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Charpidou A, Gerotziafas G, Popat S, Araujo A, Scherpereel A, Kopp HG, Bironzo P, Massard G, Jiménez D, Falanga A, Kollias A, Syrigos K. Lung Cancer Related Thrombosis (LCART): Focus on Immune Checkpoint Blockade. Cancers (Basel) 2024; 16:450. [PMID: 38275891 PMCID: PMC10814098 DOI: 10.3390/cancers16020450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/10/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Cancer-associated thrombosis (CAT) is a common complication in lung cancer patients. Lung cancer confers an increased risk of thrombosis compared to other solid malignancies across all stages of the disease. Newer treatment agents, including checkpoint immunotherapy and targeted agents, may further increase the risk of CAT. Different risk-assessment models, such as the Khorana Risk Score, and newer approaches that incorporate genetic risk factors have been used in lung cancer patients to evaluate the risk of thrombosis. The management of CAT is based on the results of large prospective trials, which show similar benefits to low-molecular-weight heparins (LMWHs) and direct oral anticoagulants (DOACs) in ambulatory patients. The anticoagulation agent and duration of therapy should be personalized according to lung cancer stage and histology, the presence of driver mutations and use of antineoplastic therapy, including recent curative lung surgery, chemotherapy or immunotherapy. Treatment options should be evaluated in the context of the COVID-19 pandemic, which has been shown to impact the thrombotic risk in cancer patients. This review focuses on the epidemiology, pathophysiology, risk factors, novel predictive scores and management of CAT in patients with active lung cancer, with a focus on immune checkpoint inhibitors.
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Affiliation(s)
- Andriani Charpidou
- Third Department of Internal Medicine and Laboratory, Athens Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, 157 72 Athens, Greece; (A.K.)
| | - Grigorios Gerotziafas
- Assistance Publique-Hôpitaux de Paris, Thrombosis Center, Service D’Hématologie Biologique Hôpital Tenon, Sorbonne Université, 75005 Paris, France
| | - Sanjay Popat
- Royal Marsden Hospital, Institute of Cancer Research, London SW3 6JJ, UK
| | - Antonio Araujo
- Department of Medical Oncology, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal;
| | - Arnaud Scherpereel
- Department of Pulmonary and Thoracic Oncology, University of Lille, University Hospital (CHU), 59000 Lille, France;
| | - Hans-Georg Kopp
- Departments of Molecular Oncology and Thoracic Oncology, Robert-Bosch-Hospital Stuttgart, 70376 Stuttgart, Germany
| | - Paolo Bironzo
- Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, 10124 Turin, Italy
| | - Gilbert Massard
- Department of Thoracic Surgery, Hôpitaux Robert Schuman, 2540 Luxembourg, Luxembourg
| | - David Jiménez
- Respiratory Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, 28034 Madrid, Spain;
| | - Anna Falanga
- Department of Transfusion Medicine and Hematology, Hospital Papa Giovanni XXIII, University of Milan Bicocca, 24129 Bergamo, Italy
| | - Anastasios Kollias
- Third Department of Internal Medicine and Laboratory, Athens Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, 157 72 Athens, Greece; (A.K.)
| | - Konstantinos Syrigos
- Third Department of Internal Medicine and Laboratory, Athens Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, 157 72 Athens, Greece; (A.K.)
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Anderson R, Rapoport BL, Steel HC, Theron AJ. Pro-Tumorigenic and Thrombotic Activities of Platelets in Lung Cancer. Int J Mol Sci 2023; 24:11927. [PMID: 37569299 PMCID: PMC10418868 DOI: 10.3390/ijms241511927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
Aside from their key protective roles in hemostasis and innate immunity, platelets are now recognized as having multifaceted, adverse roles in the pathogenesis, progression and outcome of many types of human malignancy. The most consistent and compelling evidence in this context has been derived from the notable association of elevated circulating platelet counts with the onset and prognosis of various human malignancies, particularly lung cancer, which represents the primary focus of the current review. Key topics include an overview of the association of lung cancer with the circulating platelet count, as well as the mechanisms of platelet-mediated, pro-tumorigenic immunosuppression, particularly the role of transforming growth factor beta 1. These issues are followed by a discussion regarding the pro-tumorigenic role of platelet-derived microparticles (PMPs), the most abundant type of microparticles (MPs) in human blood. In this context, the presence of increased levels of PMPs in the blood of lung cancer patients has been associated with tumor growth, invasion, angiogenesis and metastasis, which correlate with disease progression and decreased survival times. The final section of the review addresses, firstly, the role of cancer-related platelet activation and thrombosis in the pathogenesis of secondary cardiovascular disorders and the associated mortality, particularly in lung cancer, which is second only to disease progression; secondly, the review addresses the potential role of antiplatelet agents in the adjunctive therapy of cancer.
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Affiliation(s)
- Ronald Anderson
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
| | - Bernardo L. Rapoport
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
- The Medical Oncology Centre of Rosebank, Johannesburg 2196, South Africa
| | - Helen C. Steel
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
| | - Annette J. Theron
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
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He X, Wei SN, Qin WW, Geng N, Li B, Song S, Wang P. Evaluating the effect of immune checkpoint inhibitors on venous thromboembolism in non-small cell lung cancer patients. Expert Rev Hematol 2023; 16:1135-1142. [PMID: 37883026 DOI: 10.1080/17474086.2023.2276209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 10/18/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Currently, immune checkpoint inhibitors (ICIs) therapy is one of the main methods of treatment in non-small cell lung cancer (NSCLC). This study aimed to explore the risk factors of VTE and evaluate the effect of ICIs on VTE in patients with NSCLC. RESEARCH DESIGN AND METHODS We retrospectively studied patients with NSCLC who were divided into VTE group and without VTE (Non-VTE) group. We identified the risk factors of VTE in NSCLC patients and evaluated the effect of ICIs on VTE in NSCLC patients. RESULTS We found that clinical stage III-IV (P = 0.015) and Khorana score (KS) ≥ 2 (P = 0.047) were independent risk factors for the occurrence of VTE in NSCLC, and treatment with ICIs reduced the risk of VTE occurrence (P = 0.028). There were no differences of survival rates in the 12-month (P = 0.449), 24-month (P = 0.412), or 36-month (P = 0.315) between the VTE and non-VTE groups. History of anti-angiogenic therapy (P = 0.033) and chronic obstructive pulmonary disease (COPD) (P = 0.046) were independent risk factors for VTE in NSCLC patients who were treated with ICIs. CONCLUSION This study suggests that we should strengthen anticoagulant therapy when using ICIs for NSCLC patients with a history of anti-angiogenic therapy and COPD.
