1
|
Leong CH, Ranjan SR, Javed A, Alsaedi BSO, Nabi G. Predictive accuracy of boosted regression model in estimating risk of venous thromboembolism following minimally invasive radical surgery in pharmacological prophylaxis-naïve men with prostate cancer. World J Surg Oncol 2024; 22:67. [PMID: 38395873 PMCID: PMC10885400 DOI: 10.1186/s12957-023-03170-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/02/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a potentially life-threatening but preventable complication after urological surgery. Physicians are faced with the challenges of weighing the risks and benefits of thromboprophylaxis given scanty evidence for or against and practice variation worldwide. OBJECTIVE The primary objective of the study was to explore the possibility of a risk-stratified approach for thromboembolism prophylaxis following radical prostatectomy. DESIGN, SETTING, AND PARTICIPANTS A prospective database was accessed to cross-link venous thromboembolism events in 522 men who underwent minimally invasive prostatectomy between February 2010 and October 2021. A deterministic data linkage method was used to record events through electronic systems. Community Health Index (CHI) numbers were used to identify patients via electronic health records. Patient demographics and clinical characteristics such as age, comorbidities, Gleason staging, and readmission details accrued. OUTCOMES VTE within 90 days and development of a risk-stratified scoring system. All statistical analysis was performed using R-Statistical Software and the risk of VTE within 90 days of surgery was estimated via gradient-boosting decision trees (BRT) model. RESULTS AND LIMITATIONS 1.1% (6/522) of patients developed deep vein thrombosis or pulmonary embolism within 3 months post-minimally invasive prostatectomy. Statistical analysis demonstrated a significant difference in the body mass index (p = 0.016), duration of hospital stay (p < 0.001), and number of readmissions (p = 0.036) between patients who developed VTE versus patients who did not develop VTE. BRT analysis found 8 variables that demonstrated relative importance in predicting VTE. The receiver operating curves (ROC) were constructed to assess the discrimination power of a new model. The model showed an AUC of 0.97 (95% confidence intervals [CI]: 0.945,0.999). For predicting VTE, a single-center study is a limitation. CONCLUSIONS The incidence of VTE post-minimally invasive prostatectomy in men who did not receive prophylaxis with low molecular weight heparin is low (1.1%). The proposed risk-scoring system may aid in the identification of higher-risk patients for thromboprophylaxis. In this report, we looked at the outcomes of venous thromboembolism following minimally invasive radical prostatectomy for prostate cancer in consecutive men. We developed a new scoring system using advanced statistical analysis. We conclude that the VTE risk is very low and our model, if applied, can risk stratify men for the development of VTE following radical surgery for prostate cancer.
Collapse
Affiliation(s)
- Chie Hui Leong
- Academic Urology Unit, Division of Imaging Sciences and Technology, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Sushil Rodrigues Ranjan
- Academic Urology Unit, Division of Imaging Sciences and Technology, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Anna Javed
- Department of Pharmacology, AIIMS, Vijaypur, Jammu, India
| | - Basim S O Alsaedi
- Department of Statistics, University of Tabuk, 71491, Tabuk, Saudi Arabia
| | - Ghulam Nabi
- Academic Urology Unit, Division of Imaging Sciences and Technology, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
| |
Collapse
|
2
|
Fainchtein K, Tera Y, Kearn N, Noureldin A, Othman M. Hypercoagulability and Thrombosis Risk in Prostate Cancer: The Role of Thromboelastography. Semin Thromb Hemost 2023; 49:111-118. [PMID: 36410399 DOI: 10.1055/s-0042-1758116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Thrombosis is one of the leading causes of death in cancer. Cancer-induced hypercoagulable state contributes to thrombosis and is often overlooked. Prostate cancer may not be of high thrombogenic potential compared with other cancers, but its high prevalence brings it into focus. Pathological evidence for venous thromboembolisms (VTEs) in prostate cancer exists. Factors such as age, comorbidities, and therapies increase the VTE risk further. There is a need to systematically identify the risk of VTE in regard to patient-, cancer-, and treatment-related factors to risk stratify patients for better-targeted and individualized strategies to prevent VTE. Sensitive tests to enable such risk assessment are urgently required. There is sufficient evidence for the utility of thromboelastography (TEG) in cancer, but it is not yet part of the clinic and there is only limited data on the use of TEG in prostate cancer. One study revealed that compared with age-matched controls, 68.8% of prostate cancer patients demonstrated hypercoagulable TEG parameters. The absence of clinical guidelines is a limiting factor in TEG use in the cancer population. Cancer heterogeneity and the unique cancer-specific microenvironment in each patient, as well as determining the hypercoagulable state in each patient, are added limitations. The way forward is to combine efforts to design large multicenter studies to investigate the utility and clinical effectiveness of TEG in cancer and establish longitudinal studies to understand the link between hypercoagulable state and development of thrombosis. There is also a need to study low thrombogenic cancers as well as high thrombogenic ones. Awareness among clinicians and understanding of test applicability and interpretation are needed. Finally, expert discussion is critical to identify the investigation priorities.
