereas GAS6-mediated TAM signaling promoted proliferation and survival in select PDAC cell lines. Furthermore, by regulating the balance between these two signaling pathways (by overexpressing PS or knocking down GAS6), the proliferative potential of the cells was decreased. Both long-term and short-term effects of natural PS overexpression were comparable to the treatment of the cells with the drug UNC2025, which inhibits the Mer-receptor. The present study lays the foundation for investigation of PS as a therapeutic agent to control cancer progression and to concurrently arrest thrombotic events.
Collapse
Affiliation(s)
- Vijaya S Pilli
- Department of Biochemistry, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Arani Datta
- Department of Biochemistry, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Adrianne Dorsey
- Department of Biochemistry, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Bo Liu
- Department of Surgery, University of Wisconsin, Madison, WI 53705, USA
| | - Rinku Majumder
- Department of Biochemistry, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| |
Collapse
|
12
|
Salinaro JR, McQuillen K, Stemple M, Boccaccio R, Ehrisman J, Lorenzo AM, Havrilesky L, Secord AA, Galvan Turner V, Moore KN, Davidson B. Incidence of venous thromboembolism among patients receiving neoadjuvant chemotherapy for advanced epithelial ovarian cancer. Int J Gynecol Cancer 2020; 30:491-497. [PMID: 32054646 DOI: 10.1136/ijgc-2019-000980] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Neoadjuvant chemotherapy may be considered for women with epithelial ovarian cancer who have poor performance status or a disease burden not amenable to primary cytoreductive surgery. Overlap exists between indications for neoadjuvant chemotherapy and known risk factors for venous thromboembolism, including impaired mobility, increasing age, and advanced malignancy. The objective of this study was to determine the rate of venous thromboembolism among women receiving neoadjuvant chemotherapy for epithelial ovarian cancer. METHODS A multi-institutional, observational study of patients receiving neoadjuvant chemotherapy for primary epithelial ovarian, fallopian tube, or peritoneal cancer was conducted. Primary outcome was rate of venous thromboembolism during neoadjuvant chemotherapy. Secondary outcomes included rates of venous thromboembolism at other stages of treatment (diagnosis, following interval debulking surgery, during adjuvant chemotherapy, or during treatment for recurrence) and associations between occurrence of venous thromboembolism during neoadjuvant chemotherapy, subject characteristics, and interval debulking outcomes. Venous thromboembolism was defined as deep vein thrombosis in the upper or lower extremities or in association with peripherally inserted central catheters or ports, pulmonary embolism, or concurrent deep vein thrombosis and pulmonary embolism. Both symptomatic and asymptomatic venous thromboembolism were reported. RESULTS A total of 230 patients receiving neoadjuvant chemotherapy were included; 63 (27%) patients overall experienced a venous thromboembolism. The primary outcome of venous thromboembolism during neoadjuvant chemotherapy occurred in 16 (7.7%) patients. Of the remaining venous thromboembolism events, 22 were at diagnosis (9.6%), six post-operatively (3%), five during adjuvant chemotherapy (3%), and 14 during treatment for recurrence (12%). Patients experiencing a venous thromboembolism during neoadjuvant chemotherapy had a longer mean time to interval debulking and were less likely to undergo optimal cytoreduction (50% vs 80.2%, p=0.02). CONCLUSIONS Patients with advanced ovarian cancer are at high risk for venous thromboembolism while receiving neoadjuvant chemotherapy. Consideration of thromboprophylaxis may be warranted.
Collapse
Affiliation(s)
- Julia Rose Salinaro
- Obstetrics and Gynecology, Duke University Health System, Durham, North Carolina, USA
| | | | - Megan Stemple
- West Virginia University, Morgantown, West Virginia, USA
| | - Robert Boccaccio
- Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jessie Ehrisman
- Gynecologic Oncology, Duke University Health System, Durham, North Carolina, USA
| | - Amelia M Lorenzo
- Gynecologic Oncology, Duke University Health System, Durham, North Carolina, USA
| | - Laura Havrilesky
- Gynecologic Oncology, Duke University Health System, Durham, North Carolina, USA
| | | | | | - Kathleen Nadine Moore
- Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Brittany Davidson
- Gynecologic Oncology, Duke University Health System, Durham, North Carolina, USA
| |
Collapse
|
13
|
Potugari BR, Priyanka P, Komanapalli SD, Mercier RJ. Ovarian Cancer Presenting as Cryptogenic Stroke from Patent Foramen Ovale. Clin Med Res 2019; 17:97-101. [PMID: 31324738 PMCID: PMC6886892 DOI: 10.3121/cmr.2019.1444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 04/15/2019] [Accepted: 05/13/2019] [Indexed: 12/21/2022]
Abstract
A woman, aged 52 years, experienced severe headache, confusion, nausea, dizziness, and diplopia for three days. Magnetic resonance imaging of the brain showed multiple acute and subacute infarcts suggestive of embolic events. Dermatological examination was notable for splinter hemorrhages and macular patches on the fingernails and feet, respectively. Further diagnostic imaging of the chest and abdomen revealed pulmonary emboli and an ovarian mass with omental deposits and splenic infarcts. Fine-needle aspiration cytology and surgery confirmed a diagnosis of high-grade serous adenocarcinoma of the ovary with clear cell features. Extensive evaluation for malignancy should be considered on a case-by-case basis for patients with thromboembolic disease and an initial negative diagnostic evaluation for stroke. Consideration of patent foramen ovale closure is reasonable in patients with malignancy who are at risk for recurrent strokes.
Collapse
Affiliation(s)
- Bindu R Potugari
- Department of Internal Medicine, Marshfield Clinic, Marshfield, Wisconsin; Current affiliation: Oncology Fellow, St. Joseph Mercy Ann Arbor, Ypsilanti, Michigan
| | - Priyanka Priyanka
- Department of Internal Medicine, Marshfield Medical Center, Marshfield, Wisconsin; Current affiliation: Department of Internal Medicine, University of West Virginia, Morgantown, West Virginia
| | - Sarah D Komanapalli
- Department of Hospital Medicine, Marshfield Medical Center, Marshfield, Wisconsin
| | - Richard J Mercier
- Department of Oncology, Marshfield Medical Center, Marshfield, Wisconsin
| |
Collapse
|
14
|
Yannoutsos A, Lazareth I, Priollet P. Occult cancer screening and idiopathic venous thromboembolic disease: Where do we stand? JOURNAL DE MEDECINE VASCULAIRE 2018; 43:339-341. [PMID: 30522704 DOI: 10.1016/j.jdmv.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/10/2018] [Indexed: 06/09/2023]
Affiliation(s)
- A Yannoutsos
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - I Lazareth
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - P Priollet
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| |
Collapse
|
15
|
Christensen DH, Veres K, Ording AG, Jørgensen JOL, Cannegieter SC, Thomsen RW, Sørensen HT. Risk of cancer in patients with thyroid disease and venous thromboembolism. Clin Epidemiol 2018; 10:907-915. [PMID: 30123003 PMCID: PMC6080866 DOI: 10.2147/clep.s158869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Risk of venous thromboembolism (VTE) is increased in patients with hypo/hyperthyroidism. It is unknown whether VTE may be a presenting symptom of occult cancer in these patients. Design Nationwide population-based cohort study based on Danish medical registry data. Methods We identified all patients diagnosed with VTE during 1978–2013 who had a previous or concurrent diagnosis of hypothyroidism (N=1481) or hyperthyroidism (N=1788). We followed them until a first-time cancer diagnosis, death, emigration, or study end, whichever came first. We calculated 1-year absolute cancer risk and standardized incidence ratios (SIRs) for cancer incidence in the study population compared with national cancer incidence in the general population. Results During the first year after a VTE diagnosis, the 1-year absolute cancer risk was 3.0% among patients with hypothyroidism and 3.9% among those with hyperthyroidism. During the first year of follow-up, SIRs for cancer in the study population compared with the general population were 1.96 (95% CI: 1.42–2.64) among patients with hypothyroidism and 2.67 (95% CI: 2.07–3.39) among those with hyperthyroidism. SIRs declined substantially after 1 year but remained increased during the remainder of the follow-up period (up to 36 years) (SIR for hypothyroidism=1.16 [95% CI: 0.97–1.39]; SIR for hyperthyroidism=1.26 [95% CI: 1.08–1.46]). Conclusion VTE may be a marker of underlying occult cancer in patients with hypothyroidism or hyperthyroidism.
