Association between Level of Tumor Markers and Development of VTE in Patients with Pancreatic, Colorectal and Ovarian Ca: Retrospective Case- Control Study in Two Community Hospitals

Abstract

The risk of venous thromboembolism (VTE) is increased in patients with cancer. However, the role of tumor markers as potential indicators of increased risk of VTE is still undetermined. In this retrospective observational case control study, levels of the tumor markers CEA, CA 19-9 and CA 125 in patients with colorectal, pancreatic, and ovarian cancer respectively, who were admitted to two community hospitals between January 2001 and December 2011, were compared between patients who were VTE positive and those who were VTE negative. The primary goal of this study was to determine whether VTE positive cancer patients had higher tumor marker levels compared to VTE negative cancer patients. In our study, 66.7% (48/72) of patients who were positive for VTE had elevated tumor markers while 65.3% (66/101) of patients who were negative for VTE had low (normal) tumor markers, indicating an association of high tumor marker levels with the diagnosis of VTE. This was statistically significant with an odds ratio of 3.77 and p-value of <0.0001 (95% CI of 1.99-7.14). When the VTE group was further divided into DVT and PE groups, 70.2% (40/57) of patients in the DVT positive group had high tumor markers with a p value of <0.0001 and an odds ratio of 3.99 (95% CI of 2.02 to 7.89) while 57.9% (11/19) of patients in pulmonary embolism positive group had high tumor markers; this was, however, not statistically significant (p-value of 0.35 and a CI of 0.59 to 4.10). In this retrospective study of 173 individuals with a diagnosis of either colorectal, pancreatic, or ovarian Cancer, higher tumor marker levels (CEA, CA 19-9, and CA 125 respectively) were associated with an increased risk of VTE, either DVT or PE. However, when further divided into either DVT or PE groups, the association remained statistically significant only for DVT but not for PE.

A case of Trousseau’s syndrome due to intrahepatic cholangiocarcinoma with an extremely high level of CA19-9

“…Given that tumor makers are usually considered only as diagnostic biomarkers, the pathological significance of an elevation in their levels is not seriously considered. However, the elevated tumor maker levels such as CA19-9, CEA, CA125, CA15-3, and Sialyl Lewis X (SLX) in the present patient might have been triggers for the observed thrombotic events (Table 1), as reported in a previous study [12]. Although thromboembolism in cancer patients is caused by multiple factors such as tissue factor, cytokines, and mucin, the tumor maker level should be kept as low as possible to avoid additional thrombotic events.…”

Characteristics and outcomes of cancer patients who develop pulmonary embolism: A cross‑sectional study

“…CEA has been reported to be associated with an increased risk of developing VTE in patients with pancreatic, colorectal and ovarian cancer ( 21 ), and is related to PE in patients with lung cancer, with a positive correlation with D-dimer values ( 22 ). To the best of our knowledge, the present study is the first to describe low levels of CEA as a potential biomarker for detecting PE in asymptomatic cancer patients.…”

Hyperlipidemia as a risk factor for Trousseau syndrome‑related cerebral infarction in patients with advanced gastrointestinal cancer

“…However, these tumor markers were not found to be predictive factors for the occurrence of Trousseau syndrome-related cerebral infarction. Cancer may mediate the pathophysiology of stroke either directly or via coagulation disorders and infections (33). D-dimer, a degradation product of fibrin thrombus produced by the action of thrombin, activated factor XIII and plasmin, is known to be a highly sensitive index for thrombosis (34).…”