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Affiliation(s)
- Xin He
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Shan-Na Wei
- Department of Pulmonary and Critical Care Medicine, Hebei PetroChina Center Hospital, Langfang, P.R. China
| | - Wen-Wen Qin
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Nan Geng
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Bin Li
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Shan Song
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Ping Wang
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
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Nwagha T, Nweke M. Stratification of Risk Factors of Lung Cancer-Associated Venous Thromboembolism and Determining the Critical Point for Preemptive Intervention: A Systematic Review With Meta-analysis. Clin Med Insights Oncol 2023; 17:11795549231175221. [PMID: 37426681 PMCID: PMC10328178 DOI: 10.1177/11795549231175221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/20/2023] [Indexed: 07/11/2023] Open
Abstract
Background Several biomarkers or risk factors have been identified and several prediction models exist. The major limitations inherent in these models include cost-ineffectiveness and lack of systematic stratification of risk factors resulting in the inclusion of clinically insignificant biomarkers in the models. This review aimed to systematically stratify the risk factors of lung cancer-associated venous thromboembolism (VTE) and determine the critical point for preemptive intervention. Methods This systematic review was structured as per the Preferred Reporting Item for Systematic Reviews and Meta-analyses. We searched MEDLINE, PubMed, Cochrane Library, CINAHL, Academic Search Complete, and PsycINFO from the onset to June 2022. We included studies that reported the risk factors of lung cancer-associated VTE and corresponding risk estimates, irrespective of treatment status but studies were excluded if patients were on anti-VTE medications. We employed random effects models of meta-analysis and computed risk stability index and risk weight (Rw) to achieve the review objectives. The review protocol is registered with PROSPERO (CRD42022336476). Results The clinically significant risk factors of VTE in lung cancer patients were D-dimer (odds ratio [OR] = 5.510, 95% CI = 2.6-11.7; Rw = 5.0), albumin (OR = 2.2, 95% CI = 1.0-4.8; Rw = 1.79), leukocyte (OR = 2.48, 95% CI = 1.9-3.2; Rw = 1.77), histological type (OR = 1.69 , 95% CI = 1.2-2.4; Rw = 1.3), age (OR = 1.56; Rw = 0.99), and hemoglobin (OR = 1.85, 95% CI = 1.3-2.6; Rw = 0.92). Based on the distribution of Rw across risk factors, the critical point (upper third of the upper quartile class) was 4.5 and may mark the point at which preemptive intervention should be commenced. Conclusions Targeted screening for VTE in lung cancer patients could be patient-specific and should be based on a combination of the most significant risk factors required to meet the critical point, provided that such a combination is affordable as illustrated in the ALBAH model. Registration The review protocol is registered with PROSPERO (ID: CRD42022336476).
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Affiliation(s)
- Theresa Nwagha
- Department of Haematology and
Immunology, Faculty of Medicine, University of Nigeria Teaching Hospital
Ituku-Ozalla, Enugu, Nigeria
| | - Martins Nweke
- Department of Physiotherapy, Evangel
University, Akaeze, Nigeria
- Fledgelight Evidence Consult, Enugu,
Nigeria
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Venous Thromboembolism in Cancer Patients Undergoing Chemotherapy: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12122954. [PMID: 36552961 PMCID: PMC9777086 DOI: 10.3390/diagnostics12122954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/06/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Objective: Venous thromboembolism (VTE) is a life-threatening complication that may exacerbate cancer prognosis. Whilst some studies indicate an increased risk of VTE in cancer patients undergoing chemotherapy, the prevalence estimates on the pooled prevalence of VTE in cancer patients undergoing chemotherapy are not known. This study aims to calculate the pooled prevalence of VTE in chemotherapy-treated cancer patients. Methods: Studies on VTE occurrence in cancer patients undergoing chemotherapy were retrieved after database search. The terms used included “cancer”, “chemotherapy”, and “venous thromboembolism”. A random-effects meta-analysis was conducted to obtain a pooled estimate of VTE prevalence in cancer patients undergoing chemotherapy. Results: A total of 102 eligible studies involving 30,671 patients (1773 with VTE, 28,898 without) were included in the meta-analysis. The pooled estimate of VTE prevalence was found to be 6%, ranging from 6% to 7% (ES 6%; 95% CI 6−7%; z = 18.53; p < 0.001). Conclusions: The estimated pooled prevalence rate of VTEs was 6% in cancer patients undergoing CRT, which was higher than the overall crude prevalence rate (5.78%). Comprehensive cancer care should consider stratified VTE risk assessment based on cancer phenotype, given that certain phenotypes of cancer such as bladder, gastric and ovarian posing particularly high risks of VTE.
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Bayleyegn B, Adane T, Getawa S, Aynalem M, Kifle ZD. Coagulation parameters in lung cancer patients: A systematic review and meta-analysis. J Clin Lab Anal 2022; 36:e24550. [PMID: 35719003 PMCID: PMC9279983 DOI: 10.1002/jcla.24550] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/03/2022] [Accepted: 05/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background Hypercoagulability in lung cancer patients is associated with a high incidence of mortality and morbidity in the world. Therefore, this meta‐analysis aimed to explore the correlation of the basic coagulation abnormalities in lung cancer patients compared with the control. Method PubMed, Scopus, and other sources were employed to identify eligible studies. The outcome variable was expressed using mean ± standard deviation (SD). Heterogeneity among studies and publication bias were evaluated. The quality of included studies was also assessed based on Newcastle–Ottawa Scale checklist. Result Finally, through a total of eight studies, prolonged prothrombin time (PT; standard mean difference [SMD]: 1.29; 95% CI: 0.47–2.11), plasma D‐dimer value (SMD 3.10; 95% CI 2.08–4.12), fibrinogen (SMD 2.18; 95% CI:1.30–3.06), and platelet (PLT) count (SMD 1.00; 95% CI 0.84–1.16) were significantly higher in lung cancer patients when compared with the control group. The single‐arm meta‐analysis also showed that compared with control, lung cancer patients had high pooled PT 13.7 (95% CI:12.2–15.58) versus 11.79 (95% CI = 10.56–13.02), high D‐dimer 275.99 (95% CI:172.9–11735.9) versus 0.2 (95% CI:0.20–0.37), high plasma fibrinogen 5.50 (95% CI:4.21–6.79) versus 2.5 (95% CI:2.04–2.91), and high PLT count 342.3 (95% CI:236.1–448.5) versus 206.6 (95% CI:176.4–236.7). Conclusion In conclusion, almost all the coagulation abnormalities were closely associated with lung cancer, and hence coagulation indexes provide an urgent clue for early diagnosis and timely management.