Collapse
Affiliation(s)
- Diana H Christensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,
| | - Katalin Veres
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,
| | - Anne G Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,
| | - Jens Otto L Jørgensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,
| |
Collapse
|
16
|
Tumor microenvironment mediated by suppression of autophagic flux drives liver malignancy. Biomed J 2018; 41:163-168. [PMID: 30080656 PMCID: PMC6138774 DOI: 10.1016/j.bj.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 01/10/2023] Open
Abstract
The physiological role of autophagy in the catabolic process of the body involves protein synthesis and degradation in homeostasis under normal and stressed conditions. In hepatocellular carcinoma (HCC), the role of tumor microenvironment (TME) has been concerned as the main issue in fighting against this deadly malignancy. During the last decade, the crosstalk between tumor cells and their TME in HCC extensively accumulated. However, a deeper knowledge for the actual function of autophagy in this interconnection which involved in supporting tumor development, progression and chemoresistance in HCC is needed but still largely unknown. Recent studies have shown that coagulants tissue factor (TF) and factor VII (FVII) has a pathological role in promoting tumor growth by activating protease-activated receptor 2 (PAR2). Autophagy-associated LC3A/B-II formation was selectively suppressed by FVII/PAR2 signaling which mediated by mTOR activation through Atg7 but not Atg5/Atg12 axis. The coagulant-derived autophagic suppression seemed potentiate a vicious circle of malignancy in producing more FVII and PAR2 which facilitate in vivo and in vitro tumor progression of HCC and the investigations are consistent with the clinical observations. In this review, we briefly summarize the current understanding of autophagy and discuss recent evidence for its role in HCC malignancy.
Collapse
|
17
|
Cheng J, Zhu XQ. Progress in research of venous thromboembolism in hospitalized patients with digestive system diseases. Shijie Huaren Xiaohua Zazhi 2018; 26:1089-1094. [DOI: 10.11569/wcjd.v26.i18.1089] [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] [Indexed: 02/06/2023] Open
Abstract
Hospitalized patients with digestive system diseases are at high risk of venous thromboembolism (VTE) due to a variety of factors such as advanced age, prolonged bed rest, medication and so on. VTE can affect the quality of life of patients, the number of days of hospitalization, and the cost of treatment and even threaten their life. This article gives a brief overview of the pathogenesis, risk factors, assessment tools, and preventive methods for VTE to promote better prevention of this disease.
Collapse
Affiliation(s)
- Jie Cheng
- Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xiu-Qin Zhu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW Acute pulmonary embolism is a life-threatening condition that can lead to both acute and long-term morbidity and mortality. Patients with acute pulmonary embolism are at risk for significant complications including the development of chronic pulmonary embolism and chronic thromboembolic pulmonary hypertension. This review will describe the rationale for and structure of pulmonary embolism response teams, with a focus on the recognition and treatment of patients with persistent morbidity following pulmonary embolism. RECENT FINDINGS For patients with intermediate and high-risk pulmonary embolism, a myriad of treatment options exist, ranging from anticoagulation alone to surgical embolectomy and hemodynamic support with extracorporeal membrane oxygenation. Optimizing treatment for these patients requires rapid assessment and multidisciplinary cooperation. Over the last five years, the pulmonary embolism response team has emerged as a mechanism to facilitate this care. SUMMARY Pulmonary embolism response teams can streamline and expedite care for patients with intermediate and high-risk pulmonary embolism. However, the care for patients with acute pulmonary embolism does not end at hospital discharge. It is essential to ensure adequate follow-up and identify patients with persistent symptoms and impaired quality of life, particularly those who may have symptomatic chronic pulmonary embolism or chronic thromboembolic pulmonary hypertension.
Collapse
|
19
|
Pedersen AB, Vandenbroucke J, Horváth-Puhó E, Sørensen HT. Venous thromboembolism and risk of cancer in patients with rheumatoid arthritis. J Thromb Haemost 2017; 15:2325-2332. [PMID: 28913891 DOI: 10.1111/jth.13846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Indexed: 08/31/2023]
Abstract
Essentials Can venous thromboembolism (VTE) in rheumatoid arthritis (RA) patients be marker of cancer? RA patients with VTE and comparison cohorts from population-based registries were compared. Increased risk of cancer in RA patients with VTE during the first year of VTE was observed. Risk of cancer in RA patients was increased also during the longer period following VTE. SUMMARY Background It is unknown whether venous thromboembolism (VTE) in rheumatoid arthritis (RA) patients can be a marker of occult cancer. Objectives To examine risk of cancer subsequent to VTE among RA patients compared with risk of cancer in an RA cohort without VTE and in a general population without RA and without VTE. Patients/Methods All RA patients with a first-time diagnosis of VTE (index date) during 1978-2013 and comparison cohorts were identified from population-based registries in Denmark. Results We identified three cohorts: 2497 RA patients with VTE, 11 672 RA patients without VTE and 12 730 persons from the general population. The cumulative incidence of cancer within the first year of the index date was 3.2% among RA with VTE, 2.2% among RA without VTE, and 2.0% in the general population cohort. Incidence rate ratios (IRRs) were 1.79 (95% confidence interval [CI], 1.37-2.33) for RA patients with VTE vs. RA patients without VTE and 2.12 (95% CI, 1.63-2.76) for RA patients with VTE vs. the general population. The IRR of cancer at > 1 to 36 years from the index date among RA patients with VTE was 1.16 (95% CI, 1.00-1.34) compared with the RA patients without VTE and 1.33 (95% CI, 1.15-1.53) compared with the general population. Conclusions We found an increased risk of cancer in RA patients with VTE during the first year following VTE and also during the longer follow-up period. Thus, VTE may not only be a result of inflammation and immunological dysfunctions associated with RA, but may also be a marker for occult cancer.
Collapse
Affiliation(s)
- A B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - J Vandenbroucke
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands
| | - E Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| |
Collapse
|
20
|
Sayers A, Hope C, Lingam KM. Locoregional recurrence of breast cancer presenting as upper limb venous thromboembolism. BMJ Case Rep 2017; 2017:bcr-2017-220899. [PMID: 28784894 DOI: 10.1136/bcr-2017-220899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Locoregional recurrence of breast cancer is a major concern for both patient and oncologist. Presentation as venous thromboembolism (VTE) carries risk of delayed diagnosis and has a poor prognosis. Here we describe, for the first time in the literature, a delayed diagnosis of local recurrence of infiltrative inflammatory breast cancer presenting as extensive deep venous thrombosis of the upper arm veins. This case demonstrates the need for a high level of vigilance for recurrence of malignancy in patients with no concurrent risk factors for VTE and atypical clinical progression in order to reach a timely diagnosis.
Collapse
Affiliation(s)
- Anna Sayers
- Surgical Specialties Division, Chesterfield Royal Hospital, Chesterfield, Derbyshire, UK
| | - Carla Hope
- King's Mill Hospital, Sutton-in-Ashfield, Nottinghamshire, UK
| | | |
Collapse
|
21
|
Klein A, Shepshelovich D, Spectre G, Goldvaser H, Raanani P, Gafter-Gvili A. Screening for occult cancer in idiopathic venous thromboembolism - Systemic review and meta-analysis. Eur J Intern Med 2017; 42:74-80. [PMID: 28502867 DOI: 10.1016/j.ejim.2017.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/21/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Idiopathic venous thromboembolism (VTE) may be associated with an occult malignancy. Early detection of cancer might be translated to a better prognosis for these patients. However, the efficacy of extensive screening for cancer in patients with idiopathic VTE is controversial. MATERIALS AND METHODS Systemic review and meta-analysis of all available prospective trials comparing extensive to limited screening for occult malignancies in patients with idiopathic VTE. PRIMARY OUTCOME all-cause mortality. SECONDARY OUTCOMES cancer related mortality, early cancer diagnosis, cancer diagnosis at the end of follow up and cancer diagnosis at an early stage. Risk ratios (RR) with 95% confidence intervals (CIs) were estimated and pooled. RESULTS The study included five trials and 2287 patients. Extensive screening did not affect all-cause mortality at the end of follow up [RR 0.86 (95% CI 0.58-1.27)] or cancer-related mortality [RR 0.93 (95% CI 0.54-1.58)]. Yet, it yielded more diagnoses of cancer [RR 2.17 (95% CI 1.42-3.32)]. Rates of cancer diagnosis at an early stage did not differ statistically between the two groups [RR 1.49 (95% CI 0.86-2.56)]. However, analysis of the randomized controlled trials alone showed a tendency towards early stage cancer at diagnosis in extensive screening group in, with results almost statistically significant [RR 2.14 (95% CI 0.98-4.67), p=0.06]. CONCLUSIONS Extensive screening for malignancy after idiopathic VTE does not affect mortality rates. Yet, it yields more cancer diagnoses shortly after the VTE event. Further research is needed to determine whether extensive screening might be proper for specific high risk populations.
