Thrombosis risk and survival in cancer patients with elevated C‐reactive protein

Abstract

Summary. Background: The incidence of venous thromboembolism (VTE) is increased among cancer patients. Objective: We assessed serum levels of C-reactive protein (CRP) in order to study their prognostic significance for VTE and survival in the prospective observational Cancer and Thrombosis Study (CATS). Patients and methods: This study includes patients with recently diagnosed cancer or progression of disease after remission. Occurrence of VTE and information on the patientsÕ anti-cancer-treatment are recorded. Observation ends with occurrence of objectively confirmed VTE, death or after 2 years. CRP levels were determined by an immunonephelometric method. Results: We included 705 consecutive patients with solid tumors. During the observation period, VTE occurred in 43 (6.1%) patients and 413 (58.6%) died. The cumulative probability of VTE was 6.6% after 1 year. In univariate analysis, CRP (as metric variable, per double increase) was associated with VTE [hazard ratio (HR) 1.2, 95% confidence interval (CI) 1.1-1.3 P = 0.048]. However, in multivariable analysis including chemotherapy, surgery and radiotherapy, metastasis, cancer-site and sP-selectin the association with VTE (HR 1.0, 95% CI 0.9-1.2 P = 0.932) was no longer observed. CRP was clearly associated with worse survival probability with a HR of 1.3 (95% CI 1.2-1.3, P < 0.0001) in multivariable analysis. The cumulative survival after 12 months was 43% in patients with CRP above the 75th percentile (1.8 mg dL ) and 82% in those below the 75th percentile. Conclusions: In cancer patients elevated CRP was not independently associated with VTE. CRP was significantly associated with worse survival.

Association Between Decreased Serum Albumin With Risk of Venous Thromboembolism and Mortality in Cancer Patients

“…Although leukocyte count is also a risk factor for VTE occurrence in our cohort, its inclusion in the multivariable model did not diminish the association of albumin level and VTE occurrence. In a previous investigation in a subset of solid tumor patients of the CATS cohort, Kanz et al showed that the VTE risk increased by 20% (HR 1.2, 95% CI 1.0-3.8, p 5 .037) per double increase in CRP levels [18]. We substituted leukocyte counts for CRP levels in the sensitivity analysis of this investigation and obtained similar results.…”

Interleukin levels and their potential association with venous thromboembolism and survival in cancer patients

“…Moreover, IL-6 might not only be induced by chemotherapy, but also mediate therapy resistance, which could add to the worse prognosis of patients with high circulating IL-6 levels [38]. Interestingly, in a former study by our group, enhanced levels of C-reactive protein (CRP), an acute-phase protein known to be induced strongly by IL-6, indicated a worse prognosis of cancer patients not associated with VTE frequency [13]. These observations suggest that a direct tumour-promoting effect might underlie the negative prognostic impact of IL-6.…”

“…Many risk factors related to patient characteristics, tumour types and treatment influence the development of VTE in cancer patients [6]. A number of biomarkers of haemostasis and inflammatory markers have been found to play the role of risk factors of VTE in patients with cancer [13][14][15][16].…”

ATIQCTPC: a nanomedicine capable of targeting tumor and blocking thrombosis in vivo

“…As thrombosis is one of the serious complications in cancer patients, the dual actions support that as an antitumor agent, ATIQCTPC is able to prevent cancer patients from suffering from thrombosis. 32,33 As mentioned earlier, the serum concentrations of TNF-α and IL-8 of the S180 mice orally treated with 0.01 μmol/kg/day of ATIQCTPC are significantly lower than those of the S180 mice orally treated with NS. The findings of ATIQCTPC effectively downregulating serum TNF-α and IL-8 of S180 mice lead to a hypothesis that via decreasing serum TNF-α and IL-8, ATIQCTPC slows tumor growth of S180 mice.…”