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Affiliation(s)
- Biruk Bayleyegn
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tiruneh Adane
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melak Aynalem
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemen Demelash Kifle
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Li D, Sun CL, Allen R, Crook CJ, Levi A, Ballena R, Klepin HD, Elias R, Mohile SG, Tew WP, Owusu C, Muss HB, Lichtman SM, Gross CP, Chapman AE, Gajra A, Cohen HJ, Katheria V, Hurria A, Dale W. Risk Factors for Hospitalizations Among Older Adults with Gastrointestinal Cancers. Oncologist 2022; 27:e37-e44. [PMID: 35305099 PMCID: PMC8842372 DOI: 10.1093/oncolo/oyab016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background Older adults (≥65 years) with gastrointestinal (GI) cancers who receive chemotherapy are at increased risk of hospitalization caused by treatment-related toxicity. Geriatric assessment (GA) has been previously shown to predict risk of toxicity in older adults undergoing chemotherapy. However, studies incorporating the GA specifically in older adults with GI cancers have been limited. This study sought to identify GA-based risk factors for chemotherapy toxicity–related hospitalization among older adults with GI cancers. Patients and Methods We performed a secondary post hoc subgroup analysis of two prospective studies used to develop and validate a GA-based chemotherapy toxicity score. The incidence of unplanned hospitalizations during the course of chemotherapy treatment was determined. Results This analysis included 199 patients aged ≥65 years with a diagnosis of GI cancer (85 colorectal, 51 gastric/esophageal, and 63 pancreatic/hepatobiliary). Sixty-five (32.7%) patients had ≥1 hospitalization. Univariate analysis identified sex (female), cardiac comorbidity, stage IV disease, low serum albumin, cancer type (gastric/esophageal), hearing deficits, and polypharmacy as risk factors for hospitalization. Multivariable analyses found that patients who had cardiac comorbidity (OR 2.48, 95% CI 1.13-5.42) were significantly more likely to be hospitalized. Conclusion Cardiac comorbidity may be a risk factor for hospitalization in older adults with GI cancers receiving chemotherapy. Further studies with larger sample sizes are warranted to examine the relationship between GA measures and hospitalization in this vulnerable population.
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Affiliation(s)
- Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Can-Lan Sun
- Patient and Family Resource Center, City of Hope, Duarte, CA, USA
| | - Rebecca Allen
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Christiana J Crook
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Abrahm Levi
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Richard Ballena
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Heidi D Klepin
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Rawad Elias
- Department of Medical Oncology, Hartford Healthcare Cancer Institute, Hartford, CT, USA
| | - Supriya G Mohile
- Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - William P Tew
- Department of Gynecologic Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cynthia Owusu
- Department of Medicine, School of Medicine, Case Western University School of Medicine, Cleveland, OH, USA
| | - Hyman B Muss
- Geriatric Oncology Program, Division of Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stuart M Lichtman
- Department of Gynecologic Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cary P Gross
- Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - Andrew E Chapman
- Department of Medical Oncology, Sidney Kimmel Cancer Center/Jefferson Health, Philadelphia, PA, USA
| | - Ajeet Gajra
- Cardinal Health, Dublin, OH, USA
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | - Vani Katheria
- Center for Cancer and Aging, City of Hope, Duarte, CA, USA
| | - Arti Hurria
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | - William Dale
- Department of Supportive Care, City of Hope, Duarte, CA, USA
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Di W, Xu H, Xue T, Ling C. Advances in the Prediction and Risk Assessment of Lung Cancer-Associated Venous Thromboembolism. Cancer Manag Res 2021; 13:8317-8327. [PMID: 34764694 PMCID: PMC8575248 DOI: 10.2147/cmar.s328918] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/26/2021] [Indexed: 12/18/2022] Open
Abstract
According to the most recent data from the National Cancer Center, venous thromboembolism (VTE) has unsurprisingly become one of the most common complications in lung cancer. VTE not only interferes with the equilibrium of the clotting system but it also affects tumor progression and prognosis. For the identification of high-risk patients, many clinical risk assessment models have been developed and validated based on the risk factors found in previous studies. In this review, we will summarize advances in prediction and risk assessment of VTE, with a focus on early diagnosis and therapy, reduction of mortality, and the burden of medical costs in lung cancer patients.
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Affiliation(s)
- Wenjuan Di
- Department of Respiratory and Critical Care Medicine, The First Hospital Affiliated of Soochow University, Suzhou City, Jiangsu Province, People's Republic of China
| | - Haotian Xu
- Department of Respiratory and Critical Care Medicine, The First Hospital Affiliated of Soochow University, Suzhou City, Jiangsu Province, People's Republic of China
| | - Ting Xue
- Department of Respiratory and Critical Care Medicine, The First Hospital Affiliated of Soochow University, Suzhou City, Jiangsu Province, People's Republic of China
| | - Chunhua Ling
- Department of Respiratory and Critical Care Medicine, The First Hospital Affiliated of Soochow University, Suzhou City, Jiangsu Province, People's Republic of China
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Soeroso NN, Rizki Ananda F, Samosir G, Hariman H, Chairani Eyanoer P. The correlation between hemostatic parameters and mortality rate in patients with non-small cell lung cancer. Hematol Rep 2021; 13:8361. [PMID: 34650781 PMCID: PMC8447541 DOI: 10.4081/hr.2021.8361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 07/10/2020] [Indexed: 11/22/2022] Open
Abstract
The increasing level of hemostatic parameters and tumor markers were associated with cancer progression and poor prognosis, particularly in NSCLC. The objective of this study is to determine whether there was a correlation between hemostatic parameters and mortality rate in patients with NSCLC. This was a prospective analytical study with a pretest-posttest design which included 41 patients with diagnosis of NSCLC. Plasma levels of PT, APTT, TT, D-dimer, and fibrinogen were measured before initiation of chemotherapy and remeasured after 4 cycles or 6 cycles of chemotherapy, based on the clinical condition of patients. Then, patients were followed up for 1 year to evaluate the mortality rate. The majority of subjects were male (85.4%) with adenocarcinoma (75.6%). There was no significant difference in mean between adenocarcinoma and squamous cell carcinoma (P>0.05). Most patients died after one month of follow up (61%). The parameters which could predict high mortality rate in NSCLC were prolonged PT and the increased of D-dimer with RR>1, although they had not significant in statistical analysis (P>0.05). There is no correlation between hemostatic parameters and mortality rate in patients with NSCLC.