Collapse
Affiliation(s)
- Alina Klein
- Medicine A, Rabin Medical Center, Petah-Tikva, Israel
| | - Daniel Shepshelovich
- Medicine A, Rabin Medical Center, Petah-Tikva, Israel; Sackler School of Medicine, Tel-Aviv, Israel
| | - Galia Spectre
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel; Sackler School of Medicine, Tel-Aviv, Israel
| | - Hadar Goldvaser
- Institute of Oncology, Rabin Medical Center, Petah-Tikva, Israel; Sackler School of Medicine, Tel-Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel; Sackler School of Medicine, Tel-Aviv, Israel
| | - Anat Gafter-Gvili
- Medicine A, Rabin Medical Center, Petah-Tikva, Israel; Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel; Sackler School of Medicine, Tel-Aviv, Israel.
| |
Collapse
|
22
|
D’Agostino C, Zonzin P, Enea I, Gulizia MM, Ageno W, Agostoni P, Azzarito M, Becattini C, Bongarzoni A, Bux F, Casazza F, Corrieri N, D’Alto M, D’Amato N, D’Armini AM, De Natale MG, Di Minno G, Favretto G, Filippi L, Grazioli V, Palareti G, Pesavento R, Roncon L, Scelsi L, Tufano A. ANMCO Position Paper: long-term follow-up of patients with pulmonary thromboembolism. Eur Heart J Suppl 2017; 19:D309-D332. [PMID: 28751848 PMCID: PMC5520763 DOI: 10.1093/eurheartj/sux030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Venous thromboembolism (VTE), including pulmonary embolism and deep venous thrombosis, is the third most common cause of cardiovascular death. The management of the acute phase of VTE has already been described in several guidelines. However, the management of the follow-up (FU) of these patients has been poorly defined. This consensus document, created by the Italian cardiologists, wants to clarify this issue using the currently available evidence in VTE. Clinical and instrumental data acquired during the acute phase of the disease are the cornerstone for planning the FU. Acquired or congenital thrombophilic disorders could be identified in apparently unprovoked VTE during the FU. In other cases, an occult cancer could be discovered after a VTE. The main targets of the post-acute management are to prevent recurrence of VTE and to identify the patients who can develop a chronic thromboembolic pulmonary hypertension. Knowledge of pathophysiology and therapeutic approaches is fundamental to decide the most appropriate long-term treatment. Moreover, prognostic stratification during the FU should be constantly updated on the basis of the new evidence acquired. Currently, the cornerstone of VTE treatment is represented by both the oral and the parenteral anticoagulation. Novel oral anticoagulants should be an interesting alternative in the long-term treatment.
Collapse
Affiliation(s)
- Carlo D’Agostino
- Department of Cardiology, Cardiologia Ospedaliera, University General Hospital, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - Pietro Zonzin
- Department of Cardiology, Presidio Ospedaliero, Rovigo, Italy
| | - Iolanda Enea
- Emergency Care Department, Anna e S. Sebastiano Hospital, Caserta, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Garibaldi Nesima Hospital, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Walter Ageno
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | | | | | - Cecilia Becattini
- Department of Internal and Vascular Medicine, Perugia General Hospital, Perugia, Italy
| | | | - Francesca Bux
- Coronary Care Unit, Department of Cardiology, Di Venere ASL Hospital, Bari, Italy
| | | | - Nicoletta Corrieri
- Department of Clinical Sciences and Community, University of Milan, Milan, Italy
| | - Michele D’Alto
- Cardiology SUN Department, Colli and Monaldi Hospital, Naples, Italy
| | - Nicola D’Amato
- Coronary Care Unit, Department of Cardiology, Di Venere ASL Hospital, Bari, Italy
| | - Andrea Maria D’Armini
- Cardio-Thoracic Surgery Department, University of Pavia, IRCCS Foundation San Matteo General Hospital, Pavia, Italy
| | | | | | - Giuseppe Favretto
- Cardiac Rehabilitation and Preventive Unit, High Specialization Rehabilitation Hospital, Motta di Livenza, Treviso, Italy
| | - Lucia Filippi
- Thoracic and Vascular Department, University of Padova, Cardiological Sciences, Padova, Italy
| | - Valentina Grazioli
- Cardio-Thoracic Surgery Department, University of Pavia, IRCCS Foundation San Matteo General Hospital, Pavia, Italy
| | - Gualtiero Palareti
- Angiology and Blood Coagulation Unit, S. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy
| | - Raffaele Pesavento
- Thoracic and Vascular Department, University of Padova, Cardiological Sciences, Padova, Italy
| | - Loris Roncon
- Cardiology Department, S. Maria della Misericordia Hospital, Rovigo, Italy
| | - Laura Scelsi
- Department of Cardiology, University of Pavia, IRCCS Foundation San Matteo General Hospital, Pavia, Italy
| | | |
Collapse
|
23
|
Zalatnai A, Perjési E, Galambos E. Much More than Trousseau Syndrome. The Broad Spectrum of the Pancreatic Paraneoplastic Syndromes. Pathol Oncol Res 2017; 24:1-10. [PMID: 28160197 DOI: 10.1007/s12253-017-0206-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 01/24/2017] [Indexed: 11/28/2022]
Abstract
When 150 years ago Armand Trousseau proposed that some thrombotic events might be the first sign of concealed visceral malignancies, these findings seemed to be just of anecdotal interest. Since then, however, we have learned that adenocarcinomas, including pancreatic cancers could be associated with a wide spectrum of paraneoplastic syndromes. They may precede the detection of the tumor, may occur simultaneously or may develop during its progression. Due to various hematologic, endocrine, cutaneous, articular, neuromuscular, renal or even psychiatric syndromes, their correct interpretation is intriguing, and because their early signs are not necessarily recognized first by oncologists, the paraneoplastic syndromes pose a diagnostic challenge. Unfortunately, we cannot generalize about their mechanisms, because the molecular backgrounds are far-reaching. In most of the cases, the pancreatic cancer cells release various factors into the bloodstream triggering the coagulation cascade. These patients frequently present with venous thromboembolism, and sometimes they are resistant to anticoagulation. The simultaneous thrombotic and bleeding evens do reflect the abnormal hemostasis. In other instances autoantibodies are formed against cutaneous, renal, neuromuscular or nervous tissues, but the mechanism of some syndromes remains unclear. Clinicians should be aware that pancreatic carcinoma may be associated with not just the Trousseau-syndrome.
Collapse
Affiliation(s)
- Attila Zalatnai
- First Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, H-1085 Üllői út 26, Budapest, Hungary.
| | - Eszter Perjési
- First Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, H-1085 Üllői út 26, Budapest, Hungary
| | - Eszter Galambos
- First Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, H-1085 Üllői út 26, Budapest, Hungary
| |
Collapse
|
24
|
Swier N, Versteeg HH. Reciprocal links between venous thromboembolism, coagulation factors and ovarian cancer progression. Thromb Res 2016; 150:8-18. [PMID: 27988375 DOI: 10.1016/j.thromres.2016.12.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/23/2016] [Accepted: 12/03/2016] [Indexed: 02/06/2023]
Abstract
Ovarian cancer is the most lethal gynecological malignancy, which is due to late presentation. Treating advanced stage ovarian cancer is difficult, and tumor recurrence and chemoresistance frequently occur. In addition, early detection remains a major challenge as there are no early warning signs and no appropriate biomarkers. To reduce mortality rates of ovarian cancer patients, novel drug targets and biomarkers are needed. We postulate that hemostatic keyplayers are of importance when combatting ovarian cancer. The majority of ovarian cancer patients have abnormal hemostatic blood serum marker levels, which indicate an activated coagulation system. This makes patients more prone to experiencing venous thromboembolism (VTE), and the occurrence of VTE in ovarian cancer patients adversely affects survival. Coagulation activation also promotes tumor progression as it influences tumor biology at several stages and the decreased survival rates associated with ovarian cancer-associated thrombosis are more likely due to cancer metastasis rather than to fatal thromboembolic events. In this review, we will discuss; (1) Population studies that address the bidirectional relationship between VTE and ovarian cancer, and the most important risk factors involved; (2) The mechanisms of coagulation factors and platelets that are critically involved in the development of VTE, and the progression of ovarian cancer; (3) Roles and future directions of coagulation factors in ovarian cancer therapy, and in diagnosis and prognosis of ovarian cancer as biomarkers.
