title: Hypercoagulability as a prognostic factor for survival in patients with metastatic renal cell carcinoma.
abstract: BACKGROUND
  In experimental systems, interference with coagulation can affect tumor biology. We suggested that abnormal coagulation could be a negative predictor for response to immunotherapy and survival among patients with metastatic renal cell carcinoma (MRCC).
  
  
  METHODS
  To address this issue, retrospective analysis of 289 previously untreated MRCC patients entering on institutional review board-approved clinical trials was conducted between 2003 and 2006. In addition, two groups of MRCC patients with (n = 28) or without (n = 28) hypercoagulability were compared in a case-control study. Baseline and treatment characteristics were well balanced.
  
  
  RESULTS
  Hypercoagulability was present at treatment start in 40% of patients. Median baseline fibrinogen was 6.2 mg/dl. Serious disorders were found in 68% of patients. Abnormal coagulation was strongly associated with a number of metastatic sites (2 and more metastatic sites vs. 0-1 (P = .001). Patients with high extent of hypercoagulability had significantly higher number of metastatic sites (P = .02). On univariate analysis, patients with hypercoagulability had significantly shorter overall survival than patients with normal coagulation; median survivals of 8.9 and 16.3, respectively (P = .001).Short survival and low response rate also were significantly associated with hypercoagulability in a case-control study. Median survival was 8.2 months and 14.6 months, respectively (P = .0011). Disease control rate (overall response + stable disease) was significantly higher in patients with normal coagulation: 71.4 versus 42.9% (P = .003).
  
  
  CONCLUSIONS
  Hypercoagulability disorders were found to be prognostic factor for response rate to systemic therapy and survival in patients with MRCC.
authors.affiliation: Department of Biotherapy, Clinical Research Laboratory, N.N. Blokhin Russian Cancer Research Center, Kidney Cancer Research Bureau, Moscow, Russia. office@kidneytumor.org
authors.forename: Ilya V
authors.initials: IV
authors.lastname: Tsimafeyeu
authors.forename: Lev V
authors.initials: LV
authors.lastname: Demidov
authors.forename: Albina V
authors.initials: AV
authors.lastname: Madzhuga
authors.forename: Oksana V
authors.initials: OV
authors.lastname: Somonova
authors.forename: Anna L
authors.initials: AL
authors.lastname: Yelizarova
mesh_terms: D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000473:pathology / Q000628:therapy; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007167:Immunotherapy; D007680:Kidney Neoplasms / Q000097:blood* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D019851:Thrombophilia / Q000097:blood / Q000473:pathology*; D016896:Treatment Outcome