Collapse
Affiliation(s)
- Karina Fainchtein
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Yousra Tera
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada.,Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Natalie Kearn
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Abdelrahman Noureldin
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada.,Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.,School of Baccalaureate Nursing, St. Lawrence College, Kingston, Ontario, Canada
| |
Collapse
|
3
|
Cheng X, Zhou L, Liu W, Li Y, Peng M, Wang Y. Construction and Verification of Risk Predicting Models to Evaluate the Possibility of Venous Thromboembolism After Robot-Assisted Radical Prostatectomy. Ann Surg Oncol 2022; 29:5297-5306. [PMID: 35316433 PMCID: PMC9246795 DOI: 10.1245/s10434-022-11574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
Background Venous thromboembolism (VTE) is the second leading cause for death of radical prostatectomy. We aimed to establish new nomogram to predict the VTE risk after robot-assisted radical prostatectomy (RARP). Methods Patients receiving RARP in our center from November 2015 to June 2021, were enrolled in study. They were randomly divided into training and testing cohorts by 8:2. Univariate and multivariate logistic regression (model A) and stepwise logistic regression (model B) were used to fit two models. The net reclassification improvement (NRI), integrated discrimination improvement (IDI), and receiver operating characteristic (ROC) curve were used to compare predictive abilities of two new models with widely used Caprini risk assessment (CRA) model. Then, two nomograms were constructed and received internal validation. Results Totally, 351 patients were included. The area under ROC of model A and model B were 0.967 (95% confidence interval: 0.945–0.990) and 0.978 (95% confidence interval: 0.960–0.996), which also were assayed in the testing cohorts. Both the prediction and classification abilities of the two new models were superior to CRA model (NRI > 0, IDI > 0, p < 0.05). The C-index of Model A and Model B were 0.968 and 0.978, respectively. For clinical usefulness, the two new models offered a net benefit with threshold probability between 0.08 and 1 in decision curve analysis, suggesting the two new models predict VTE events more accurately. Conclusions Both two new models have good prediction accuracy and are superior to CRA model. Model A has an advantage of less variable. This easy-to-use model enables rapid clinical decision-making and early intervention in high-risk groups, which ultimately benefit patients. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-022-11574-5.
Collapse
Affiliation(s)
- Xu Cheng
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Lizhi Zhou
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Wentao Liu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Yijian Li
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Mou Peng
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Yinhuai Wang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| |
Collapse
|
4
|
Hoek M, Schultz M, Alummoottil S, Aneck-Hahn N, Mathabe K, Bester J. Ex vivo Vitamin D supplementation improves viscoelastic profiles in prostate cancer patients. Clin Hemorheol Microcirc 2022; 81:221-232. [DOI: 10.3233/ch-211353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Increased risk of thromboembolic events is associated with prostate cancer, specifically linked to activation of tissue factor. Vitamin D has potential anticoagulant effects by the downregulation of tissue factor expression. OBJECTIVES: To evaluate the effects on clot formation, the morphological and viscoelastic profiles of prostate cancer patients, before and after ex vivo supplementation of Vitamin D was studied. METHODS: Participants were recruited into a metastatic, non-metastatic and reference group. Whole blood samples were treated ex vivo with a dose of 0.5μg/kg Calcitriol. Clot kinetics were assessed using Thromboelastography ®. Morphology of the blood components were studied using scanning electron microscopy (SEM). RESULTS: Results from the Thromboelastography ® and SEM indicated no major differences between the non-metastatic group before and after treatment compared to the reference group. The Thromboelastography ® showed that the metastatic group had an increased viscoelastic profile relating to a hypercoagulable state. Visible changes with regards to platelet activation and fibrin morphology were demonstrated with SEM analysis of the metastatic group. The viscoelastic and morphological properties for the non-metastatic group after treatment improved to be comparable to the reference group. CONCLUSION: Vitamin D supplementation may lead to a more favorable viscoelastic profile, with less dangerous clots forming.
Collapse
Affiliation(s)
- Marinka Hoek
- Department of Urology, University of Pretoria, Pretoria, South Africa
| | - Michelle Schultz
- Department of Physiology, University of Pretoria, Pretoria, South Africa
| | - Sajee Alummoottil
- Department of Physiology, University of Pretoria, Pretoria, South Africa
| | - Natalie Aneck-Hahn
- Department of Urology, University of Pretoria, Pretoria, South Africa
- Environmental Chemical Pollution and Health Research Unit, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Kgomotso Mathabe
- Department of Urology, University of Pretoria, Pretoria, South Africa
| | - Janette Bester
- Department of Physiology, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
5
|
Marhold M, Udovica S, Topakian T, Horak P, Horvat R, Tomasich E, Heller G, Krainer M. MALAT1 Fusions and Basal Cells Contribute to Primary Resistance against Androgen Receptor Inhibition in TRAMP Mice. Cancers (Basel) 2022; 14:cancers14030749. [PMID: 35159020 PMCID: PMC8833778 DOI: 10.3390/cancers14030749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary We deeply characterized a frequently used mouse model of prostate cancer and found cellular and molecular regulators of resistance against antihormonal treatment, such as basal cell function and MALAT1 gene fusions. As these mechanisms also occur in human disease, our findings highlight the importance of this model for human cancer and may be helpful for future research focusing on overcoming antihormonal treatment resistance. Abstract Targeting testosterone signaling through androgen deprivation therapy (ADT) or antiandrogen treatment is the standard of care for advanced prostate cancer (PCa). Although the large majority of patients initially respond to ADT and/or androgen receptor (AR) blockade, most patients suffering from advanced PCa will experience disease progression. We sought to investigate drivers of primary resistance against antiandrogen treatment in the TRAMP mouse model, an SV-40 t-antigen driven model exhibiting aggressive variants of prostate cancer, castration resistance, and neuroendocrine differentiation upon antihormonal treatment. We isolated primary tumor cell suspensions from adult male TRAMP mice and subjected them to organoid culture. Basal and non-basal cell populations were characterized by RNA sequencing, Western blotting, and quantitative real-time PCR. Furthermore, effects of androgen withdrawal and enzalutamide treatment were studied. Basal and luminal TRAMP cells exhibited distinct molecular signatures and gave rise to organoids with distinct phenotypes. TRAMP cells exhibited primary resistance against antiandrogen treatment. This was more pronounced in basal cell-derived TRAMP organoids when compared to luminal cell-derived organoids. Furthermore, we found MALAT1 gene fusions to be drivers of antiandrogen resistance in TRAMP mice through regulation of AR. Summarizing, TRAMP tumor cells exhibited primary resistance towards androgen inhibition enhanced through basal cell function and MALAT1 gene fusions.