Collapse
Affiliation(s)
- Nathalie Swier
- Department of Internal Medicine, Thrombosis and Hemostasis Division, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Henri H Versteeg
- Department of Internal Medicine, Thrombosis and Hemostasis Division, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
| |
Collapse
|
25
|
Jara-Palomares L, Otero R, Jimenez D, Carrier M, Tzoran I, Brenner B, Margeli M, Praena-Fernandez JM, Grandone E, Monreal M. Development of a Risk Prediction Score for Occult Cancer in Patients With VTE. Chest 2016; 151:564-571. [PMID: 27815153 DOI: 10.1016/j.chest.2016.10.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/11/2016] [Accepted: 10/17/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The benefits of a diagnostic workup for occult cancer in patients with VTE are controversial. Our aim was to provide and validate a risk score for occult cancer in patients with VTE. METHODS We designed a nested case-control study in a cohort of patients with VTE included in the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry from 2001 to 2014. Cases included cancer detected beyond the first 30 days and up to 24 months after VTE. Control subjects were defined as patients with VTE with no cancer in the same period. RESULTS Of 5,863 eligible patients, 444 (7.6%; 95% CI, 6.8%-8.2%) were diagnosed with occult cancer. On multivariable analysis, variables selected were male sex, age > 70 years, chronic lung disease, anemia, elevated platelet count, prior VTE, and recent surgery. We built a risk score assigning points to each variable. Internal validity was confirmed using bootstrap analysis. The proportion of patients with cancer who scored ≤ 2 points was 5.8% (241 of 4,150) and that proportion in those who scored ≥ 3 points was 12% (203 of 1,713). We also identified scores divided by sex and age subgroups. CONCLUSIONS This is the first risk score that has identified patients with VTE who are at increased risk for occult cancer. Our score needs to be externally validated.
Collapse
Affiliation(s)
- Luis Jara-Palomares
- Medical Surgical Unit of Respiratory Diseases, Virgen del Rocio Hospital, Seville, Spain; Instituto de Biomedicina de Sevilla (IBiS), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Seville, Spain.
| | - Remedios Otero
- Medical Surgical Unit of Respiratory Diseases, Virgen del Rocio Hospital, Seville, Spain; Instituto de Biomedicina de Sevilla (IBiS), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Seville, Spain
| | - David Jimenez
- Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
| | - Marc Carrier
- Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Inna Tzoran
- Thrombosis and Hemostasis Unit, Department of Hematology and Bone Marrow Transplantation Rambam Medical Center, Haifa, Israel
| | - Benjamin Brenner
- Thrombosis and Hemostasis Unit, Department of Hematology and Bone Marrow Transplantation Rambam Medical Center, Haifa, Israel
| | - Mireia Margeli
- Department of Medical Oncology, Hospital Universitari Germans Trias i Pujol de Badalona, Barcelona, Spain
| | - Juan Manuel Praena-Fernandez
- Statistics, Methodology and Research Evaluation Unit, Andalusian Public Foundation for Health Research Management, Hospital Virgen del Rocío, Seville, Spain
| | - Elvira Grandone
- Atherosclerosis and Thrombosis Unit, Casa Sollievo della Sofferenza, Foggia, Italy
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol de Badalona, Barcelona, Universidad Católica de Murcia, Guadalupe, Spain
| | | |
Collapse
|
26
|
Abstract
Venous thromboembolism (VTE) is a highly prevalent complication of malignancy with emerging changes in incidence, diagnosis and treatment paradigms. This manuscript, initiated by the Anticoagulation Forum, provides clinical guidance based on existing guidelines and consensus expert opinion where guidelines are lacking. We address a) the appropriate workup to search for occult malignancy in patients with idiopathic VTE, b) identification of high-risk cancer patients for primary thromboprophylaxis, c) the appropriate immediate and long-term treatment for people with cancer diagnosed with acute thromboembolism, d) the appropriate duration of anticoagulation and e) the appropriate treatment strategy in patients with recurrent VTE on anticoagulation. Areas of controversy and future directions in this field are highlighted.
Collapse
|
27
|
Sassi M, Chakroun T, Mbemba E, Van Dreden P, Elalamy I, Larsen AK, Gerotziafas GT. The Antithrombotic Potential of Tinzaparin and Enoxaparin Upon Thrombin Generation Triggered In Vitro by Human Ovarian Cancer Cells IGROV1. Clin Appl Thromb Hemost 2016; 23:155-163. [PMID: 27609342 DOI: 10.1177/1076029616665922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A documented relationship between ovarian cancer and thrombosis does exist. Low-molecular-weight heparins (LMWHs) are cornerstone drugs in the primary prevention and treatment of venous thromboembolic events in patients with cancer. However, cancer cells may alter the efficiency of these antithrombotic agents. OBJECTIVE We aimed to characterize the procoagulant phenotype of human epithelial ovarian adenocarcinoma cells, IGROV1, and to compare the capacity of tinzaparin and enoxaparin to inhibit thrombin generation triggered by these cells. METHODS Thrombin generation induced by different concentrations of IGROV1 cells on platelet poor plasma (PPP) was assessed by the calibrated automated thrombogram assay. Tissue factor (TF) expression was studied using Western blot analysis. Then, the experimental model of thrombin generation was used to compare the inhibitory effect of clinically relevant concentrations of both tinzaparin and enoxaparin. The inhibitory concentration 50 (IC50) of the mean rate index and the endogenous thrombin potential and the 2-fold increase in lag time were analyzed on the basis of the anti-Xa and anti-IIa activities of the LMWHs. RESULTS IGROV1 cells suspended into PPP resulted in a significant increase in thrombin generation in the absence of any exogenous source of TF and phospholipids. Tissue factor was expressed by IGROV1 cells. Tinzaparin was a more potent inhibitor of thrombin generation than enoxaparin. The inhibition of thrombin generation induced by IGROV1 cancer cells depended mainly on the anti-Xa activity of the LMWHs. CONCLUSION This experimental study in ovarian cancer cells demonstrates that the antithrombotic activity of LMWHs is not completely predicted by the anti-Xa or anti-IIa activities measured in PPP.
Collapse
Affiliation(s)
- Mouna Sassi
- 1 Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938, Sorbonne Universities, Université Pierre et Marie Curie (UPMC), Paris, France.,2 Laboratoire de Biologie, Centre de Maternité et de Néonatologie, Hôpital Fattouma Bourguiba, Monastir, Tunisia
| | - Taher Chakroun
- 1 Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938, Sorbonne Universities, Université Pierre et Marie Curie (UPMC), Paris, France.,3 Centre Régional de Transfusion Sanguine, Sousse, Tunisia
| | - Elisabeth Mbemba
- 1 Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938, Sorbonne Universities, Université Pierre et Marie Curie (UPMC), Paris, France
| | - Patrick Van Dreden
- 4 Clinical Research Department, Diagnostica Stago, Gennevilliers, France
| | - Ismail Elalamy
- 1 Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938, Sorbonne Universities, Université Pierre et Marie Curie (UPMC), Paris, France.,4 Clinical Research Department, Diagnostica Stago, Gennevilliers, France.,5 Service d'Hématologie Biologique, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Annette K Larsen
- 1 Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938, Sorbonne Universities, Université Pierre et Marie Curie (UPMC), Paris, France
| | - Grigoris T Gerotziafas
- 1 Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938, Sorbonne Universities, Université Pierre et Marie Curie (UPMC), Paris, France.,4 Clinical Research Department, Diagnostica Stago, Gennevilliers, France.,5 Service d'Hématologie Biologique, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France
| |
Collapse
|
28
|
Christensen DH, Horváth-Puhó E, Thomsen RW, Knudsen ST, Dekkers O, Prandoni P, Sørensen HT. Venous thromboembolism and risk of cancer in patients with diabetes mellitus. J Diabetes Complications 2016; 30:603-7. [PMID: 26874682 DOI: 10.1016/j.jdiacomp.2016.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/30/2015] [Accepted: 01/08/2016] [Indexed: 12/11/2022]
Abstract
AIM Venous thromboembolism (VTE) has long been regarded as a marker of underlying malignancy in the general population. Patients with diabetes mellitus are at increased risk of developing VTE, but it is unclear whether VTE in diabetes patients is also a harbinger of occult cancer. METHODS From Danish medical health databases, we identified all diabetes patients (N=8783) with a first-time diagnosis of VTE during 1978-2011. We followed the patients until a first-time diagnosis of cancer, emigration, death, or study end, whichever came first. We calculated one-year absolute cancer risk and overall and site-specific standardized incidence ratios (SIRs) for cancer based on national cancer incidence. RESULTS During the total study period 878 cancers were observed. The one-year absolute cancer risk was 4.1% and the corresponding SIR was 3.28 (95% confidence interval [CI]: 2.94-3.64). The highest SIRs were observed for cancers of the gallbladder and biliary tract (SIR 13.59; 6.77-24.31), the pancreas (SIR 10.16; 6.85-14.50), the ovary (SIR 9.85; 5.63-16.00), and the liver (SIR 9.39; 4.30-17.84). After the first year of follow-up, the overall cancer SIR associated with VTE and diabetes decreased to 1.05 (95% CI: 0.97-1.15). CONCLUSIONS VTE may be a marker of underlying cancer in patients with diabetes mellitus.
Collapse
Affiliation(s)
- Diana Hedevang Christensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Norrebrogade 44, 8000 Aarhus C, Denmark.
