Frequency, clinical pattern and outcome of thrombosis in cancer patients in Saudi Arabia.

OBJECTIVES: Thrombotic risk is increased in patients with cancer and there are important implications for those who suffer a venous thromboembolism (VTE). We undertook this study to determine the frequency, clinical patterns, and outcome of VTE in Saudi patients with cancer. METHODS: Cancer (solid tumors and lymphoma) patients who developed VTE from January 2004 to January 2009 were studied retrospectively. Demographics and clinical characteristics related to thrombosis and cancer were evaluated. RESULTS: A total of 701 patients with cancer were seen during the study period. VTE was diagnosed in 47 (6.7%) patients (median age 52, range 18-80 years). Lower limb DVT was the most common type, seen in 47% patients, followed by PE in 19%, and 19% patients had both DVT and PE. Thrombosis was symptomatic in 72% patients while it was an incidental finding on routine workup in 28% . Cancer and VTE were diagnosed at the same time in 38% of patients, and 47% patients developed VTE during the course of disease after the cancer diagnosis. The majority of VTE post cancer diagnoses occurred during the first year (median 4 months, range 1-14). Additional risk factors for VTE were present in 22 (47%) patients and 14 (30%) of these patients were receiving chemotherapy at the time of thrombosis. Only 5 (10.6%) patients were receiving thrombo-prophylaxis at the time of VTE diagnosis. Most common types of tumors associated with thrombosis were breast cancer, non-Hodgkin's lymphoma and lung cancer. The majority of the affected patients (79%) had advanced stage of cancer. After a median follow-up of 13 (range 0.5-60) months, 38 (81%) patients had died. There was no difference in the mortality of patients with symptomatic or asymptomatic thrombosis (82% vs 78.6%). CONCLUSIONS: Thrombotic complications can develop in a significant number of patients with cancer, and almost half of the patients have additional risk factors for VTE. Thrombosis is usually associated with advanced disease and can be asymptomatic in more than a quarter of cases. Thromboprophylaxis in cancer patients is under-utilized. Community based studies are needed to accurately define the extent of this problem and to develop effective prophylactic strategies.

A new lung cancer biomarker--a preliminary report.

OBJECTIVE: To investigate a unique biomarker from the blood plasma and sputum of lung cancer patients based on native fluorescence analysis of body fluids. BACKGROUND: Conventionally, biomarkers indicative of malignancy are identified by biochemical or biophysical processes. Most of the cancer biomarkers, often useful in monitoring disease progression, have sensitivity and specificity in the range of 60%. METHODS: We employed synchronous fluorescence excitation spectroscopy (SFXS) and fluorescence emission spectroscopy for the native fluorescence analysis of blood plasma of 32 normal controls, 32 patients with lung cancer, and 32 patients with other types of cancer. RESULTS: Based on the native fluorescence analysis of blood plasma and sputum, we found that the structural protein elastin, with an excitation peak at 327 nm and an emission peak at 405 nm, is an exclusive biomarker for lung carcinoma with 77% sensitivity and 83% specificity from plasma alone, 92.3% sensitivity and 100% specificity from plasma acetone extract alone, and 66% sensitivity and 100% specificity from sputum alone. CONCLUSION: In this preliminary report with a limited number of lung cancer patients, we have used SFXS of plasma and sputa as the basis for a new technique identifying elastin as an exclusive lung cancer biomarker. This technique has the potential to become a new protocol for rapid and cost-effective screening and diagnosis of lung cancer.

Clinico-pathological pattern of extranodal non-Hodgkin's lymphoma in Saudi Arabia.

OBJECTIVES: The incidence of primary extranodal non-Hodgkin's lymphoma (NHL) is variable in different regions of world but there is a paucity of literature on various demographic aspects of extranodal NHL as a group. This study was conducted to evaluate the clinico-pathological pattern of extranodal NHL in Saudi patients. METHODS: We retrospectively studied a cohort of 855 NHL patients in four tertiary care centres in Riyadh, Saudi Arabia over a period of 5 years. RESULTS: Extranodal NHL constituted 41.4% of the total. The mean age of affected patients was 55∓18 years and a male to female ratio of 1.5:1.0. Most presented in the age range of 41-60 years. NHL of gastro-intestinal (GI) tract was the most common extranodal variety, followed by head and neck NHL (18%), primary cutaneous lymphoma (14.4%), primary CNS lymphoma (5.6%), and primary bone, thyroid and soft tissue lymphoma (4.5% each). In the GI tract, stomach was the most common site involved, accounting for more than 81% of GI NHL. Diffuse large B-cell lymphoma was the most common histologic type, comprising around 72% of all extranodal lymphomas. CONCLUSIONS: Extranodal NHL is common in Saudi Arabia and diffuse large B cell lymphoma is the most common histologic subtype. We found significant differences in the pattern of extranodal NHL in Saudi patients compared to those reported from other parts of the world. Further studies focused on the risk factors and treatment outcome are needed to better understand the biology of a disease common in this population.