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Affiliation(s)
- Noni Novisari Soeroso
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Sumatera Utara, Universitas Sumatera Utara Hospital
| | - Fannie Rizki Ananda
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Sumatera Utara, Universitas Sumatera Utara Hospital
| | - Ganda Samosir
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Sumatera Utara, Universitas Sumatera Utara Hospital
| | - Herman Hariman
- Department of Clinical Pathology, Faculty of Medicine Universitas Sumatera Utara, Adam Malik General Hospital
| | - Putri Chairani Eyanoer
- Department of Community Medicine, Faculty of Medicine Universitas Sumatera Utara, Indonesia
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Yan AR, Samarawickrema I, Naunton M, Peterson GM, Yip D, De Rosa S, Mortazavi R. Risk Factors and Prediction Models for Venous Thromboembolism in Ambulatory Patients with Lung Cancer. Healthcare (Basel) 2021; 9:778. [PMID: 34205695 PMCID: PMC8233898 DOI: 10.3390/healthcare9060778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 12/21/2022] Open
Abstract
Venous thromboembolism (VTE) is a significant cause of mortality in patients with lung cancer. Despite the availability of a wide range of anticoagulants to help prevent thrombosis, thromboprophylaxis in ambulatory patients is a challenge due to its associated risk of haemorrhage. As a result, anticoagulation is only recommended in patients with a relatively high risk of VTE. Efforts have been made to develop predictive models for VTE risk assessment in cancer patients, but the availability of a reliable predictive model for ambulate patients with lung cancer is unclear. We have analysed the latest information on this topic, with a focus on the lung cancer-related risk factors for VTE, and risk prediction models developed and validated in this group of patients. The existing risk models, such as the Khorana score, the PROTECHT score and the CONKO score, have shown poor performance in external validations, failing to identify many high-risk individuals. Some of the newly developed and updated models may be promising, but their further validation is needed.
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Affiliation(s)
- Ann-Rong Yan
- School of Health Sciences, Faculty of Health, University of Canberra, Canberra 2617, Australia; (A.-R.Y.); (M.N.); (G.M.P.); (D.Y.)
| | - Indira Samarawickrema
- School of Nursing, Midwifery and Public Health, Faculty of Health, University of Canberra, Canberra 2617, Australia;
| | - Mark Naunton
- School of Health Sciences, Faculty of Health, University of Canberra, Canberra 2617, Australia; (A.-R.Y.); (M.N.); (G.M.P.); (D.Y.)
| | - Gregory M. Peterson
- School of Health Sciences, Faculty of Health, University of Canberra, Canberra 2617, Australia; (A.-R.Y.); (M.N.); (G.M.P.); (D.Y.)
- College of Health and Medicine, University of Tasmania, Hobart 7005, Australia
| | - Desmond Yip
- School of Health Sciences, Faculty of Health, University of Canberra, Canberra 2617, Australia; (A.-R.Y.); (M.N.); (G.M.P.); (D.Y.)
- Department of Medical Oncology, The Canberra Hospital, Garran 2605, Australia
- ANU Medical School, Australian National University, Canberra 0200, Australia
| | - Salvatore De Rosa
- Department of Medical and Surgical Science, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Reza Mortazavi
- School of Health Sciences, Faculty of Health, University of Canberra, Canberra 2617, Australia; (A.-R.Y.); (M.N.); (G.M.P.); (D.Y.)
- Prehab Activity Cancer Exercise Survivorship Research Group, Faculty of Health, University of Canberra, Canberra 2617, Australia
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Feng Y, Fu Y, Xiang Q, Xie L, Yu C, Li J. Plasminogen activator inhibitor-1 gene promoter 4G/5G polymorphism and risks of peripherally inserted central catheter-related venous thrombosis in patients with lung cancer: a prospective cohort study. Support Care Cancer 2021; 29:6431-6439. [PMID: 33893843 DOI: 10.1007/s00520-021-06207-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 04/07/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE This study investigated the influence of plasminogen activator inhibitor-1 (PAI-1) gene polymorphisms and other contributing clinical factors on peripherally inserted central catheter-related venous thrombosis (PICC-RVT) in Chinese patients with lung cancer. METHODS We conducted a prospective study of 237 participants. Blood samples were collected to detect the PAI-1 4G/5G genotype. Venous thromboembolism risk was calculated by the Caprini risk assessment model. Color Doppler ultrasonography was performed every 7 days for 3 weeks to confirm PICC-RVT. RESULTS The rate of PICC-RVT was 13.50% (32/237). The 5G/5G, 4G/5G, and 4G/4G genotypes were found in 12.50% vs 17.56%, 59.38% vs 49.27%, and 28.12% vs 34.17% in the thrombus group and the non-thrombus group of the participants. No difference was observed in the distribution frequency of the three genotypes between the thrombus and non-thrombus groups. A higher fibrinogen level (OR 1.194, 95% CI 1.004-1.420, P = 0.045) and a higher Caprini score (OR 1.698, 95% CI 1.103-2.614, P = 0.016) were statistically significant risk factors for PICC-RVT. Compared with patients who underwent a pemetrexed/cisplatin regimen, those who were administered paclitaxel/cisplatin (OR 18.332, 95% CI 2.890-116.278, P = 0.002) or gemcitabine/cisplatin (OR 6.617, 95% CI 1.210-36.180, P = 0.029) were at increased risk of PICC-RVT. CONCLUSION Our finding suggested that there is no statistically significant influence of the PAI-1 4G/5G gene variant on PICC-RVT in Chinese patients with lung cancer. However, patients with higher Caprini scores and higher fibrinogen levels are at increased risk for PICC-RVT, as are patients receiving chemotherapy. Clinical staff should carefully perform a risk assessment for patients with PICC. Those with the above risk factors should pay close attention and take timely and effective preventive measures.
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Affiliation(s)
- Yue Feng
- West China School of Nursing/Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yan Fu
- Department of Thoracic Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Qiufen Xiang
- Department of Thoracic Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Lingling Xie
- Department of Thoracic Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Chunhua Yu
- Department of Thoracic Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China.
| | - Junying Li
- Department of Thoracic Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China.
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12
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Liu Y, Wang W, Wu F, Gao G, Xu J, Li X, Zhao C, Yang S, Mao S, Pan Y, Jia K, Shao C, Chen B, Ren S, Zhou C. High discrepancy in thrombotic events in non-small cell lung cancer patients with different genomic alterations. Transl Lung Cancer Res 2021; 10:1512-1524. [PMID: 33889526 PMCID: PMC8044490 DOI: 10.21037/tlcr-20-1290] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Acute complications, such as venous thromboembolism (VTE), are common in patients with advanced severe lung cancers. However, current VTE risk scores cannot adequately identify high-risk patients with non-small cell lung cancer (NSCLC). The study proposed to elucidated the incidence of thromboembolism (TE) in patients with different oncogenic aberrations and the impact of these aberrations on the efficacy of targeted therapy in patients with NSCLC. Methods A systemic review was conducted in Web of Science, PubMed, Embase and the Cochrane Library to evaluate the incidence of TE in different molecular subtypes of NSCLC. Data from patients diagnosed of advanced NSCLC who harboring anaplastic lymphoma kinase (ALK) or ROS proto-oncogene 1 receptor tyrosine kinase (ROS1) rearrangements since 2016 to 2019 were also retrospectively collected. A meta-analysis with random-effects model, sensitivity analysis and publication bias were performed. The principal summary measure was incidence of thrombotic events in NSCLC patients. And the efficacy of tyrosine kinase inhibitor (TKI) therapy was compared between the two subgroups. Results A total of 5,767 cases from 20 studies were included in the analysis of the incidence of thrombosis in patients with different oncogenic alterations. The pooled analysis showed a higher risk of thrombosis in ROS1-fusion types (41%, 95% CI: 35-47%) and ALK-fusion types (30%, 95% CI: 24-37%) than in EGFR-mutation (12%, 95% CI: 8-17%), KRAS-mutation (25%, 95% CI: 13-50%), and wild-type (14%, 95% CI: 10-20%) cases. A high prevalence of thrombosis (ALK: 24.4%; ROS1: 32.6%) was observed in the Shanghai Pulmonary Hospital (SPH) cohort of 224 patients with ALK or ROS1 fusion. Furthermore, patients with embolism had significantly shorter progression-free survival (PFS) after TKI therapy than those without embolism, both in the ALK+ cohort (5.6 vs. 12.9 months, P<0.0001) and in the ROS1+ cohort (9.6 vs. 17.6 months, P=0.0481). Conclusions NSCLC patients with ALK/ROS1 rearrangements are more likely to develop thrombosis than patients with other oncogenic alterations. Thrombosis may also be associated with an inferior response and PFS after TKI therapy.