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Søren Tang Knudsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Norrebrogade 44, 8000 Aarhus C, Denmark
| | - Olaf Dekkers
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark; Department of Clinical Epidemiology and Metabolism, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Paolo Prandoni
- Department of Cardiothoracic and Vascular Science, Thromboembolism Unit, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| |
Collapse
|
29
|
Sun LM, Chung WS, Lin CL, Liang JA, Kao CH. Unprovoked venous thromboembolism and subsequent cancer risk: a population-based cohort study. J Thromb Haemost 2016; 14:495-503. [PMID: 26748492 DOI: 10.1111/jth.13251] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED ESSENTIALS: A relationship between unprovoked venous thromboembolism (VTE) and cancer risk was investigated. We collected 27,751 VTE patients and compared them with 110,409 frequency-matched people without VTE. This cohort study showed significantly higher risks of overall and site-specific cancers in the VTE group. There is an increased risk in the first 6 months after VTE, and VTE can be an indicator of occult cancer. SUMMARY BACKGROUND We investigated the relationship between unprovoked venous thromboembolism (VTE) and subsequent cancer risk in Taiwan, focusing on both short-term and long-term cancer development. METHODS For the case group, we obtained data on 27,751 patients diagnosed with unprovoked VTE between 1 January 1998, and 31 December 2008. For the comparison group, four people without unprovoked VTE were frequency-matched with each unprovoked VTE patient according to age, sex, and index year. Cox proportional hazards regression models were employed to determine the effects of unprovoked VTE on cancer risk. RESULTS Overall cancer risk was significantly higher in the unprovoked VTE group than in the comparison group (adjusted hazard ratio = 2.26, 95% confidence interval = 2.16-2.37). The increased risk was observed in both men and women in various age groups. The patients in the unprovoked VTE group showed a significantly increased risk of cancer at all site-specific cancer sites. Analyses stratified according to follow-up duration revealed that significant differences were more evident between the two groups over a follow-up duration of < 0.5 years than over a follow-up duration of ≥ 3 years. Furthermore, the 1-year mortality risk of cancer patients with unprovoked VTE was significantly higher than that for cancer patients in the non-VTE group. CONCLUSION The results of this study show that unprovoked VTE is associated with a consistently high risk of subsequent cancer diagnosis. This is particularly true in the first 6 months after VTE. It suggests that unprovoked VTE can be an indicator of occult malignancy.
Collapse
Affiliation(s)
- L-M Sun
- Department of Radiation Oncology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - W-S Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - C-L Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - J-A Liang
- Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - C-H Kao
- Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
30
|
Qian C, Yan H, Hu X, Zhang W, Liu H. Increased risk of venous thromboembolism in patients with brain tumors: A systematic review and meta-analysis. Thromb Res 2015; 137:58-63. [PMID: 26610747 DOI: 10.1016/j.thromres.2015.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/13/2015] [Accepted: 11/14/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Currently published studies investigating the association between brain tumors and venous thromboembolism (VTE) risk have yielded inconsistent findings. To provide a more precise estimate for this association, we firstly performed a meta-analysis by pooling all currently available data. METHODS Pooled relative risks (RRs) with 95% confidence intervals (95% CIs) were calculated by use of STATA 12.0 software. All eligible studies were identified by a comprehensive literature search in databases of PubMed, Embase, Web of Science, and Google scholar. RESULTS According to the inclusion criteria, 9 independent studies were finally included into this study. Individuals with brain tumors were at an increased risk of VTE (RR=1.66, 95% CI 1.31-2.12, P<0.001), particularly those undergoing surgery (RR=1.68, 95% CI 1.44-1.98, P<0.001). Stratified analysis by type of tumor showed that the risk of VTE was significantly associated with glioma (RR=1.68, 95% CI 1.44-1.98, P<0.001), high-grade glioma (RR=1.70, 95% CI 1.29-2.23, P<0.001), and glioblastoma multiforme (RR=1.74, 95% CI 1.43-2.12, P<0.001). CONCLUSIONS The present meta-analysis suggests increased risk of VTE in patients with brain tumors, particularly those undergoing surgery.
Collapse
Affiliation(s)
- Chunfa Qian
- Department of Neurosurgery, Nanjing Medical University, Affiliated Nanjing Brain Hospital, 264 Guangzhou Road, Nanjing 210029, China.
| | - Hua Yan
- Department of Neurosurgery, Nanjing Medical University, Affiliated Nanjing Brain Hospital, 264 Guangzhou Road, Nanjing 210029, China
| | - Xinhua Hu
- Department of Neurosurgery, Nanjing Medical University, Affiliated Nanjing Brain Hospital, 264 Guangzhou Road, Nanjing 210029, China
| | - Wenbin Zhang
- Department of Neurosurgery, Nanjing Medical University, Affiliated Nanjing Brain Hospital, 264 Guangzhou Road, Nanjing 210029, China
| | - Hongyi Liu
- Department of Neurosurgery, Nanjing Medical University, Affiliated Nanjing Brain Hospital, 264 Guangzhou Road, Nanjing 210029, China.
| |
Collapse
|
31
|
Kneihsl M, Enzinger C, Wünsch G, Khalil M, Culea V, Urbanic-Purkart T, Payer F, Niederkorn K, Fazekas F, Gattringer T. Poor short-term outcome in patients with ischaemic stroke and active cancer. J Neurol 2015; 263:150-6. [DOI: 10.1007/s00415-015-7954-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
|
32
|
Koizume S, Ito S, Yoshioka Y, Kanayama T, Nakamura Y, Yoshihara M, Yamada R, Ochiya T, Ruf W, Miyagi E, Hirahara F, Miyagi Y. High-level secretion of tissue factor-rich extracellular vesicles from ovarian cancer cells mediated by filamin-A and protease-activated receptors. Thromb Haemost 2015; 115:299-310. [PMID: 26446354 DOI: 10.1160/th15-03-0213] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 09/14/2015] [Indexed: 12/19/2022]
Abstract
Thromboembolic events occur frequently in ovarian cancer patients. Tissue factor (TF) is often overexpressed in tumours, including ovarian clear-cell carcinoma (CCC), a subtype with a generally poor prognosis. TF-coagulation factor VII (fVII) complexes on the cell surface activate downstream coagulation mechanisms. Moreover, cancer cells secrete extracellular vesicles (EVs), which act as vehicles for TF. We therefore examined the characteristics of EVs produced by ovarian cancer cells of various histological subtypes. CCC cells secreted high levels of TF within EVs, while the high-TF expressing breast cancer cell line MDA-MB-231 shed fewer TF-positive EVs. We also found that CCC tumours with hypoxic tissue areas synthesised TF and fVII in vivo, rendering the blood of xenograft mice bearing these tumours hypercoagulable compared with mice bearing MDA-MB-231 tumours. Incorporation of TF into EVs and secretion of EVs from CCC cells exposed to hypoxia were both dependent on the actin-binding protein, filamin-A (filA). Furthermore, production of these EVs was dependent on different protease-activated receptors (PARs) on the cell surface. These results show that CCC cells could produce large numbers of TF-positive EVs dependent upon filA and PARs. This phenomenon may be the mechanism underlying the increased incidence of venous thromboembolism in ovarian cancer patients.
Collapse
Affiliation(s)
- Shiro Koizume
- Shiro Koizume, 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan, Tel.: +81 45 391 5761, E-mail:
| | | | | | | | | | | | | | | | | | | | | | - Yohei Miyagi
- Yohei Miyagi, 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan, Tel.: +81 45 391 5761, E-mail:
| |
Collapse
|
33
|
Koizume S, Miyagi Y. Tissue Factor-Factor VII Complex As a Key Regulator of Ovarian Cancer Phenotypes. BIOMARKERS IN CANCER 2015; 7:1-13. [PMID: 26396550 PMCID: PMC4562604 DOI: 10.4137/bic.s29318] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/05/2015] [Accepted: 08/07/2015] [Indexed: 02/07/2023]
Abstract
Tissue factor (TF) is an integral membrane protein widely expressed in normal human cells. Blood coagulation factor VII (fVII) is a key enzyme in the extrinsic coagulation cascade that is predominantly secreted by hepatocytes and released into the bloodstream. The TF–fVII complex is aberrantly expressed on the surface of cancer cells, including ovarian cancer cells. This procoagulant complex can initiate intracellular signaling mechanisms, resulting in malignant phenotypes. Cancer tissues are chronically exposed to hypoxia. TF and fVII can be induced in response to hypoxia in ovarian cancer cells at the gene expression level, leading to the autonomous production of the TF–fVII complex. Here, we discuss the roles of the TF–fVII complex in the induction of malignant phenotypes in ovarian cancer cells. The hypoxic nature of ovarian cancer tissues and the roles of TF expression in endometriosis are discussed. Arguments will be extended to potential strategies to treat ovarian cancers based on our current knowledge of TF–fVII function.
