Prospective Assessment of Clinical Risk Factors and Biomarkers of Hypercoagulability for the Identification of Patients with Lung Adenocarcinoma at Risk for Cancer‐Associated Thrombosis: The Observational ROADMAP‐CAT Study

Autor: Ilias Evmorfiadis, Elias Kotteas, Andriani Charpidou, Paraskevi Boura, Patrick Van Dreden, Grigoris T. Gerotziafas, Dimitra Grapsa, Annette K. Larsen, Anna Falanga, Ismail Elalamy, Theodoros N. Sergentanis, Konstantinos N. Syrigos, Rabiatou Sangare
Přispěvatelé: National and Kapodistrian University of Athens (NKUA), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université (SU), Service d'Hématologie biologique [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Syrigos, K, Grapsa, D, Sangare, R, Evmorfiadis, I, Larsen, A, Van Dreden, P, Boura, P, Charpidou, A, Kotteas, E, Sergentanis, T, Elalamy, I, Falanga, A, Gerotziafas, G
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
Oncology
Cancer Research
030204 cardiovascular system & hematology
Cohort Studies
0302 clinical medicine
Risk Factors
Thrombophilia
Medicine
Prospective Studies
Cancer‐associated thrombosis
Prospective cohort study
Aged
80 and over
biology
Cancer-associated thrombosis
Area under the curve
Factor V
Middle Aged
Thrombosis
3. Good health
Symptom Management and Supportive Care
030220 oncology & carcinogenesis
Ambulatory
Adenocarcinoma
Female
Lung cancer
Venous thromboembolism
Adult
medicine.medical_specialty
Thrombin generation
Adenocarcinoma of Lung
[SDV.CAN]Life Sciences [q-bio]/Cancer
Risk Assessment
Fibrin
Young Adult
03 medical and health sciences
Internal medicine
Cancer‐associated thrombosi
Humans
Aged
business.industry
medicine.disease
Risk assessment model
biology.protein
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
business
Biomarkers
Zdroj: Oncologist
Oncologist, AlphaMed Press, 2018, 23 (11), pp.1372-1381. ⟨10.1634/theoncologist.2017-0530⟩
ISSN: 1083-7159
1549-490X
Popis: Background The aim of this prospective study was to identify the most clinically relevant hypercoagulability biomarkers in lung adenocarcinoma patients for elaboration of an improved risk assessment model (RAM) for venous thromboembolism (VTE). Subjects, Materials, and Methods One hundred fifty ambulatory patients with lung adenocarcinoma were prospectively enrolled. Thrombin generation, procoagulant phospholipid-dependent clotting time (Procoag-PPL), tissue factor activity (TFa), factor VIIa (FVIIa), factor V (FV), antithrombin, D-Dimers, P-selectin, and heparanase levels were assessed in platelet-poor plasma at inclusion (baseline) and at the end of the third chemotherapy cycle (third chemotherapy). Cox regression analysis was used to identify independent VTE predictors. Results At baseline, patients had significantly attenuated thrombin generation, shorter Procoag-PPL, higher levels of TFa, D-Dimers, and heparanase, and lower levels of FVIIa and P-selectin, compared with controls. A significant increase in Procoag-PPL, FV, and FVIIa and a decrease of P-selectin levels were observed between baseline and third chemotherapy. Hospitalization within the last 3 months prior to assessment, time since cancer diagnosis less than 6 months, mean rate index (MRI) of thrombin generation, and Procoag-PPL were independently associated with symptomatic VTE. Accordingly, a prediction model including Procoag-PPL and MRI showed significant discriminating capacity (area under the curve: 0.84). Conclusion Ambulatory patients with lung adenocarcinoma may display pronounced blood hypercoagulability due to decreased Procoag-PPL, increased endothelial cell activation, and increased degradation of fibrin. Incorporation of Procoag-PPL and MRI of thrombin generation may improve the accuracy of a VTE-RAM in the above setting. Implications for Practice The prospective ROADMAP-CAT study identified two biomarkers of hypercoagulability, the procoagulant phospholipid-dependent clotting time (Procoag-PPL) and the mean rate index (MRI) of the propagation phase of thrombin generation assessed with the Calibrated Automated Thrombinoscope, as being clinically relevant for the classification of ambulatory patients with lung adenocarcinoma receiving a maximum of one cycle of chemotherapy into high and intermediate/low risk for venous thromboembolism. Measurement of Procoag-PPL and MRI within 1 month after the administration of the first chemotherapy cycle provides significant accuracy of the assessment. Association of the Procoag-PPL and MRI with the clinical risk assessment model for cancer-associated thrombosis in ambulatory patients with solid tumors (COMPASS-CAT RAM) further improved its accuracy.
Databáze: OpenAIRE
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