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Affiliation(s)
- Yiwei Liu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wanying Wang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fengying Wu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Guanghui Gao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jian Xu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xuefei Li
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chao Zhao
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shuo Yang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shiqi Mao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yingying Pan
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Keyi Jia
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chuchu Shao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bin Chen
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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13
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Zhang M, Wu S, Hu C. Do lung cancer patients require routine anticoagulation treatment? A meta-analysis. J Int Med Res 2020; 48:300060519896919. [PMID: 31948304 PMCID: PMC7113707 DOI: 10.1177/0300060519896919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective We conducted this meta-analysis to investigate the utility of anticoagulant treatment in lung cancer patients. Method We retrieved studies focused on thrombosis and lung cancer by searching electronic databases. We evaluated the impact of thrombosis on the prognosis of lung cancer patients, assessed the efficacy and effect of anticoagulation treatment in lung cancer patients, and investigated risk factors for thrombosis in lung cancer patients. Result Lung cancer patients with thrombosis have a significantly worse overall survival. Anticoagulant treatment did not improve the prognosis of lung cancer patients. Although anticoagulant treatment was associated with a reduced incidence of venous thromboembolism and pulmonary embolism, there was an increased risk of hemorrhage in this population. The risk factors for thrombosis in lung cancer patients are adenocarcinoma, advanced tumor stage, and high serum levels of d-dimer. Conclusion Anticoagulation treatment in lung cancer patients should be more individualized. Routine anticoagulant treatment is not recommended.
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Affiliation(s)
- Mengying Zhang
- Department of Respiratory Medicine, National Key Clinical Specialty, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuxie Wu
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chengping Hu
- Department of Respiratory Medicine, National Key Clinical Specialty, Xiangya Hospital, Central South University, Changsha, Hunan, China
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14
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Meikle CK, Meisler AJ, Bird CM, Jeffries JA, Azeem N, Garg P, Crawford EL, Kelly CA, Gao TZ, Wuescher LM, Willey JC, Worth RG. Platelet-T cell aggregates in lung cancer patients: Implications for thrombosis. PLoS One 2020; 15:e0236966. [PMID: 32776968 PMCID: PMC7416940 DOI: 10.1371/journal.pone.0236966] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023] Open
Abstract
Platelet-leukocyte aggregates (PLAs) are associated with increased thrombosis risk. The influence of PLA formation is especially important for cancer patients, since thrombosis accounts for approximately 10% of cancer-associated deaths. Our objective was to characterize and quantify PLAs in whole blood samples from lung cancer patients compared to healthy volunteers with the intent to analyze PLA formation in the context of lung cancer-associated thrombosis. Consenting lung cancer patients (57) and healthy volunteers (56) were enrolled at the Dana Cancer Center at the University of Toledo Health Science Campus. Peripheral blood samples were analyzed by flow cytometry. Patient medical history was reviewed through electronic medical records. Most importantly, we found lung cancer patients to have higher percentages of platelet-T cell aggregates (PTCAs) than healthy volunteers among both CD4+ T lymphocyte and CD8+ T lymphocyte populations. Our findings demonstrate that characterization of PTCAs may have clinical utility in differentiating lung cancer patients from healthy volunteers and stratifying lung cancer patients by history of thrombosis.
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Affiliation(s)
- Claire K. Meikle
- Department of Medical Microbiology & Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Adam J. Meisler
- Department of Medical Microbiology & Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Cara M. Bird
- Department of Medical Microbiology & Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Joseph A. Jeffries
- Department of Medical Microbiology & Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Nabila Azeem
- Department of Medical Microbiology & Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Priyanka Garg
- Department of Medical Microbiology & Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Erin L. Crawford
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Clare A. Kelly
- Department of Medical Microbiology & Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Tess Z. Gao
- Department of Medical Microbiology & Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Leah M. Wuescher
- Department of Medical Microbiology & Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - James C. Willey
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Randall G. Worth
- Department of Medical Microbiology & Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
- * E-mail:
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15
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Wang P, Zhao H, Zhao Q, Ren F, Shi R, Liu X, Liu J, Liu H, Chen G, Chen J. Risk Factors and Clinical Significance of D-Dimer in the Development of Postoperative Venous Thrombosis in Patients with Lung Tumor. Cancer Manag Res 2020; 12:5169-5179. [PMID: 32636679 PMCID: PMC7335272 DOI: 10.2147/cmar.s256484] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The incidence of venous thromboembolism (VTE) is higher in patients with lung cancer. The aim of this study was to investigate the risk factors associated with postoperative VTE and explore the VTE predication capacity of D-dimer kinetics. PATIENTS AND METHODS Six hundred patients who had lung tumor surgery were analyzed retrospectively between January 2018 and August 2019, and venous ultrasound imaging and D-dimer examination before and after surgery were recommended to all operative patients. Of these 600 patients, 523 patients had venous thromboembolism after surgery, and 77 patients had not found. The general clinical data, postoperative prophylactic anticoagulant therapy, early systemic thromboprophylaxis, 50% increment of D-dimer, 100% increment of D-dimer, and perioperative (preoperative and days 1, 3, and 5 after surgery) D-dimer levels were collected. Logistic regression analysis was used to analyze the independent risk factors of postoperative VTE. RESULTS VTE developed in 77 (12.8%) patients. In a univariate analysis, age, surgical approach, tumor size, histology, postoperative preventive anticoagulation, postoperative limb compression therapy, postoperative hemostasis, duration of operation, early systemic thromboprophylaxis, 100% increment of D-dimer, preoperative and postoperative D-dimer level, intraoperative blood loss, and time spent in the hospital were significantly different between the thrombus group and nonthrombus group (P < 0.05). Multivariate analysis showed that age >60 years (P = 0.006) and D-dimer level on 5 days after surgery (P = 0.000) were significant independent risk factors for VTE. Postoperative D-dimer was significantly higher than the preoperative level (P < 0.001). Postoperative D-dimer level was significantly different between benign and malignant tumor groups (P < 0.05) and between the thrombus group and nonthrombus group (P < 0.001). Preventive anticoagulation and limb compression therapy starting from the first day after surgery was statistically significant between the thrombus group and the nonthrombus group (P < 0.05). CONCLUSION Continuous detection of D-dimer level after pulmonary tumor surgery combined with thrombotic-related risk factors can better evaluate the occurrence of VTE. Preventive anticoagulant therapy and limb compression therapy starting from the first day after surgery can effectively reduce the incidence of VTE.