Collapse
Affiliation(s)
- Shiro Koizume
- Molecular Pathology and Genetics Division, Kanagawa Cancer Center, Yokohama, Japan
| | - Yohei Miyagi
- Molecular Pathology and Genetics Division, Kanagawa Cancer Center, Yokohama, Japan
| |
Collapse
|
34
|
Maisonneuve P, Lowenfels AB. Risk factors for pancreatic cancer: a summary review of meta-analytical studies. Int J Epidemiol 2014; 44:186-98. [PMID: 25502106 DOI: 10.1093/ije/dyu240] [Citation(s) in RCA: 258] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aetiology of pancreatic cancer (PC) has been extensively studied and is the subject of numerous meta-analyses and pooled analyses. We have summarized results from these pooled and meta-analytical studies to estimate the fraction of PCs attributable to each of the identified risk factors. METHODS Using a comprehensive strategy, we retrieved 117 meta-analytical or pooled reports dealing with the association between specific risk factors and PC risk. We combined estimates of relative risk and estimates of exposure to calculate the fraction of PCs caused or prevented by a particular exposure. RESULTS Tobacco smoking ('strong' evidence) and Helicobacter pylori infection ('moderate' evidence) are the major risk factors associated with PC, with respective estimated population attributable fractions of 11-32% and 4-25%. The major protective factors are history of allergy ('strong' evidence) and increasing fruit or folate intake ('moderate' evidence), with respective population preventable fractions of 3-7% and 0-12%. CONCLUSIONS We summarized results of 117 meta-analytical or pooled data reports dealing with 37 aetiological exposures, to obtain robust information about the suspected causes of PC. By combining these estimates with their prevalences in the population, we calculated population attributable or population preventable fractions. About two-thirds of the major risk factors associated with PC are potentially modifiable, affording a unique opportunity for preventing one of our deadliest cancers.
Collapse
Affiliation(s)
- Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy and Departments of Surgery and of Family and Preventive Medicine, New York Medical College, Valhalla, NY, USA
| | - Albert B Lowenfels
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy and Departments of Surgery and of Family and Preventive Medicine, New York Medical College, Valhalla, NY, USA
| |
Collapse
|
35
|
Koizume S, Miyagi Y. Breast cancer phenotypes regulated by tissue factor-factor VII pathway: Possible therapeutic targets. World J Clin Oncol 2014; 5:908-920. [PMID: 25493229 PMCID: PMC4259953 DOI: 10.5306/wjco.v5.i5.908] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/31/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Breast cancer is a leading cause of cancer death in women, worldwide. Fortunately, breast cancer is relatively chemosensitive, with recent advances leading to the development of effective therapeutic strategies, significantly increasing disease cure rate. However, disease recurrence and treatment of cases lacking therapeutic molecular targets, such as epidermal growth factor receptor 2 and hormone receptors, referred to as triple-negative breast cancers, still pose major hurdles in the treatment of breast cancer. Thus, novel therapeutic approaches to treat aggressive breast cancers are essential. Blood coagulation factor VII (fVII) is produced in the liver and secreted into the blood stream. Tissue factor (TF), the cellular receptor for fVII, is an integral membrane protein that plays key roles in the extrinsic coagulation cascade. TF is overexpressed in breast cancer tissues. The TF-fVII complex may be formed in the absence of injury, because fVII potentially exists in the tissue fluid within cancer tissues. The active form of this complex (TF-fVIIa) may stimulate the expression of numerous malignant phenotypes in breast cancer cells. Thus, the TF-fVII pathway is a potentially attractive target for breast cancer treatment. To date, a number of studies investigating the mechanisms by which TF-fVII signaling contributes to breast cancer progression, have been conducted. In this review, we summarize the mechanisms controlling TF and fVII synthesis and regulation in breast cancer cells. Our current understanding of the TF-fVII pathway as a mediator of breast cancer progression will be also described. Finally, we will discuss how this knowledge can be applied to the design of future therapeutic strategies.
Collapse
|
36
|
Schmidt SAJ, Farkas DK, Pedersen L, Prandoni P, Sørensen HT. Venous thrombosis and risk of cancer in patients with arterial cardiovascular disease. Thromb Res 2014; 135:96-101. [PMID: 25467083 DOI: 10.1016/j.thromres.2014.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/03/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Patients with acute myocardial infarction or stroke are at high risk of venous thromboembolism, which is traditionally considered a complication rather than a marker of occult cancer. We examined the association between venous thromboembolism and cancer in patients with acute myocardial infarction or stroke. METHODS We used medical databases to conduct a population-based cohort study including all patients with a first-time venous thromboembolism from 1978 through 2011 who also had a diagnosis of acute myocardial infarction (n=2,878) or stroke (n=1,971) recorded on the same day or within the previous 90days. We followed patients until a first-time cancer diagnosis, emigration, death, or December 31, 2011, whichever came first. We computed 1-year absolute risks and standardised incidence ratios for cancer based on national incidence rates. RESULTS The 1-year absolute cancer risk was 2.7% in the acute myocardial infarction cohort and 3.7% in the stroke cohort. The corresponding standardised incidence ratios were 3.22 (95% confidence interval [CI]: 2.54-4.03) and 3.76 (95% CI: 2.95-4.74), respectively. For cancers diagnosed in the first year, the estimated number of venous thromboembolism patients needed to examine to detect one excess cancer was 25 in the acute myocardial infarction cohort and 19 in the stroke cohort. CONCLUSION Among acute myocardial infarction and stroke patients, venous thromboembolism can be a marker of occult cancer. We suggest that current guidelines for cancer screening in patients with unprovoked venous thromboembolism could be applied to this group of patients.
Collapse
Affiliation(s)
| | | | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Paolo Prandoni
- Department of Medicine, Vascular Medicine Unit, University Hospital of Padua, Padua, Italy
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
37
|
Galanaud JP, Arnoult AC, Sevestre MA, Genty C, Bonaldi M, Guyard A, Giordana P, Pichot O, Colonna M, Quéré I, Bosson JL. Impact of anatomical location of lower limb venous thrombus on the risk of subsequent cancer. Thromb Haemost 2014; 112:1129-36. [PMID: 25104514 DOI: 10.1160/th14-04-0351] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/20/2014] [Indexed: 01/01/2023]
Abstract
After a proximal deep-vein thrombosis (P-DVT), the risk of diagnosis of a previously unsuspected cancer is high. Isolated distal DVT (iD-DVT; i.e. infra-popliteal DVT without pulmonary embolism [PE]) and isolated superficial-vein thrombosis (iSVT; i.e. without concomitant DVT and PE) are at least as frequent as P-DVT but their association with subsequent cancer is uncertain. We exploited data from the OPTIMEV prospective, observational, multicentre study to i) compare the risk of subsequent cancer three years after a first objectively confirmed iSVT, iD-DVT and iP-DVT in patients without a prior history of cancer or of venous thromboembolism, ii) assess predictors of subsequent cancer in cases of iD-DVT. The overall cumulative rates of cancer among the 304 patients with iSVT, 536 patients with iD-DVT, and 327 patients with iP-DVT were similar (3.4% 95% confidence interval [1.8-6.2], 3.9% [2.5-5.9] and 3.9% [2.3-6.8], respectively), regardless of whether the index venous thromboembolic event was unprovoked or associated with a major transient risk factor. Neither anatomical (muscular vs deep-calf DVT) nor ultrasound scan characteristics (number of thrombosed veins, clot diameter under compression) seemed strongly associated with the risk of cancer in cases of iD-DVT. In patients managed in routine practice, all the different clinical expressions of lower limb venous thromboembolism are associated with a similar risk of subsequent cancer. From a clinical practice point of view, this suggests that cancer screening, without discussing the necessity, or not, of such screening, should not differ between a deep-proximal, deep-distal or superficial location of thrombosis.
Collapse
Affiliation(s)
- J-P Galanaud
- Jean-Philippe Galanaud, MD, PhD, Centre d'Investigations Cliniques et, Service de Médecine Interne et Maladies Vasculaires, Hôpital Saint Eloi, Centre Hospitalier Universitaire de Montpellier, 80, avenue Augustin Fliche, 34295 Montpellier Cedex 05, France, Tel.: +33 467 33 70 24, Fax: +33 467 33 70 23, E-mail:
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Chung WS, Lin CL, Hsu WH, Sung FC, Li RY, Kao CH. Idiopathic venous thromboembolism: a potential surrogate for occult cancer. QJM 2014; 107:529-36. [PMID: 24472734 DOI: 10.1093/qjmed/hcu023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Several studies have indicated an association between venous thromboembolism (VTE) and a subsequent diagnosis of cancer in Western countries. However, information is scant on subsequent cancer incidence after idiopathic VTE events in Asian people. Through a nationwide cohort study, we evaluated the cancer prevalence of VTE and new cancer incidence in patients after the first episode of idiopathic VTE. METHODS To conduct a nationwide population cohort study on VTE, we retrieved data from the Taiwan National Health Insurance Database from 1998 to 2008, including a 2-year follow-up period extending to the end of 2010. The occurrence of cancer in the cohort was also determined by accessing the Registry for Catastrophic Illness Patient Database. RESULTS A total of 45,242 patients had the newly diagnosed VTE from 1998 to 2008. The incidence of VTE increased with age. Among 28,243 idiopathic VTE patients, 1944 patients (6.89%) had a subsequent cancer diagnosis within 2 years of the first idiopathic VTE episode. The three most common newly diagnosed cancers after idiopathic VTE were lung cancer, liver cancer and colorectal cancer (18.3%, 12.3% and 10.9%, respectively). Male sex and advanced age are independent risk factors of having an underlying malignant disorder among patients diagnosed with idiopathic VTE. CONCLUSION Patients with symptomatic VTE without an identifiable risk factor have a 6.89% incidence of subsequent cancer diagnosis in Taiwan. An extensive screening for an occult cancer in an idiopathic VTE patient may be warranted.