Collapse
Affiliation(s)
- Maximilian Marhold
- Division of Oncology, Department for Medicine I, Medical University of Vienna, A-1090 Vienna, Austria; (T.T.); (E.T.); (G.H.); (M.K.)
- Comprehensive Cancer Center Vienna, Medical University of Vienna, A-1090 Vienna, Austria
- Correspondence:
| | - Simon Udovica
- Clinic of Internal Medicine I and Wilhelminen Cancer Research Institute, Klinik Ottakring, A-1090 Vienna, Austria;
| | - Thais Topakian
- Division of Oncology, Department for Medicine I, Medical University of Vienna, A-1090 Vienna, Austria; (T.T.); (E.T.); (G.H.); (M.K.)
- Comprehensive Cancer Center Vienna, Medical University of Vienna, A-1090 Vienna, Austria
| | - Peter Horak
- National Tumor Center (NCT), DKFZ, 69120 Heidelberg, Germany;
| | - Reinhard Horvat
- Institute for Pathology, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Erwin Tomasich
- Division of Oncology, Department for Medicine I, Medical University of Vienna, A-1090 Vienna, Austria; (T.T.); (E.T.); (G.H.); (M.K.)
- Comprehensive Cancer Center Vienna, Medical University of Vienna, A-1090 Vienna, Austria
| | - Gerwin Heller
- Division of Oncology, Department for Medicine I, Medical University of Vienna, A-1090 Vienna, Austria; (T.T.); (E.T.); (G.H.); (M.K.)
- Comprehensive Cancer Center Vienna, Medical University of Vienna, A-1090 Vienna, Austria
| | - Michael Krainer
- Division of Oncology, Department for Medicine I, Medical University of Vienna, A-1090 Vienna, Austria; (T.T.); (E.T.); (G.H.); (M.K.)
- Comprehensive Cancer Center Vienna, Medical University of Vienna, A-1090 Vienna, Austria
| |
Collapse
|
6
|
Nie Z, Chen M, Gao Y, Huang D, Cao H, Peng Y, Guo N, Zhang S. Regulated Cell Death in Urinary Malignancies. Front Cell Dev Biol 2021; 9:789004. [PMID: 34869390 PMCID: PMC8633115 DOI: 10.3389/fcell.2021.789004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/25/2021] [Indexed: 12/14/2022] Open
Abstract
Urinary malignancies refer to a series of malignant tumors that occur in the urinary system and mainly include kidney, bladder, and prostate cancers. Although local or systemic radiotherapy and chemotherapy, immunotherapy, castration therapy and other methods have been applied to treat these diseases, their high recurrence and metastasis rate remain problems for patients. With in-depth research on the pathogenesis of urinary malignant tumors, this work suggests that regulatory cell death (RCD) plays an important role in their occurrence and development. These RCD pathways are stimulated by various internal and external environmental factors and can induce cell death or permit cell survival under the control of various signal molecules, thereby affecting tumor progression or therapeutic efficacy. Among the previously reported RCD methods, necroptosis, pyroptosis, ferroptosis, and neutrophil extracellular traps (NETs) have attracted research attention. These modes transmit death signals through signal molecules, such as cysteine-aspartic proteases (caspase) family and tumor necrosis factor-α (TNF-α) that have a wide and profound influence on tumor proliferation or death and even change the sensitivity of tumor cells to therapy. This review discussed the effects of necroptosis, pyroptosis, ferroptosis, and NETs on kidney, bladder and prostate cancer and summarized the latest research and achievements in these fields. Future directions and possibility of improving the denouement of urinary system tumors treatment by targeting RCD therapy were also explored.