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Affiliation(s)
- Pan Wang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Honglin Zhao
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Qingchun Zhao
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Fan Ren
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Ruifeng Shi
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Xingyu Liu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Jinghao Liu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Hongyu Liu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Gang Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
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16
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Howlett J, Benzenine E, Cottenet J, Foucher P, Fagnoni P, Quantin C. Could venous thromboembolism and major bleeding be indicators of lung cancer mortality? A nationwide database study. BMC Cancer 2020; 20:461. [PMID: 32448219 PMCID: PMC7245783 DOI: 10.1186/s12885-020-06930-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/05/2020] [Indexed: 02/06/2023] Open
Abstract
Background Venous thromboembolism (VTE) is highly prevalent in cancer patients and can cause severe morbidity. VTE treatment is essential, but anticoagulation increases the risk of major bleeding. The purpose was to evaluate the impact of VTE and major bleeding on survival and to identify significant risk factors for these events in lung cancer patients. Methods Data were extracted from a permanent sample of the French national health information system (including hospital and out-of-hospital care) from 2009 to 2016. All episodes of VTE and major bleeding events within one year after cancer diagnosis were identified. A Cox model was used to analyse the effect of VTE and major bleeding on the patients’ one-year survival. VTE and major bleeding risk factors were analysed with a Fine and Gray survival model. Results Among the 2553 included patients with lung cancer, 208 (8%) had a VTE episode in the year following diagnosis and 341 (13%) had major bleeding. Almost half of the patients died during follow-up. Fifty-six (60%) of the patients presenting with pulmonary embolism (PE) died, 48 (42%) of the patients presenting with deep vein thrombosis (DVT) alone died and 186 (55%) of those presenting with a major bleeding event died. The risk of death was significantly increased following PE and major bleeding events. VTE concomitant with cancer diagnosis was associated with an increased risk of VTE recurrence beyond 6 months after the first VTE event (sHR = 4.07 95% CI: 1.57–10.52). Most major bleeding events did not appear to be related to treatment. Conclusion VTE is frequent after a diagnosis of lung cancer, but so are major bleeding events. Both PE and major bleeding are associated with an increased risk of death and could be indicators of lung cancer mortality.
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Affiliation(s)
- Jennifer Howlett
- CHRU Dijon, Pharmacy, F-21000, Dijon, France.,Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Eric Benzenine
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.,INSERM, CIC 1432, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon University Hospital, Dijon, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.,INSERM, CIC 1432, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon University Hospital, Dijon, France
| | | | - Philippe Fagnoni
- CHRU Dijon, Pharmacy, F-21000, Dijon, France.,Unité INSERM U866, Dijon University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France. .,INSERM, CIC 1432, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon University Hospital, Dijon, France. .,Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France.
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17
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Fu Y, Liu Y, Jin Y, Jiang H. [Value of Coagulation and Fibrinolysis Biomarker in Lung Cancer Patients with Thromboembolism]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:583-587. [PMID: 30172264 PMCID: PMC6105356 DOI: 10.3779/j.issn.1009-3419.2018.08.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
背景与目的 凝血与纤溶标志物能有效反映肺癌术后静脉置管患者体内止凝血各系统的功能紊乱,其水平变化与患者高凝状态密切相关。本研究旨在分析凝血与纤溶标志物在肺癌术后静脉置管患者中的变化趋势,评价其在肺癌血栓性疾病中的诊断效能,探讨其在肺癌深静脉置管患者凝血与纤溶平衡改变中的临床意义。 方法 收集肺癌术后静脉置管患者118例,其中肺癌血栓栓塞患者29例、对照组89例。分别检测血浆中血栓调节蛋白(thrombomodulin, TM)、凝血酶-抗凝血酶Ⅲ复合物(thrombin-antithrombin complex, TAT)、纤溶酶-α2纤溶酶抑制剂复合物(α2-plasmin inhibitor-plasmin complexes, PIC)、组织型纤溶酶原激活剂-抑制剂1复合物(tissue plasminogen activator-inhibitor complexes, t-PAIC)和凝血酶原时间(prothrombin time, PT)、活化部分凝血活酶时间(activatedpartial thrombo plastin time, APTT)、凝血酶时间(thrombin time, TT)、纤维蛋白原(fibrinogen, FIB)、抗凝血酶Ⅲ(antithrombin Ⅲ, ATIII)、纤维蛋白原降解产物(fibrinogen degradation products, FDP)以及D二聚体(D-Dimer, D-D)的水平,分析其变化及血栓发生的诊断效能。 结果 在肺癌术后静脉置管患者中,凝血与纤溶标志物TM、TAT、PIC、t-PAIC、D-D、FDP水平在血栓组高于非血栓组,差异均有统计学意义(P < 0.05)。诊断效能分析显示,TM、TAT、PIC、t-PAIC、D-D及FDP的曲线下面积分别为0.770、0.771、0.669、0.671、0.819和0.816,差异具有统计学意义(P < 0.05)。 结论 肺癌术后置管患者体内凝血和纤溶活性增强,早期监测凝血和纤溶标志物可预防血栓的发生,减少肺癌患者术后血栓并发症的发生。
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Affiliation(s)
- Yang Fu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yumei Liu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yaxiong Jin
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hong Jiang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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18
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Li Y, Shang Y, Wang W, Ning S, Chen H. Lung Cancer and Pulmonary Embolism: What Is the Relationship? A Review. J Cancer 2018; 9:3046-3057. [PMID: 30210627 PMCID: PMC6134828 DOI: 10.7150/jca.26008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/08/2018] [Indexed: 11/11/2022] Open
Abstract
Pulmonary embolism (PE) is gradually considered to be the third most common disease in the vascular disease category. Lung cancer is the most frequently diagnosed cancer and the leading cause of cancer death among males worldwide. Although initially appearing as distinct entities, lung cancer is a great risk factor for the development of PE. Pulmonary embolism is common in lung cancer patients, with a pooled incidence of 3.7%, and unsuspected pulmonary embolism (UPE) is also non-negligible with a rough rate ranging from 29.4% to 63%. Many risk factors of PE have been detected and could be classified into three categories: lung cancer-related, patient-related, and treatment-related factors. Decreased mean survival time could be significantly observed in lung cancer patients with PE or UPE compared to those only, but suspected PE has higher mortality than UPE. Prophylactic anticoagulant therapy benefit might be highest in patients with stage IV non-small cell lung cancer (NSCLC) or limited small cell lung cancer (SCLC), and heparin seems superior to warfarin for thrombotic prophylaxis. Periodically reassessing the risk-benefit ratio of anticoagulant treatment will be an efficient treatment strategy in lung cancer patients with PE.
