title: Prospective evaluation of protein C and factor VIII in prediction of cancer-associated thrombosis.
abstract: Venous thromboembolism (VTE) is a preventable disease, yet it is one of the leading causes of death among patients with cancer. Improving risk stratification mechanisms will allow us to personalize thrombo-prophylaxis strategies. We sought to evaluate Collagen and Thrombin Activated Platelets (COAT-platelets) as well as protein C and factor VIII as biomarkers predictive of cancer-associated thrombosis in a prospective cohort of patients with cancer. Protein C was selected as a candidate based on bioinformatics prediction. Blood samples were collected before chemotherapy. All specimen processing was blinded to clinical data. Surveillance and adjudication of the main outcome of VTE was performed for up to 1 year. We used Cox proportional hazard regression to measure the association of biomarkers and incident events using SAS 9.2 for all statistical analysis. Death was modeled as a competing event. Among 241 patients followed for an average of 10.4 months, 15% died and 13% developed a VTE. COAT-platelets were not predictive of VTE. Low levels of pre-chemotherapy protein C (<118%) (HR 2.5; 95% CI 1.1-5.5) and high baseline factor VIII (>261% I) (HR 3.0; 95% CI 1.1-8.0) were predictive of VTE after adjusting for age, Khorana prediction risk, metastatic disease and D dimer. In addition, low protein C was predictive of overall mortality independent of age, metastatic disease and functional status (HR 2.8; 95% CI 1.3-6.0). Addition of these biomarkers to cancer-VTE risk prediction models may add to risk stratification and patient selection to optimize thrombo-prophylaxis.
authors.affiliation: Department of Medicine - Cardiology-Vascular Section, University of Oklahoma Health Sciences Center, United States. Electronic address: ATafur@Northshore.org.
authors.forename: A J
authors.initials: AJ
authors.lastname: Tafur
authors.affiliation: Department of Medicine - Cardiology-Vascular Section, University of Oklahoma Health Sciences Center, United States.
authors.forename: G
authors.initials: G
authors.lastname: Dale
authors.affiliation: Department of Medicine - Hematology-Oncology section, University of Oklahoma Health Sciences Center, United States.
authors.forename: M
authors.initials: M
authors.lastname: Cherry
authors.affiliation: Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, United States.
authors.forename: J D
authors.initials: JD
authors.lastname: Wren
authors.affiliation: Department of Oncology, Division of Medical Oncology, Mayo Clinic Rochester, United States.
authors.forename: A S
authors.initials: AS
authors.lastname: Mansfield
authors.affiliation: Department of Medicine - Hematology-Oncology section, University of Oklahoma Health Sciences Center, United States.
authors.forename: P
authors.initials: P
authors.lastname: Comp
authors.affiliation: Department of Medicine - Cardiology-Vascular Section, University of Oklahoma Health Sciences Center, United States.
authors.forename: S
authors.initials: S
authors.lastname: Rathbun
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, United States.
authors.forename: J A
authors.initials: JA
authors.lastname: Stoner
mesh_terms: D000368:Aged; D005169:Factor VIII / Q000032:analysis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D015539:Platelet Activation; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011486:Protein C / Q000032:analysis*; D054556:Venous Thromboembolism / Q000097:blood / Q000209:etiology*
chemical_list: D011486:Protein C; D005169:Factor VIII
keywords: Bioinformatics; Biomarkers; Cancer; Venous thromboembolism