Journal of Clinical Oncology, Vol 5, 1998-2003, Copyright © 1987 by American Society of Clinical Oncology
Hemostatic abnormalities in untreated cancer: incidence and correlation with thrombotic and hemorrhagic complications
S Nand, SG Fisher, R Salgia and RI Fisher
Department of Medicine, Loyola University Stritch School of Medicine, Maywood, IL 60153.
Over a 2-month period, 40 patients with untreated malignancy were studied
for protein-C (PRC), antithrombin-III (AT-III), fibrinopeptide A (FPA),
routine hemostatic screens, and presence of liver metastases to determine
pretreatment changes of hemostasis and relate them to subsequent
development of thrombotic or hemorrhagic complications. These patients were
observed for a mean period of 18 months. There were 23 males and 17 females
with a median age of 64 years. Nine patients had lung carcinoma, 8 colon
carcinoma, 7 lymphoma, 5 breast carcinoma, 5 head and neck carcinoma, 2
acute leukemia, 2 prostate carcinoma, 1 adenocarcinoma of unknown primary,
and 1 sarcoma. Eight patients had liver metastases. PRC was measured by
ELISA, AT-III by radial immunodiffusion, and FPA by RIA. Four patients had
decreased AT-III, 28 had decreased levels of PRC, and 39 had elevated
levels of FPA. All patients with liver metastases had low PRC. Albumin
levels were lower in patients with low PRC (mean 3.3 g/dL v 4.0 g/dL for
others). Eight patients, five with liver metastases, developed thrombotic
(4), hemorrhagic (3), or both (1) complications. Statistically significant
associations were found between (1) presence of liver metastases and
development of thrombotic and hemorrhagic complications (P less than .001),
(2) presence of liver metastases and decreased PRC (P = .001), and (3)
lower albumin levels and decreased PRC (P = .0001). Our study documents
early changes of hemostasis in untreated malignancy. We extend previous
observations that decreased PRC levels in malignancy may be due to poor
synthetic functions of liver. Presence of liver metastases was the only
factor associated with subsequent development of thrombotic and hemorrhagic
complications. Biochemical markers of hemostatic abnormalities, even though
encountered frequently at the time of presentation, are of little
predictive value for development of thrombotic and hemorrhagic
complications.
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