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Affiliation(s)
- Yupeng Li
- Department of Respiration, Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China.,Drs Yupeng Li and Yu Shang contribute equally to this article
| | - Yu Shang
- Department of Respiration, First Hospital of Harbin, Harbin 150081, China.,Drs Yupeng Li and Yu Shang contribute equally to this article
| | - Wenwen Wang
- Department of Respiration, Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Shangwei Ning
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Hong Chen
- Department of Respiration, Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
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19
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Young K, Paz-Ares L, Thatcher N, Spigel DR, Shahidi J, Soldatenkova V, Grau G, Kurek R, Shepherd FA. Venous thromboembolism with EGFR monoclonal antibody necitumumab in stage IV non-small cell lung cancer: A retrospective cohort analysis. Thromb Res 2018; 167:50-56. [PMID: 29787943 DOI: 10.1016/j.thromres.2018.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 04/30/2018] [Accepted: 05/04/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Metastatic non-small cell lung cancer (NSCLC) is a recognized risk factor for VTE. Some systemic treatments may increase this risk further. Here, we present the risk of VTE and its prognostic significance for patients treated with chemotherapy (chemo) and the EGFR monoclonal antibody necitumumab (neci) for metastatic NSCLC. METHODS Four trials of 1st-line treatment for Stage IV NSCLC were analyzed: two randomized phase 3 studies of cisplatin/gemcitabine ±neci in squamous NSCLC (SQUIRE: N = 1079) and cisplatin/pemetrexed ±neci in non-squamous NSCLC (INSPIRE: N = 616); JFCL (N = 161), a randomized phase 2 trial of carboplatin/paclitaxel ±neci in squamous NSCLC; and JFCK (N = 61), a single arm phase 2 trial of cisplatin/gemcitabine +neci in squamous NSCLC. A Cox proportional hazards model with VTE as a time-dependent covariate was used for overall survival (OS) analyses. RESULTS Neci + chemo was associated with an increased risk of VTE (Relative Risk [RR]: 1.579; 95% CI: 1.155-2.158). History of VTE (RR: 1.899; 95% CI: 1.142-3.156) and prior cardiac/cardiovascular events (RR: 1.514; 95% CI: 1.102-2.082) were associated with increased risk of VTE. Decreased VTE risk was seen with: male sex (RR: 0.696; 95% CI: 0.502-0.964), eastern European geographic region (RR: 0.387; 95% CI: 0.267-0.562) and squamous cell pathology (RR: 0.653; 95% CI: 0.483-0.883). VTE occurrence showed no association with OS (HR: 1.121; 95% CI: 0.930-1.351). CONCLUSION Our data suggest that certain patient characteristics such as prior history of VTE and non-squamous histology might be associated with an increased risk of on-treatment VTE in NSCLC, although in this study, overall survival was not affected. Further studies to develop measures for identifying high-risk patients are needed to inform treatment decisions as well as VTE management and prophylaxis.
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Affiliation(s)
- Kelvin Young
- Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue Toronto, Ontario, M5G2M9, Canada.
| | - Luis Paz-Ares
- Instituto de Biomedicina de Sevilla - IBIS (Hospital Virgen del Rocío, Universidad de Sevilla & CSIC), Calle Antonio Maura Montaner, 41013 Sevilla, Spain; Hospital Universitario Doce de Octubre, CNIO Lung Cancer Unit, Carretera de Andalucía, 28041 Madrid, Spain
| | - Nick Thatcher
- The Christie Hospital, 550 Wilmslow Rd, Manchester M20 4BX, United Kingdom
| | - David R Spigel
- Sarah Canon Research Institute, LCC, 250 25th Ave N, Nashville, TN 37203, USA
| | - Javad Shahidi
- Eli Lilly and Company, 1555 S Harding St., Indianapolis, IN 46221, USA
| | - Victoria Soldatenkova
- Lilly Deutschland GmbH, Werner-Reimers-Straße 2, 61352 Bad Homburg vor der Höhe, Germany
| | - Gerrit Grau
- Lilly Deutschland GmbH, Werner-Reimers-Straße 2, 61352 Bad Homburg vor der Höhe, Germany
| | - Raffael Kurek
- Lilly Deutschland GmbH, Werner-Reimers-Straße 2, 61352 Bad Homburg vor der Höhe, Germany
| | - Frances A Shepherd
- Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue Toronto, Ontario, M5G2M9, Canada
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Meikle CKS, Kelly CA, Garg P, Wuescher LM, Ali RA, Worth RG. Cancer and Thrombosis: The Platelet Perspective. Front Cell Dev Biol 2017; 4:147. [PMID: 28105409 PMCID: PMC5214375 DOI: 10.3389/fcell.2016.00147] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/12/2016] [Indexed: 01/03/2023] Open
Abstract
Platelets are critical to hemostatic and immunological function, and are key players in cancer progression, metastasis, and cancer-related thrombosis. Platelets interact with immune cells to stimulate anti-tumor responses and can be activated by immune cells and tumor cells. Platelet activation can lead to complex interactions between platelets and tumor cells. Platelets facilitate cancer progression and metastasis by: (1) forming aggregates with tumor cells; (2) inducing tumor growth, epithelial-mesenchymal transition, and invasion; (3) shielding circulating tumor cells from immune surveillance and killing; (4) facilitating tethering and arrest of circulating tumor cells; and (5) promoting angiogenesis and tumor cell establishment at distant sites. Tumor cell-activated platelets also predispose cancer patients to thrombotic events. Tumor cells and tumor-derived microparticles lead to thrombosis by secreting procoagulant factors, resulting in platelet activation and clotting. Platelets play a critical role in cancer progression and thrombosis, and markers of platelet-tumor cell interaction are candidates as biomarkers for cancer progression and thrombosis risk.