Collapse
Affiliation(s)
- Zhenyu Nie
- Central Laboratory, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Mei Chen
- Central Laboratory, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Yuanhui Gao
- Central Laboratory, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Denggao Huang
- Central Laboratory, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Hui Cao
- Central Laboratory, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Yanling Peng
- Central Laboratory, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Na Guo
- Central Laboratory, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Shufang Zhang
- Central Laboratory, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| |
Collapse
|
7
|
Paulsen B, Gran OV, Severinsen MT, Hammerstrøm J, Kristensen SR, Cannegieter SC, Skille H, Tjønneland A, Rosendaal FR, Overvad K, Næss IA, Hansen JB, Brækkan SK. Association of smoking and cancer with the risk of venous thromboembolism: the Scandinavian Thrombosis and Cancer cohort. Sci Rep 2021; 11:18752. [PMID: 34548519 PMCID: PMC8455552 DOI: 10.1038/s41598-021-98062-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/31/2021] [Indexed: 12/21/2022] Open
Abstract
Smoking is a well-established risk factor for cancer, and cancer patients have a high risk of venous thromboembolism (VTE). Conflicting results have been reported on the association between smoking and risk of VTE, and the effect of smoking on VTE-risk in subjects with cancer is scarcely studied. We aimed to investigate the association between smoking and VTE in subjects with and without cancer in a large population-based cohort. The Scandinavian Thrombosis and Cancer (STAC) cohort included 144,952 participants followed from 1993-1997 to 2008-2012. Information on smoking habits was derived from self-administered questionnaires. Active cancer was defined as the first two years following the date of cancer diagnosis. Former smokers (n = 35,890) and those with missing information on smoking status (n = 3680) at baseline were excluded. During a mean follow up of 11 years, 10,181 participants were diagnosed with cancer, and 1611 developed incident VTE, of which 214 were cancer-related. Smoking was associated with a 50% increased risk of VTE (HR 1.49, 95% CI 1.12-1.98) in cancer patients, whereas no association was found in cancer-free subjects (HR 1.07, 95% CI 0.96-1.20). In cancer patients, the risk of VTE among smokers remained unchanged after adjustment for cancer site and metastasis. Stratified analyses showed that smoking was a risk factor for VTE among those with smoking-related and advanced cancers. In conclusion, smoking was associated with increased VTE risk in subjects with active cancer, but not in those without cancer. Our findings imply a biological interaction between cancer and smoking on the risk of VTE.
Collapse
Affiliation(s)
- Benedikte Paulsen
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsö, Norway
| | - Olga V Gran
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsö, Norway
| | - Marianne T Severinsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Hammerstrøm
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Søren R Kristensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hanne Skille
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsö, Norway
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Inger Anne Næss
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
| | - John-Bjarne Hansen
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsö, Norway.,Division of Internal Medicine, University Hospital of North Norway, Tromsö, Norway
| | - Sigrid K Brækkan
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsö, Norway. .,Division of Internal Medicine, University Hospital of North Norway, Tromsö, Norway.
| |
Collapse
|
8
|
Ayodele O, Cabral HJ, McManus D, Jick S. The Risk of Venous Thromboembolism (VTE) in Men with Benign Prostatic Hyperplasia Treated with 5-Alpha Reductase Inhibitors (5ARIs). Clin Epidemiol 2021; 13:661-673. [PMID: 34377032 PMCID: PMC8349190 DOI: 10.2147/clep.s317019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Many men receive 5-alpha reductase inhibitors (5ARIs) for ongoing treatment of benign prostatic hyperplasia (BPH). The increased risk of cardiovascular complications with 5ARIs has been documented in BPH studies and the occurrence of cerebral venous thrombosis, presumably due to increased estrogen level following 5ARI use, was described in multiple case reports. The objective of this study was to determine if 5ARIs with or without alpha blockers (AB) were associated with an increased risk of venous thromboembolism (VTE) in males with BPH. Methods We conducted a nested case–control study among a population of men ages 40–79 who received at least one 5ARI or AB prescription for treatment of BPH between 1995 and 2015 in the UK-based Clinical Practice Research Datalink GOLD. Cases of incident VTE (pulmonary embolism [PE] or deep venous thrombosis [DVT]) and matched controls were identified from this population. We used descriptive analyses and conditional logistic regression to evaluate the risk of VTE in users of 5ARIs compared to users of ABs. Results For 5ARI only users, the adjusted odds ratios (aORs), (95% CI) for VTE were 1.51 (0.98–2.32) in current 5ARI users and 1.23 (0.70–2.17) in recent/distant past, compared to AB only users. However, the aOR (95% CI) in men who had 50 or more current 5ARI prescriptions compared to users of ABs only was higher: 2.29 (1.14–4.63). For 5ARI with AB use, the aORs, (95% CI) for VTE were 1.16 (0.64–2.10) in current 5ARI+AB users and 1.93 (0.71–5.25) in recent/distant past, compared to AB only users. The aOR (95% CI) in men who had 50 or more current 5ARI+AB prescriptions compared to users of ABs only was 1.65 (0.64–4.26). Conclusion Current use of 5ARI, particularly long-term use, is associated with an increased risk of incident idiopathic VTE compared to patients treated with AB use only.
Collapse
Affiliation(s)
- Olulade Ayodele
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.,Biostatistics and Research Design Program, Boston University Clinical and Translational Science Institute, Boston, MA, USA
| | - David McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Susan Jick
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Boston Collaborative Drug Surveillance Program, Lexington, MA, USA
| |
Collapse
|
9
|
Abreu SC, Tavares V, Carneiro F, Medeiros R. Venous thromboembolism and prostate cancer: what about genetic markers? Pharmacogenomics 2021; 22:365-373. [PMID: 33749329 DOI: 10.2217/pgs-2020-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim & methods: To review the existing literature concerning the relationship between venous thromboembolism (VTE) and prostate cancer (PC) and explore the putative biological and clinical implications of VTE genetic markers on PC patients by screening the PubMed database. Results: Considering the roles of VTE genome-wide association studies-identified genetic determinants in disease development in the general population, these variants might also underlie the susceptibility for PC-related VTE. Therefore, they could help to identify those with a positive benefit-to-harm ratio for thromboprophylaxis approaches during cancer therapy management, thereby improving patient's prognosis. Conclusion: Future studies are mandatory to explore the relationship between VTE and PC and dissect the predictive value of VTE genome-wide association studies-identified genetic determinants in PC patients, given their clinical implications.
