Procoagulant factors in patients with cancer.

BACKGROUND: Clotting activation and thromboembolic manifestations are common features in patients with cancer. Tumor cells can directly activate the clotting through two procoagulants: tissue factor (TF) and cancer procoagulant (CP). AIMS: The aim was to evaluate the levels of TF and CP in patients with different tumors in order to: (1) establish an association between these markers and the tumor localization, (2) establish a correlation between the levels of procoagulants and the status of the disease, (3) evaluate if the treatment with chemotherapy induced some modifications on the levels of procoagulants, (4) evaluate the possibility of using procoagulants as predictors in the development of thrombosis. METHODS: Sixty-one patients with different types of cancer (lung, breast, digestive and genitourinary) and 20 normal controls were included. The activity of TF and CP was studied in serum samples. Statistical analysis of the data was performed by two-tailed Fisher exact test. RESULTS: The TF was increased in 72.5 and 0% (p < 0.01) of cancer patients and normal controls, respectively. PC was found to be increased in 88% of the cancer patients but in healthy controls it was increased in only 15% (p < 0.01). The patients with genitourinary cancer presented the highest values of both procoagulants coinciding with a major prevalence of thrombotic events. The activity CP was found in 93% of patients with stages I and II but in patients with stages II and IV disease it was found in 85% (not significant). There were no differences in the levels of both procoagulants between the patients treated with chemotherapy and those with other treatments. CONCLUSIONS: TF and CP are elevated in patients with cancer. The highest values of both procoagulants are in the genitourinary cancer group in agreement with the greater presence of thrombosis observed in this group. Clinical follow up is important in order to determine the potential value of these procoagulants and the tendency to develop thrombosis in patients with cancer.

Factores procoagulantes en pacientes con cáncer / Procoagulant factors in patients with cancer

El objetivo del presente estudio fue determinar los niveles de factor tisular (FT) y procoagulante del cáncer (PC) en pacientes con enfermedades neoplásicas para intentar establecer: 1) si existe asociación entre la presencia de estos marcadores y el origen del tumor; 2) si los niveles de estas proteínas procoagulantes se correlacionan con los estadíos I/II o III/IV de la enfermedad; 3) si los tratamientos con quimioterapia modifican los niveles séricos del FT y PC y, finalmente 4) evaluar si estos procoagulantes podrían comportarse como marcadores predictivos en el desarrollo de trombosis. Se incluyeron 61 pacientes con diferentes tipos de cáncer: pulmón (n=14), mama (n=19), digestivo (n=13), y génitourinario (n=12) y controles normales (n=20). Los resultados demostraron una sensibilidad y especificidad del 87,9% y 85%, respectivamente, para el PC y del 72,4% y 100% para el FT. Los pacientes con cáncer génitourinario presentaron los valores más altos de ambos procoagulantes coicidiendo con la mayor prevalencia de trombosis objetiva clínica y radiológicamente. Ninguno de los procoagulantes evaluados permitió difenciar estadío I-II de III-IV de la enfermedad. Por otra parte, el tratamiento con quioterapia no modificó con significancia estadística, los niveles de ambos procoagulantes. Un seguimiento clínico y de laboratorio en función del tiempo y del tratamiento sería importante para establecer el valor pronóstico de los niveles de estos procoagulantes y su propensión a desarrollar trombosis en pacientes con cáncer.