Collapse
Affiliation(s)
- W-S Chung
- From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - C-L Lin
- From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - W-H Hsu
- From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - F-C Sung
- From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - R-Y Li
- From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - C-H Kao
- From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
39
|
Use of oral anticoagulants and risk of prostate cancer: a population-based case-control study in Montreal, Canada. Cancer Causes Control 2014; 25:1159-66. [PMID: 24946744 DOI: 10.1007/s10552-014-0417-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE A few recent epidemiological observations suggest that anticoagulant medications may protect against prostate cancer development. Most studies have been small or subjected to methodological issues, including potential confounding. We provide here new evidence on this association in the context of a population-based case-control study of prostate cancer conducted in Montreal, Canada. METHODS Cases were 1,588 men with incident prostate cancer, aged ≤75 years, diagnosed across French hospitals in the Montreal area between 2005 and 2009. Concurrently, 1,618 population controls from the same residential area and age distribution (±5 years) were randomly selected from the electoral list of French-speaking men. In-person interviews elicited information on socio-demographic, lifestyle and environmental factors, along with a detailed medical history. Unconditional logistic regression was used to assess the association between lifetime use of anticoagulants and prostate cancer risk. RESULTS 102 subjects (2.6 % of cases and 3.7 % of controls) reported a history of oral anticoagulant therapy. After controlling for age, ancestry, education, family history of prostate cancer, prostate cancer screening frequency, diabetes, body mass index and statin use, ever use of oral anticoagulants showed a weak inverse, non-statistically significant association with prostate cancer (odds ratio 0.76, 95% confidence interval 0.50-1.16). Similar results were observed in analyses considering duration of use or indication for use, restricted to subjects recently screened or stratified by cancer aggressiveness. CONCLUSIONS Our findings provide weak support for a protective effect of oral anticoagulant therapy against prostate cancer. Further confirmation is required, especially in light of potential bleeding complications associated with anticoagulants.
Collapse
|
40
|
Naoi H, Hashimoto H, Kajimoto E, Takeda M, Yoshida S, Miyatake T, Yokoi T, Isaka S, Nagamatsu M. Cerebral infarctions as manifestation of ovarian clear cell carcinoma: report of two cases and review of the literature. Int Cancer Conf J 2013. [DOI: 10.1007/s13691-013-0092-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
41
|
Singh L, Stevens EE. Leg Pain and Gynecologic Malignancy. Am J Hosp Palliat Care 2013; 30:594-600. [DOI: 10.1177/1049909112460422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Gynecologic malignancies affect more than 83 000 women in the United States, each year. Because the disease involves the pelvis, many patients have side effects distal to this area in their lower extremities. The differential diagnosis of leg pain can be divided into vascular, neurologic, and musculoskeletal causes. In this review article, we address numerous etiologies of leg pain, reviewing the prevalence of disease, physical examination findings, diagnostic as well as treatment modalities.
Collapse
Affiliation(s)
- Lilly Singh
- Department of Obstetrics & Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Erin E. Stevens
- Department of Obstetrics & Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| |
Collapse
|
42
|
Tormoen GW, Khader A, Gruber A, McCarty OJT. Physiological levels of blood coagulation factors IX and X control coagulation kinetics in an in vitro model of circulating tissue factor. Phys Biol 2013; 10:036003. [PMID: 23585459 DOI: 10.1088/1478-3975/10/3/036003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Thrombosis significantly contributes to cancer morbidity and mortality. The mechanism behind thrombosis in cancer may be circulating tissue factor (TF), as levels of circulating TF are associated with thrombosis. However, circulating TF antigen level alone has failed to predict thrombosis in patients with cancer. We hypothesize that coagulation factor levels regulate the kinetics of circulating TF-induced thrombosis. Coagulation kinetics were measured as a function of individual coagulation factor levels and TF particle concentration. Clotting times increased when pooled plasma was mixed at or above a ratio of 4:6 with PBS. Clotting times increased when pooled plasma was mixed at or above a ratio of 8:2 with factor VII-depleted plasma, 7:3 with factor IX- or factor X-depleted plasmas, or 2:8 with factor II-, V- or VIII-depleted plasmas. Addition of coagulation factors VII, X, IX, V and II to depleted plasmas shortened clotting and enzyme initiation times, and increased enzyme generation rates in a concentration-dependent manner. Only additions of factors IX and X from low-normal to high-normal levels shortened clotting times and increased enzyme generation rates. Our results demonstrate that coagulation kinetics for TF particles are controlled by factor IX and X levels within the normal physiological range. We hypothesize that individual patient factor IX and X levels may be prognostic for susceptibility to circulating TF-induced thrombosis.
Collapse
Affiliation(s)
- Garth W Tormoen
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, USA.
| | | | | | | |
Collapse
|
43
|
van Ryn J, Goss A, Hauel N, Wienen W, Priepke H, Nar H, Clemens A. The discovery of dabigatran etexilate. Front Pharmacol 2013; 4:12. [PMID: 23408233 PMCID: PMC3569592 DOI: 10.3389/fphar.2013.00012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 01/23/2013] [Indexed: 01/18/2023] Open
Abstract
Thromboembolic disease is a major cause of mortality and morbidity in the developed world and is caused by an excessive stimulation of coagulation. Thrombin is a key serine protease in the coagulation cascade and numerous efforts have been made to develop safe and effective orally active direct thrombin inhibitors (DTIs). Current anticoagulant therapy includes the use of indirect thrombin inhibitors (e.g., heparins, low-molecular-weight-heparins) and vitamin K antagonists such as warfarin. However there are several caveats in the clinical use of these agents including narrow therapeutic window, parenteral delivery, and food- and drug-drug interactions. Dabigatran is a synthetic, reversible DTI with high affinity and specificity for its target binding both free and clot-bound thrombin, and offers a favorable pharmacokinetic profile. Large randomized clinical trials have demonstrated that dabigatran provides comparable or superior thromboprophylaxis in multiple thromboembolic disease indications compared to standard of care. This minireview will highlight the discovery and development of dabigatran, the first in a class of new oral anticoagulant agents to be licensed worldwide for the prevention of thromboembolism in the setting of orthopedic surgery and stroke prevent in atrial fibrillation.