Collapse
Affiliation(s)
- Sofia Coelho Abreu
- Oncology Department, Portuguese Institute of Oncology, Porto, 4200 072, Portugal
| | - Valéria Tavares
- Molecular Oncology & Viral Pathology Group, Research Center of Portuguese Institute of Oncology, Porto, 4200 072, Portugal.,Research Department, Portuguese League Against Cancer of Northern Region, Porto, 4200 172, Portugal
| | - Filipa Carneiro
- Oncology Department, Portuguese Institute of Oncology, Porto, 4200 072, Portugal
| | - Rui Medeiros
- Molecular Oncology & Viral Pathology Group, Research Center of Portuguese Institute of Oncology, Porto, 4200 072, Portugal.,Research Department, Portuguese League Against Cancer of Northern Region, Porto, 4200 172, Portugal.,Faculty of Health Sciences, CEBIMED, Fernando Pessoa University, Porto, 4200 150, Portugal
| |
Collapse
|
10
|
Voigtlaender M, Beckmann L, Schulenkorf A, Sievers B, Rolling C, Bokemeyer C, Langer F. Effect of myeloperoxidase on the anticoagulant activity of low molecular weight heparin and rivaroxaban in an in vitro tumor model. J Thromb Haemost 2020; 18:3267-3279. [PMID: 32865287 DOI: 10.1111/jth.15075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inflammation with leukocyte activation is a hallmark of cancer-associated thrombosis (CAT), and elevated leukocytes predict venous thromboembolism in cancer outpatients. In a recent trial, rivaroxaban was more efficacious than dalteparin in preventing CAT recurrence. OBJECTIVES In a proof-of-concept study, we aimed to provide a mechanistic basis for improved efficacy of rivaroxaban compared to low molecular weight heparin in CAT treatment. METHODS We studied the effects of rivaroxaban, dalteparin, and tinzaparin at peak and trough levels on tumor cell-induced procoagulant activity and platelet aggregation in the presence or absence of the cationic leukocyte-derived enzyme, myeloperoxidase (MPO). Furthermore, pro-inflammatory conditions were generated by stimulating whole blood with lipopolysaccharide (LPS) or phorbol-myristate-acetate (PMA), before measuring thrombin generation in plasma supernatants. RESULTS All three anticoagulants inhibited thrombin generation, fibrin clot formation, and platelet aggregation induced by the tissue factor-expressing prostate carcinoma cell line, 22Rv1. Pre-incubation with MPO partially attenuated the anticoagulant activity of dalteparin and tinzaparin, but not rivaroxaban, at trough levels. The effect of MPO did not involve the enzyme's catalytic properties, but required its structural integrity, as indicated by heat denaturation. In plasma obtained from LPS- or PMA-stimulated whole blood, elevated MPO antigen levels inversely correlated with the ability of tinzaparin to inhibit 22Rv1-induced thrombin generation. CONCLUSIONS Myeloperoxidase release may partially attenuate the anticoagulant activity of trough levels of dalteparin and tinzaparin in the context of paraneoplastic leukocyte activation. However, this effect is likely not sufficient to explain the improved efficacy of rivaroxaban, and possibly other oral factor Xa inhibitors, in CAT treatment.
Collapse
Affiliation(s)
- Minna Voigtlaender
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Beckmann
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anita Schulenkorf
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bianca Sievers
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Rolling
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Langer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
11
|
Michalski W, Poniatowska G, Jonska-Gmyrek J, Kucharz J, Stelmasiak P, Nietupski K, Ossolinska-Skurczynska K, Sobieszczuk M, Demkow T, Wiechno P. Venous thromboprophylaxis in urological cancer surgery. Med Oncol 2019; 37:11. [PMID: 31768889 DOI: 10.1007/s12032-019-1331-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/11/2019] [Indexed: 11/26/2022]
Abstract
Venous thromboembolism (VTE) represents a major complication of cancer and its treatment, contributing to increased morbidity and mortality. The appropriate choice of thromboprophylaxis method and duration is, therefore, of utmost importance. We conducted an extensive review of the literature concerning VTE in patients undergoing surgery for urological cancers. Special attention was paid to risk factors, different types of surgery (transurethral, pelvic, abdominal-open, laparoscopic and robot-assisted) and different medications used (heparins, vitamin K antagonists and new oral anticoagulants). Original papers, reviews and guidelines were identified in Medline database. The available data were then summarised for the purpose of this article. Venous thromboprophylaxis is obligatory in urological cancer patients undergoing surgical treatment. Unless individual contraindications are recognised, the available guidelines should be followed. The variety of clinical scenarios and patients' comorbidities necessitate cooperation with other specialists (cardiologists, neurologists, etc.) in choosing the optimal management. Thrombosis risk must be carefully weighed against bleeding risk.
