Hypercoagulability as a prognostic factor for survival in patients with metastatic renal cell carcinoma

Abstract

BackgroundIn 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).MethodsTo 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.ResultsHypercoagulability 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).ConclusionHypercoagulability disorders were found to be prognostic factor for response rate to systemic therapy and survival in patients with MRCC.

Clinical significance of plasma fibrinogen and D-dimer in predicting the chemotherapy efficacy and prognosis for small cell lung cancer patients

“…Our findings accord with previous studies addressing the clinical and prognostic significance of fibrinogen and D-dimer in cancer patients in general [17][18][19][20][21][22][23][24][25][26][27][28][29][30]. Regarding NSCLC patients specially, Sheng et al [32] found significantly increased risk of disease progression and death among patients with hyperfibrinogenemia, and Altiay et al [28] reported that elevated plasma levels of D-dimer were associated with decreased survival and a poor response to chemotherapy.…”

“…Additionally, a growing body of evidence suggests the existence of a correlation between activation of coagulation and fibrinolysis and tumor angiogenesis, invasion, progression, and metastatic spread [9][10][11][12][13][14][15][16]. In clinical studies, many researchers have documented the relationship between hemostatic abnormalities and several malignancies, and various hemostasis markers associated with tumor staging and prognosis have previously been reported [17][18][19][20][21][22][23][24][25][26][27][28][29][30]. In lung cancer, plasma fibrinogen and D-dimer levels are associated with tumor pathological stage, response to therapy, and survival [26][27][28][29][30].…”

Pretherapeutic Plasma Fibrinogen Level is an Independent Survival Predictor in Renal Cell Carcinoma

“…To our knowledge, only 5 reports have recently demonstrated an association between the plasma fibrinogen levels and clinical features in RCC patients [9,10,11,12,13]. In a retrospective analysis of 289 previously untreated metastatic RCC patients, Tsimafeyeu et al [9] reported that the prevalence of hypercoagulability was associated with metastatic RCC, and that hypercoagulability determines worse survival and response to treatment for metastatic RCC.…”

“…In a retrospective analysis of 289 previously untreated metastatic RCC patients, Tsimafeyeu et al [9] reported that the prevalence of hypercoagulability was associated with metastatic RCC, and that hypercoagulability determines worse survival and response to treatment for metastatic RCC. Xiao et al [10] found that preoperative plasma fibrinogen levels are elevated in patients with RCC with distant metastasis or lymph node metastasis.…”

“…In Japan, inflammatory responses such as fever, ESR, CRP and serum protein fractions in RCC patients are known to be correlated with disease progression [8]. However, there have been only 5 reports focused on pretherapeutic plasma fibrinogen levels, which represents 1 of the inflammatory parameters used to predict disease progression at the time of diagnosis in RCC patients [9,10,11,12,13]. The data from these reports demonstrated that the pretherapeutic plasma fibrinogen level is an important tool for predicting disease progression in RCC patients either with or without metastasis.…”