Collapse
Affiliation(s)
- Joanne van Ryn
- Department of CardioMetabolic Disease Research, Boehringer Ingelheim Pharma GmbH & Co. KGBiberach an der Riss, Baden-Württemberg, Germany
| | - Ashley Goss
- Department of CardioMetabolic Disease Research, Boehringer Ingelheim Pharmaceuticals Inc.Ridgefield, CT, USA
| | - Norbert Hauel
- Department of Medicinal Chemistry, Boehringer Ingelheim Pharma GmbH & Co. KGBiberach an der Riss, Baden-Württemberg, Germany
| | - Wolfgang Wienen
- Department of Respiratory Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KGBiberach an der Riss, Baden-Württemberg, Germany
| | - Henning Priepke
- Department of Medicinal Chemistry, Boehringer Ingelheim Pharma GmbH & Co. KGBiberach an der Riss, Baden-Württemberg, Germany
| | - Herbert Nar
- Department of Lead Identification and Optimization Support, Boehringer Ingelheim Pharma GmbH & Co. KGBiberach an der Riss, Baden-Württemberg, Germany
| | - Andreas Clemens
- Global Clinical Development and Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co. KGIngelheim, Baden-Württemberg, Germany
| |
Collapse
|
44
|
Addition of Bevacizumab to Standard Radiation Therapy and Daily Temozolomide Is Associated With Minimal Toxicity in Newly Diagnosed Glioblastoma Multiforme. Int J Radiat Oncol Biol Phys 2012; 82:58-66. [DOI: 10.1016/j.ijrobp.2010.08.058] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 08/02/2010] [Accepted: 08/12/2010] [Indexed: 11/21/2022]
|
45
|
Wang DS, Chen DL, Ren C, Wang ZQ, Qiu MZ, Luo HY, Zhang DS, Wang FH, Li YH, Xu RH. ABO blood group, hepatitis B viral infection and risk of pancreatic cancer. Int J Cancer 2011; 131:461-8. [PMID: 21858814 DOI: 10.1002/ijc.26376] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 08/10/2011] [Indexed: 12/14/2022]
Abstract
Little is known about the role of association between ABO blood type and risk of pancreatic cancer develops through effects on hepatitis B viral (HBV) infection. Our study aimed to determine whether joint ABO blood type and HBV infection could increase the risk for pancreatic cancer. A total of 645 patients with pancreatic adenocarcinoma and 711 age- and sex-matched individuals who had nonmalignant diseases treated at the Sun Yat-sen University Cancer Center in China were retrospectively analyzed. Blood samples were tested for ABO blood type and hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), hepatitis B e antigen (HBeAg), hepatitis B e antibody (anti-HBe) and hepatitis B core antibody (anti-HBc). Multivariable unconditional logistic regression analysis was used to estimate adjusted odds ratios [AORs] and 95% confidence interval [CI]. Multivariable analysis with adjustment for risk factors showed that A blood type, HBsAg-positive/anti-HBc-positive, anti-HBs-positive/anti-HBc-positive were significantly associated with pancreatic cancer. The estimated AORs (95% CI) were as follows: A blood type, 1.425 (1.071-1.894), HBsAg-positive/anti-HBc-positive, 1.610 (1.125-2.304), anti-HBs-positive/anti-HBc-positive, 1.526 (1.159-2.011). The effect of A blood type significantly modified the risk of pancreatic cancer among subjects with anti-HBc-positive (AORs = 1.882, 95% CI, 1.284-2.760). In our study, we reported an association between A blood type, infection with HBV and pancreatic cancer risk. Moreover, we found a synergism between A blood type and HBV infection in the development of pancreatic cancer.
Collapse
Affiliation(s)
- De-Shen Wang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Egan K, Crowley D, Smyth P, O'Toole S, Spillane C, Martin C, Gallagher M, Canney A, Norris L, Conlon N, McEvoy L, Ffrench B, Stordal B, Keegan H, Finn S, McEneaney V, Laios A, Ducrée J, Dunne E, Smith L, Berndt M, Sheils O, Kenny D, O'Leary J. Platelet adhesion and degranulation induce pro-survival and pro-angiogenic signalling in ovarian cancer cells. PLoS One 2011; 6:e26125. [PMID: 22022533 PMCID: PMC3192146 DOI: 10.1371/journal.pone.0026125] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 09/20/2011] [Indexed: 01/22/2023] Open
Abstract
Thrombosis is common in ovarian cancer. However, the interaction of platelets with ovarian cancer cells has not been critically examined. To address this, we investigated platelet interactions in a range of ovarian cancer cell lines with different metastatic potentials [HIO-80, 59M, SK-OV-3, A2780, A2780cis]. Platelets adhered to ovarian cancer cells with the most significant adhesion to the 59M cell line. Ovarian cancer cells induced platelet activation [P-selectin expression] in a dose dependent manner, with the most significant activation seen in response to the 59M cell line. The platelet antagonists [cangrelor, MRS2179, and apyrase] inhibited 59M cell induced activation suggesting a P2Y12 and P2Y1 receptor mediated mechanism of platelet activation dependent on the release of ADP by 59M cells. A2780 and 59M cells potentiated PAR-1, PAR-4, and TxA2 receptor mediated platelet activation, but had no effect on ADP, epinephrine, or collagen induced activation. Analysis of gene expression changes in ovarian cancer cells following treatment with washed platelets or platelet releasate showed a subtle but valid upregulation of anti-apoptotic, anti-autophagy pro-angiogenic, pro-cell cycle and metabolic genes. Thus, ovarian cancer cells with different metastatic potential adhere and activate platelets differentially while both platelets and platelet releasate mediate pro-survival and pro-angiogenic signals in ovarian cancer cells.
Collapse
Affiliation(s)
- Karl Egan
- Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Darragh Crowley
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | - Paul Smyth
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | - Sharon O'Toole
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
- Department of Obstetrics and Gynaecology, Trinity College Dublin, Dublin, Ireland
| | - Cathy Spillane
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | - Cara Martin
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | - Michael Gallagher
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | - Aoife Canney
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | - Lucy Norris
- Department of Obstetrics and Gynaecology, Trinity College Dublin, Dublin, Ireland
| | - Niamh Conlon
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | - Lynda McEvoy
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | - Brendan Ffrench
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | - Britta Stordal
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | - Helen Keegan
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | - Stephen Finn
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | | | - Alex Laios
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
- Department of Obstetrics and Gynaecology, Trinity College Dublin, Dublin, Ireland
| | - Jens Ducrée
- The Biomedical Diagnostics Institute, Dublin City University, Dublin, Ireland
| | - Eimear Dunne
- Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leila Smith
- Fluidigm Corporation [Europe], Amsterdam, Netherlands
| | - Michael Berndt
- Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
- The Biomedical Diagnostics Institute, Dublin City University, Dublin, Ireland
| | - Orla Sheils
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | - Dermot Kenny
- Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
- The Biomedical Diagnostics Institute, Dublin City University, Dublin, Ireland
| | - John O'Leary
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
- * E-mail:
| |
Collapse
|
47
|
Blann AD, Dunmore S. Arterial and venous thrombosis in cancer patients. Cardiol Res Pract 2011; 2011:394740. [PMID: 21403876 PMCID: PMC3051163 DOI: 10.4061/2011/394740] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 01/04/2011] [Indexed: 12/26/2022] Open
Abstract
The most frequent ultimate cause of death is myocardial arrest. In many cases this is due to myocardial hypoxia, generally arising from failure of the coronary macro- and microcirculation to deliver enough oxygenated red cells to the cardiomyocytes. The principle reason for this is occlusive thrombosis, either by isolated circulating thrombi, or by rupture of upstream plaque. However, an additionally serious pathology causing potentially fatal stress to the heart is extra-cardiac disease, such as pulmonary hypertension. A primary cause of the latter is pulmonary embolus, considered to be a venous thromboembolism. Whilst the thrombotic scenario has for decades been the dominating paradigm in cardiovascular disease, these issues have, until recently, been infrequently considered in cancer. However, there is now a developing view that cancer is also a thrombotic disease, and notably a disease predominantly of the venous circulation, manifesting as deep vein thrombosis and pulmonary embolism. Indeed, for many, a venous thromboembolism is one of the first symptoms of a developing cancer. Furthermore, many of the standard chemotherapies in cancer are prothrombotic. Accordingly, thromboprophylaxis in cancer with heparins or oral anticoagulation (such as Warfarin), especially in high risk groups (such as those who are immobile and on high dose chemotherapy), may be an important therapy. The objective of this communication is to summarise current views on the epidemiology and pathophysiology of arterial and venous thrombosis in cancer.
Collapse
Affiliation(s)
- Andrew D Blann
- University of Birmingham Centre for Cardiovascular Sciences, Department of Medicine, City Hospital, Birmingham B18 7QH, UK
| | | |
Collapse
|
48
|
Abstract
BACKGROUND There is an urgent need for biomarkers to detect pancreatic cancer in the early, potentially curable, stages. METHODS We have used SELDI profiling to analyze serum from 75 patients with pancreatic cancer and 61 patients with nonmalignant pancreaticobiliary diseases. RESULTS A peak in the SELDI spectra corresponding to a 53 residue fragment of the α-chain of fibrinogen is remarkably elevated in approximately 50% of the cancer patients. In addition, fibrinogen degradation products were measured using the DR-70 assay. The areas under the receiver operating characteristic curves for the SELDI-detected fibrinogen fragment, DR-70 and CA19-9 were 0.65, 0.75 and 0.86, respectively. Class prediction models using combinations of these markers did not increase the area under the receiver operating characteristic curve compared with CA19-9. The novel fibrinogen fragment was not elevated to the same extent in other malignancies but was elevated in some patients with benign pancreatic disease. CONCLUSION Both the SELDI-detected fragment of fibrinogen and DR-70 are significantly elevated in the serum of pancreatic cancer patients. However, they do not seem to improve pancreatic cancer detection over CA19-9 alone.
Collapse
|
49
|
Panova-Noeva M, Falanga A. Treatment of thromboembolism in cancer patients. Expert Opin Pharmacother 2010; 11:2049-58. [DOI: 10.1517/14656566.2010.494181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
50
|
Beyer-Westendorf J, Werth S, Halbritter K, Weiss N. Cancer in males and risk of venous thromboembolism. Thromb Res 2010; 125 Suppl 2:S155-9. [DOI: 10.1016/s0049-3848(10)70035-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|