Collapse
Affiliation(s)
- Wojciech Michalski
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Grazyna Poniatowska
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Joanna Jonska-Gmyrek
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Jakub Kucharz
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland.
| | - Pawel Stelmasiak
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Karol Nietupski
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Katarzyna Ossolinska-Skurczynska
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Michal Sobieszczuk
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Tomasz Demkow
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Pawel Wiechno
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| |
Collapse
|
12
|
Lovrenski A, Vrekić Ž, Škrbić D, Višnjić BA, Vasilijević M, More LV. An autopsy case of massive pulmonary tumor embolism due to undiagnosed prostatic adenocarcinoma. Forensic Sci Med Pathol 2019; 16:152-156. [PMID: 31691070 DOI: 10.1007/s12024-019-00184-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 12/31/2022]
Abstract
Adenocarcinoma of the prostate is occasionally associated with pulmonary embolism, occurring as a result of secondary hypercoagulable states or cancer-associated emboli. The objective of this study was to provide a review of clinical, histopathological and immunohistochemical features of poorly differentiated prostatic adenocarcinoma, emphasizing the relevance of undiagnosed malignancy as a cause of pulmonary embolism. The current study describes the case of a 78-year-old male who experienced remarkable clinical symptoms suggestive of pulmonary embolism. Following several diagnostic examinations, the patient was diagnosed with pulmonary embolism, which led to the detection of prostatic adenocarcinoma. Poorly differentiated adenocarcinoma with a Gleason's score of nine was set as a definite diagnosis. Multiple tumor emboli within small and medium-sized pulmonary blood vessels were found in all specimens taken from lung tissue. Immunohistochemical analysis showed diffuse and strong positivity of tumor cells within pulmonary arteries. Hidden malignancy is a diagnostic challenge that should be considered in the differential diagnosis of pulmonary embolism. Laboratory and radiological findings with additional histopathological evaluation are needed for the definite diagnosis.
Collapse
Affiliation(s)
| | - Željka Vrekić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Dušan Škrbić
- Institute For Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | | | | | | |
Collapse
|
13
|
Johansen TEB, Zahl PH, Baco E, Bartoletti R, Bonkat G, Bruyere F, Cai T, Cek M, Kulchavenya E, Köves B, Mouraviev V, Pilatz A, Tandogdu Z, Tenke P, Wagenlehner FME. Antibiotic resistance, hospitalizations, and mortality related to prostate biopsy: first report from the Norwegian Patient Registry. World J Urol 2019; 38:17-26. [PMID: 31183524 DOI: 10.1007/s00345-019-02837-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/03/2019] [Indexed: 12/27/2022] Open
Affiliation(s)
- Truls E Bjerklund Johansen
- Department of Urology, Oslo University Hospital, Nydalen, Po. Box 4959, 0424, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Per-Henrik Zahl
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Eduard Baco
- Department of Urology, Oslo University Hospital, Nydalen, Po. Box 4959, 0424, Oslo, Norway
| | | | - Gernot Bonkat
- Department of Urology, alta uro AG, Basel, Switzerland
| | - Franck Bruyere
- Urologie, 2 bd Tonnelle, 37044, Tours, France
- Université Francois Rabelais de Tours, PRES Centre val de Loire, 37044, Tours, France
| | - Tommaso Cai
- Department of Urology, Santa Chiara Hospital, Trento, Italy
| | - Mete Cek
- Department of Urology, Medical Faculty of Trakya University, Edirne, Turkey
| | - Ekaterina Kulchavenya
- Urogenital Department, Novosibirsk Research TB Institute, 630040, Novosibirsk, Russian Federation
| | - Bela Köves
- South-Pest Teaching Hospital, Budapest, Hungary
| | - Vladimir Mouraviev
- University of Central Florida, Orlando, FL, USA
- Central Florida Cancer Institute, Davenport, FL, USA
| | - Adrian Pilatz
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany
| | - Zafer Tandogdu
- Department of Urology, Oslo University Hospital, Nydalen, Po. Box 4959, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Tenke
- South-Pest Teaching Hospital, Budapest, Hungary
| | - Florian M E Wagenlehner
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany
| |
Collapse
|
14
|
Gade IL, Brækkan SK, Næss IA, Hansen JB, Cannegieter SC, Rosendaal FR, Overvad K, Hindberg K, Hammerstrøm J, Gran OV, Tjønneland A, Severinsen MT, Kristensen SR. Long-Term Incidence of Venous Thromboembolism in Cancer: The Scandinavian Thrombosis and Cancer Cohort. TH OPEN 2018; 2:e131-e138. [PMID: 31249936 PMCID: PMC6524868 DOI: 10.1055/s-0038-1641678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/19/2018] [Indexed: 12/21/2022] Open
Abstract
The risk of venous thromboembolism (VTE) in patients who survive the first years after a cancer diagnosis after the acute effects of disease and treatment in comparison to a similar background population has been sparsely investigated. The aim of the study was to investigate if incidence rates (IRs) of VTE differed in patients who were alive at least 2 years after a cancer diagnosis without VTE compared with cancer-free references in a population-based cohort study. The study entry was 2 years after a first cancer diagnosis. For each cancer-exposed subject, five reference subjects were identified within the cohort. The IRs were calculated as number of VTEs per 1,000 person years (×10 -3 p-y) in total and in distinct cancer types and corresponding reference subjects. Incidence rate ratios (IRRs) were calculated by Poisson's regression. During a mean follow-up of 5.3 years, 110 VTEs occurred among the 7,288 cancer-exposed subjects and 321 VTEs occurred among the 36,297 identified reference subjects. The IR of VTE was higher for cancer-exposed subjects compared with reference subjects, IRs 3.7 × 10 -3 p-y, 95% CI: 3.1 to 4.5 and 1.9 × 10 -3 p-y, 95% CI: 1.7 to 2.2, respectively. IRs of VTE in most solid cancer types declined to almost the same level as in the reference subjects 2 years after cancer diagnosis, but remained higher in hematological cancers, IRR 4.0, 95% CI: 2.0 to 7.8.
