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Blood, 1 October 2008, Vol. 112, No. 7, pp. 2703-2708.
Prepublished online as a Blood First Edition Paper on June 6, 2008; DOI 10.1182/blood-2008-02-142422.
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CLINICAL TRIALS AND OBSERVATIONS
High plasma levels of soluble P-selectin are predictive of venous thromboembolism in cancer patients: results from the Vienna Cancer and Thrombosis Study (CATS)
Cihan Ay1,
Ralph Simanek1,
Rainer Vormittag1,
Daniela Dunkler2,
Guelay Alguel1,
Silvia Koder1,
Gabriela Kornek3,
Christine Marosi3,
Oswald Wagner4,
Christoph Zielinski3, and
Ingrid Pabinger1
1 Clinical Division of Haematology and Haemostaseology, Department of Medicine I,
2 Core Unit for Medical Statistics and Informatics, Section of Clinical Biometrics,
3 Clinical Division of Oncology, Department of Medicine I, and
4 Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
Cancer patients are at high risk for venous thromboembolism (VTE). Laboratory parameters with a predictive value for VTE could help stratify patients into high- or low-risk groups. The cell adhesion molecule P-selectin was recently identified as risk factor for VTE. To investigate soluble P-selectin (sP-selectin) in cancer patients as risk predictor for VTE, we performed a prospective cohort study of 687 cancer patients and followed them for a median (IQR) of 415 (221-722) days. Main tumor entities were malignancies of the breast (n = 125), lung (n = 86), gastrointestinal tract (n = 130), pancreas (n = 42), kidney (n = 19), prostate (n = 72), and brain (n = 80); 91 had hematologic malignancies; 42 had other tumors. VTE occurred in 44 (6.4%) patients. In multivariable analysis, elevated sP-selectin (cutoff level, 53.1 ng/mL, 75th percentile of study population) was a statistically significant risk factor for VTE after adjustment for age, sex, surgery, chemotherapy, and radiotherapy (hazard ratio = 2.6, 95% confidence interval, 1.4-4.9, P = .003). The cumulative probability of VTE after 6 months was 11.9% in patients with sP-selectin above and 3.7% in those below the 75th percentile (P = .002). High sP-selectin plasma levels independently predict VTE in cancer patients. Measurement of sP-selectin at diagnosis of cancer could help identify patients at increased risk for VTE.
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