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Affiliation(s)
- Claire K S Meikle
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences Toledo, OH, USA
| | - Clare A Kelly
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences Toledo, OH, USA
| | - Priyanka Garg
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences Toledo, OH, USA
| | - Leah M Wuescher
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences Toledo, OH, USA
| | - Ramadan A Ali
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences Toledo, OH, USA
| | - Randall G Worth
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences Toledo, OH, USA
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Alexander M, Burbury K. A systematic review of biomarkers for the prediction of thromboembolism in lung cancer - Results, practical issues and proposed strategies for future risk prediction models. Thromb Res 2016; 148:63-69. [PMID: 27815968 DOI: 10.1016/j.thromres.2016.10.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/13/2016] [Accepted: 10/24/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION This review aimed to identify candidate biomarkers for the prediction of thromboembolism (TE) in lung cancer. MATERIALS AND METHODS Systematic review of publications indexed in PubMed or EMBASE databases in the past 5years (01/05/2011-01/05/2016) which evaluated baseline and/or longitudinal biomarker measurements as a predictor of subsequent TE (venous and arterial) in lung cancer patients. RESULTS Of 1105 studies identified, 18 fulfilled predefined inclusion criteria: 6 prospective and 12 retrospective. The 18 studies included 11,262 patients and 36 unique biomarkers. The combined TE rate was 7% (741/10,854), increasing to 11% (294/2612) within prospective studies. All biomarker measurements were baseline only, with no longitudinal assessment reported. The most frequently investigated biomarkers were tumour-related driver mutations, D-dimer, haemoglobin, white cell, and platelet count; as well as biomarker combinations previously used in risk prediction models, such as Khorana risk score. Biomarker thresholds rather than continuous variable analyses were generally applied, however thresholds were not consistent across studies. D-dimer and epidermal growth factor receptor mutation were the strongest and most reproducible predictors of TE. CONCLUSION An important limitation is the lack of prospective data across specific subpopulations of cancer, with correlative, and preferably longitudinal, biomarker assessments. This would provide insight into the pathophysiology, allow patient profiling, and the development of personalised decision-making tools that can be used real-time and throughout the course of the patients' journey, for targeted, risk-adaptive preventative strategies.
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Affiliation(s)
- Marliese Alexander
- Department of Epidemiology and Preventative Medicine Monash University, Commercial Road Melbourne Australia; Departments of Pharmacy and Haematology Peter MacCallum Cancer Centre, Grattan Street Melbourne Australia.
| | - Kate Burbury
- Department of Haematology Peter MacCallum Cancer Centre, Grattan Street Melbourne Australia
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Risk of venous thromboembolism in people with lung cancer: a cohort study using linked UK healthcare data. Br J Cancer 2016; 115:115-21. [PMID: 27253177 PMCID: PMC4931366 DOI: 10.1038/bjc.2016.143] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/09/2016] [Accepted: 04/26/2016] [Indexed: 02/07/2023] Open
Abstract
Background: Venous thromboembolism (VTE) is a potentially preventable cause of death in people with lung cancer. Identification of those most at risk and high-risk periods may provide the opportunity for better targeted intervention. Methods: We conducted a cohort study using the Clinical Practice Research Datalink linked to Hospital Episode Statistics and Cancer Registry data. Our cohort comprises 10 598 people with lung cancer diagnosed between 1997 and 2006 with follow-up continuing to the end of 2010. Cox regression analysis was performed to determine which demographic, tumour and treatment-related factors (time-varying effects of chemotherapy and surgery) independently affected VTE risk. We also determined the effect of a VTE diagnosis on the survival of people with lung cancer. Results: People with lung cancer had an overall VTE incidence of 39.2 per 1000 person-years (95% confidence interval (CI), 35.4–43.5), though rates varied depending on the patient group and treatment course. Independent factors associated with increased VTE risk were metastatic disease (hazard ratio (HR)=1.9, CI 1.2–3.0 vs local disease); adenocarcinoma subtype (HR=2.0, CI 1.5–2.7, vs squamous cell; chemotherapy administration (HR=2.1, CI 1.4–3.0 vs outside chemotherapy courses); and diagnosis via emergency hospital admission (HR=1.7, CI 1.2–2.3 vs other routes to diagnosis). Patients with VTE had an approximately 50% higher risk of mortality than those without VTE. Conclusions: People with lung cancer have especially high risk of VTE if they have advanced disease, adenocarcinoma or are undergoing chemotherapy. The presence of VTE is an independent risk factor for death.
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Vitale C, D'Amato M, Calabrò P, Stanziola AA, Mormile M, Molino A. Venous thromboembolism and lung cancer: a review. Multidiscip Respir Med 2015; 10:28. [PMID: 26380084 PMCID: PMC4570636 DOI: 10.1186/s40248-015-0021-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 07/27/2015] [Indexed: 12/03/2022] Open
Abstract
Venous thromboembolism (VTE) is a common complication of malignancies and epidemiological studies suggest that lung cancer belonged to the group of malignancies with the highest incidence rates of VTE. Risk factors for VTE in lung cancer patients are adenocarcinoma, NSCLC in comparison with SCLC, advanced disease, pneumonectomy, chemotherapy including antiangiogenic therapy. Other risk factors are pretreatment platelet counts and increased release of TF-positive microparticles. Elevated D-dimer levels do not necessarily indicate an increased risk of VTE but have been shown to be predictive for a worse clinical outcome in lung cancer patients. Mechanisms responsible for the increase in venous thrombosis in patients with lung cancer are not understood. Currently no biomarker is recognized as a predictor for VTE in lung cancer patients. Although several clinical trials have reported the efficacy of antithrombotic prophylaxis in patients with lung cancer who are receiving chemotherapy, further trials are needed to assess the clinical benefit since these patients are at an increased risk of developing a thromboembolism.
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Affiliation(s)
- Carolina Vitale
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Maria D'Amato
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Paolo Calabrò
- Department of Cardiology, High Speciality Hospital "V. Monaldi", Second University of Naples, Naples, Italy
| | - Anna Agnese Stanziola
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Mauro Mormile
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Antonio Molino
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
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Abdalla AME, Xiao L, Ouyang C, Yang G. Engineered nanoparticles: thrombotic events in cancer. NANOSCALE 2014; 6:14141-14152. [PMID: 25347245 DOI: 10.1039/c4nr04825c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Engineered nanoparticles are being increasingly produced for specific applications in medicine. Broad selections of nano-sized constructs have been developed for applications in diagnosis, imaging, and drug delivery. Nanoparticles as contrast agents enable conjugation with molecular markers which are essential for designing effective diagnostic and therapeutic strategies. Such investigations can also lead to a better understanding of disease mechanisms such as cancer-associated thrombosis which remains unpredictable with serious bleeding complications and high risk of death. Here we review the recent and current applications of engineered nanoparticles in diagnosis and therapeutic strategies, noting their toxicity in relation to specific markers as a target.
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Affiliation(s)
- Ahmed M E Abdalla
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
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