Collapse
Affiliation(s)
- Inger Lise Gade
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sigrid K Brækkan
- Department of Clinical Medicine, K.G Jebsen Thrombosis Research and Expertise Centre (TREC), University of Tromsø-The Arctic University of Norway, Tromsø, Norway.,Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Inger Anne Næss
- Department of Haematology, Trondheim University Hospital, Trondheim, Norway
| | - John-Bjarne Hansen
- Department of Clinical Medicine, K.G Jebsen Thrombosis Research and Expertise Centre (TREC), University of Tromsø-The Arctic University of Norway, Tromsø, Norway.,Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Hindberg
- Department of Clinical Medicine, K.G Jebsen Thrombosis Research and Expertise Centre (TREC), University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Jens Hammerstrøm
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Olga V Gran
- Department of Clinical Medicine, K.G Jebsen Thrombosis Research and Expertise Centre (TREC), University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Anne Tjønneland
- Department of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marianne T Severinsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren R Kristensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
15
|
Mauracher LM, Posch F, Martinod K, Grilz E, Däullary T, Hell L, Brostjan C, Zielinski C, Ay C, Wagner DD, Pabinger I, Thaler J. Citrullinated histone H3, a biomarker of neutrophil extracellular trap formation, predicts the risk of venous thromboembolism in cancer patients. J Thromb Haemost 2018; 16:508-518. [PMID: 29325226 PMCID: PMC6294121 DOI: 10.1111/jth.13951] [Citation(s) in RCA: 168] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Indexed: 12/12/2022]
Abstract
Essentials Neutrophil extracellular traps (NETs) might play a role in cancer-related coagulopathy. We determined NET biomarkers and followed cancer patients for venous thromboembolism (VTE). We found a constant association with VTE for citrullinated histone H3. Biomarkers of NET formation could reflect a novel pathomechanism of cancer-related VTE. SUMMARY Background Neutrophil extracellular traps (NETs) are decondensed chromatin fibers that might play a role in the prothrombotic state of cancer patients. Objectives To investigate whether the levels of citrullinated histone H3 (H3Cit), a biomarker for NET formation, cell-free DNA (cfDNA) and nucleosomes predict venous thromboembolism (VTE) in cancer patients. Patients/Methods Nine-hundred and forty-six patients with newly diagnosed cancer or progression after remission were enrolled in this prospective observational cohort study. H3Cit, cfDNA and nucleosome levels were determined at study inclusion, and patients were followed for 2 years. VTE occurred in 89 patients; the cumulative 3-month, 6-month, 12-month and 24-month incidence rates of VTE were 3.7%, 6.0%, 8.1%, and 10.0%, respectively. Results Patients with elevated H3Cit levels (> 75th percentile of its distribution, n = 236) experienced a higher cumulative incidence of VTE (2-year risk of 14.5%) than patients with levels below this cut-off (2-year risk of 8.5%, n = 710). In a competing-risk regression analysis, a 100 ng mL-1 increase in H3Cit level was associated with a 13% relative increase in VTE risk (subdistribution hazard ratio [SHR] 1.13, 95% confidence interval [CI] 1.04-1.22). This association remained after adjustment for high VTE risk and very high VTE risk tumor sites, D-dimer level, and soluble P-selectin level (SHR 1.13, 95% CI 1.04-1.22). The association of elevated nucleosome and cfDNA levels with VTE risk was time-dependent, with associations with a higher risk of VTE only during the first 3-6 months. Conclusion These data suggest that biomarkers of NET formation are associated with the occurrence of VTE in cancer patients, indicating a role of NETs in the pathogenesis of cancer-associated thrombosis.
Collapse
Affiliation(s)
- L-M Mauracher
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - F Posch
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - K Martinod
- Program in Cellular and Molecular Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - E Grilz
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - T Däullary
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - L Hell
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - C Brostjan
- Department of Surgery, Medical University of Vienna, Austria
| | - C Zielinski
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - C Ay
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - D D Wagner
- Program in Cellular and Molecular Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - I Pabinger
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - J Thaler
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
16
|
Gade IL, Braekkan SK, Naess IA, Hansen JB, Cannegieter SC, Overvad K, Jensvoll H, Hammerstrøm J, Blix K, Tjønneland A, Kristensen SR, Severinsen MT. The impact of initial cancer stage on the incidence of venous thromboembolism: the Scandinavian Thrombosis and Cancer (STAC) Cohort. J Thromb Haemost 2017; 15:1567-1575. [PMID: 28585779 DOI: 10.1111/jth.13752] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Indexed: 12/13/2022]
Abstract
Essentials Impact of cancer stage on venous thromboembolism (VTE) risk is not well-known in all cancers. The Scandinavian Thrombosis and Cancer Cohort provides person-time data and validated VTEs. Impact of cancer stage on VTE incidence tended to vary with cancer type. Cancer stage may not per se be a risk factor for VTE in all cancer types. SUMMARY Background Absolute measures of the impact of cancer stage on the incidence of venous thromboembolism (VTE) in patients with distinct cancer types have not been investigated in a large population-based cohort study. Objectives To investigate differences in the incidence rates of objectively confirmed VTE according to the development of cancer in a large population-based cohort study. Cancer type and stage at the time of diagnosis were taken into account. Patients and Methods The Scandinavian Thrombosis and Cancer Cohort includes data regarding cancer types, stages and objectively confirmed VTE diagnoses among 144 952 participants followed from 1993 to 2012. We studied stage-specific incidence rates of VTE, and calculated incidence rate differences (IRDs) for VTE according to stages in patients with 10 types of solid cancer. Results During the entire follow-up, 335 VTEs occurred, of which 293 occurred within 5 years. The IRD of VTE in patients with distant metastasis as compared with those with localized disease indicated large variation depending on cancer type. The highest IRD was observed for pancreatic cancer (IRD of 187.0 × 10-3 person-years [p-y]; 95% confidence interval [CI] - 6.7 to 380.8), and the lowest IRD was observed for prostate cancer (IRD of 3.7 × 10-3 p-y; 95% CI - 7 to 15.2). Regional spread as compared with localized disease also indicated large variation depending on cancer type; the highest IRD was observed for uterine cancer (IRD of 37.6 × 10-3 p-y; 95% CI - 23.7 to 99), and the IRDs for breast and prostate cancer were close to zero. Conclusion More advanced cancer at the time of diagnosis was associated with a higher risk of VTE, but the strength of the associations differed substantially between cancer types.
