Full Length ArticleHigh plasma levels of soluble P-Selectin and Factor VIII predict venous thromboembolism in non-small cell lung cancer patients: The Thrombo-Nsclc risk score
Introduction
Cancer patients have a higher risk of developing venous thromboembolism (VTE), which is their most common cause of death after tumor progression [1]. Lung cancer is highly associated with VTE, and patients are six times more likely to have a pulmonary embolism (PE) compared to the healthy population in the 12 months before diagnosis [2]. Chemotherapy constitutes an additional risk for newly diagnosed patients. Non-small cell lung cancer (NSCLC) accounts for more than 80% of lung cancers. NSCLC is primarily treated with platins, and VTE is a common finding during this therapy [3]. Therefore, anticoagulant prophylaxis should be considered during the treatment period. For safety and economic reasons, indiscriminate anticoagulation is not recommended, and treatment should be limited to those patients at highest thromboembolic risk. Nevertheless, the identification of the most appropriate candidates still poses a challenge to specialists. A decade ago, a risk prediction model, the Khorana score (KRS), was developed. Assessment of platelet and leukocyte count, haemoglobin level, body mass index (BMI) and tumor localization, makes it possible to allocate patients to high, intermediate or low VTE risk groups [4]. Nonetheless, KRS exhibits limitations, especially when used with lung cancer patients [[5], [6], [7], [8], [9]]. Furthermore, KRS and other alternative models have been built upon cohorts of patients with heterogeneous tumors [4,[10], [11], [12]]. Thus, designing NSCLC-specific tools to better detect suitable candidates for anticoagulation is mandatory. To fill this gap, we performed a study with a cohort of NSCLC patients, in order to construct a predictive VTE risk model based on the association of variables assessed before chemotherapy with subsequent occurrence of VTE.
Section snippets
Patients and study design
This is a prospective, observational one-center study with newly diagnosed patients with locally advanced or metastatic NSCLC who were about to undergo systemic outpatient chemotherapy. Ethical approval was received from the Medical Ethical Committee of Hospital Torrecárdenas (Almería, Spain). Signed informed consent was obtained from each patient. Inclusion criteria were age >18 years, ECOG 0-2, suitability for treatment with outpatient chemotherapy according to standard guidelines and life
Results and discussion
This is the first attempt to develop a VTE risk score to apply to NSCLC patients to face chemotherapy. 90 consecutive newly diagnosed NSCLC patients were recruited in our center between February 2015 and March 2016. Age, tumor histology and stage, metastasis, functional status and comorbidity profile did not differ from those in other series, although the proportion of male patients was higher than expected [3,9]. Median baseline levels of FVIII (%), fibrinogen, D-dimer and CRP were higher than
Conclusions
In summary, baseline sP-selectin and FVIII (%) were independently associated with a prospective study with newly diagnosed NSCLC patients due to undergo outpatient chemotherapy. The remarkably large risk imparted by high sP-selectin levels allowed us to build an encouraging model to predict the VTE risk which could thus be useful to identify candidates for thromboprophylaxis. These results should prompt further research to confirm the validity of the Thrombo-NSCLC risk score.
CRediT authorship contribution statement
V.E. Castellón planned research, obtained baseline data, followed-up patients, wrote the manuscript and approved the final version; P. Pérez Segura planned research, read critically the manuscript and approved the final version; A.J. Muñoz Martín contributed to study design, read critically the manuscript and approved the final version; A. López Farré performed non-routine analytical methods, read critically the manuscript and approved the final version; L. Canosa Ruiz followed-up patients,
Declaration of competing interest
None.
Acknowledgements
This work was supported by Leo Pharma. This entity has not contributed to the study design, data analysis, interpretation of the results, drafting of the document, or in the decision regarding publication in any way.
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