PROGNOSTIC SIGNIFICANCE OF BLOOD COAGULATION TESTS IN LUNG CANCER

Domenico Ferrigno, MD (*), Gianfranco Buccheri, MD (*), Irene Ricca, MD (§)

From the (*) Cuneo Lung Cancer Study Group (www.culcasg.org), at the Division of Respiratory Medicine, "S. Croce e Carle" Hospital, I-12100 Cuneo, Italy, (§) Department of Oncology-Haemathology,"San Giovanni Battista" Hospital, I-10126 Torino, Italy

The correspondence regarding the manuscript should be sent to:

Domenico Ferrigno, MD, Divisione di Pneumologia, Ospedale "S.Croce e Carle", I-12100 Cuneo, Italy, Tel.: + 39.171.441733, Fax: + 39.171.441764, E-mail: ferrigno@culcasg.org

Running Head
HAEMOSTATIC ABNORMALITIES IN LUNG CANCER

Key words
Lung cancer, prognosis, blood coagulation, pre-thrombotic state

Abstract
Many authors demonstrated that activation of coagulation has an impact on the clinical course of lung cancer.

This study was carried out in order to assess the potential prognostic significance of platelet count (P), prothrombin time (PT), partial thromboplastin time (PTT), anti-thrombin III (AT-III), fibrinogen (F), D-dimer (DD), factor II (F-II), factor VII (F-VII), factor X (F-X), protein C clotting (PCC), plasminogen (PL), and antiplasmin (AP) in 343 consecutive new lung cancer patients, , during the last 4 years. A set of 32 anthropometric, clinical, physical, laboratory, radiological, and pathological variables was prospectively recorded for all patients. Patients were carefully followed-up, and their subsequent clinical course recorded.

The most frequent abnormalities regarded DD, F, and AT-III (55, 42, and 28% of the cases), followed by F-VII (27%), F-X (20%), and F-II (16%). Among the 12 clotting variables, the strongest relationships were those of F-II and F-X (rs=0.565), PT and F-VII (rs=0.562), F-VII and F-X (rs=0.514), PL and AP (rs=0.515), F and P (rs=0.490), AT-III and PCC (rs=0.476). Univariate analyses of survival showed that prolonged values of PT (p<0.043), and abnormally elevated values of DD (p<0.003), F (p<0.031), and P (p<0.047) were all associated with a bad prognosis. The multivariate model, on the contrary, did not confirm the prognostic capability of the coagulation factors.

This data indicates that there has been a subclinical activation of blood coagulation in lung cancer patients since the early clinical stages of the disease. In addition, the clotting activation is confirmed as predictor of survival, although not independently of the other prognostic factors.