Collapse
Affiliation(s)
- I L Gade
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - S K Braekkan
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - I A Naess
- Department of Hematology, Trondheim University Hospital, Trondheim, Norway
| | - J-B Hansen
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - S C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - H Jensvoll
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - J Hammerstrøm
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Blix
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - A Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - S R Kristensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - M T Severinsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
17
|
A rare case of prostatic ductal adenocarcinoma presenting as papillary metastatic carcinoma of unknown primary: A case report and review of the literature. HUMAN PATHOLOGY: CASE REPORTS 2016. [DOI: 10.1016/j.ehpc.2015.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
18
|
Gerotziafas GT, Elalamy I. [Risk of venous thromboembolism in cancer patients: Reality, actuality and perspectives]. Bull Cancer 2016; 103:764-75. [PMID: 27481723 DOI: 10.1016/j.bulcan.2016.07.001] [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: 11/14/2015] [Revised: 06/30/2016] [Accepted: 07/03/2016] [Indexed: 02/07/2023]
Abstract
Cancer is a leading cause of venous thromboembolism (VTE) and vice versa. Pulmonary embolism is the second cause of death in cancer patients. Tumor progression is associated with coagulation activation. The pathogenesis of thrombosis during cancer is particularly complex stemming from multiple connections of this disease with both systems of inflammation and hemostasis. The risk of VTE depends on cancer type and the stage of the disease, the anticancer treatments and the time since cancer diagnosis as well as on the presence of patient-related risk factors (i.e. age, obesity, previous history of VTE, underlying diseases…). The presence of other precipitating factors and the duration of the exposure to them are also key elements in the assessment of such a thrombotic risk. It is therefore important to identify all the VTE risk factors to identify patients at high vascular risk and to determine the period during which this risk is significantly increased. The integration of biomarkers of hypercoagulability in proposed risk assessment models for VTE will improve their capacity to identify patients eligible for pharmacological thromboprophylaxis. In this review, we report the current status of knowledge on the connection between cancer and hypercoagulability, the numerous risk factors for VTE must be identified in cancer patients and the best methodology to build a more accurate assessment of this vascular risk in such a complex medical context.
Collapse
Affiliation(s)
- Grigoris T Gerotziafas
- Université Paris VI, faculté de médecine Pierre-et-Marie-Curie, institut universitaire de cancérologie, Inserm U938, 75012 Paris, France; Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Est Parisien, hôpital Tenon, service d'hématologie biologique, 75020 Paris, France.
| | - Ismail Elalamy
- Université Paris VI, faculté de médecine Pierre-et-Marie-Curie, institut universitaire de cancérologie, Inserm U938, 75012 Paris, France; Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Est Parisien, hôpital Tenon, service d'hématologie biologique, 75020 Paris, France
| |
Collapse
|
19
|
Ording AG, Nielsen ME, Smith AB, Horváth-Puhó E, Sørensen HT. Venous thromboembolism and effect of comorbidity in bladder cancer: A danish nationwide cohort study of 13,809 patients diagnosed between 1995 and 2011. Urol Oncol 2016; 34:292.e1-8. [DOI: 10.1016/j.urolonc.2016.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/07/2016] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
|
20
|
Barresi V, Ieni A, Cardia R, Licata L, Vitarelli E, Reggiani Bonetti L, Tuccari G. HOXB13 as an immunohistochemical marker of prostatic origin in metastatic tumors. APMIS 2015; 124:188-93. [DOI: 10.1111/apm.12483] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/22/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Valeria Barresi
- Department of Human Pathology “G. Barresi”; University of Messina; Messina Italy
| | - Antonio Ieni
- Department of Human Pathology “G. Barresi”; University of Messina; Messina Italy
| | - Roberta Cardia
- Department of Human Pathology “G. Barresi”; University of Messina; Messina Italy
| | - Luana Licata
- Department of Human Pathology “G. Barresi”; University of Messina; Messina Italy
| | - Enrica Vitarelli
- Department of Human Pathology “G. Barresi”; University of Messina; Messina Italy
| | - Luca Reggiani Bonetti
- Department of Forensic Medicine; Laboratory and Pathologic Anatomy; Polyclinic of Modena; Modena Italy
| | - Giovanni Tuccari
- Department of Human Pathology “G. Barresi”; University of Messina; Messina Italy
| |
Collapse
|
21
|
Alibhai SMH, O'Neill ME. Comorbidity and the risk of venous thromboembolism in prostate cancer. Cancer 2015; 121:3574-6. [PMID: 26149890 DOI: 10.1002/cncr.29536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/02/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Shabbir M H Alibhai
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Meagan E O'Neill
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|