ACTIVATION OF COAGULATION AND FIBRINOLYSIS IN PATIENTS WITH LUNG-CANCER - RELATION TO TUMOR STAGE AND PROGNOSIS

Activation of coagulation and fibrinolysis within tumour tissues is thought to be associated with tumour growth, angiogenesis, and metastasis. The plasma levels of markers of thrombin and plasmin generation arc sensitive tools for monitoring activation of coagulation and fibrinolysis. We studied 47 patients with histologically confirmed lung cancer, 15 with small cell (SCLC) and 32 with non-small cell lung cancer (NSCLC). The plasma levels of the following markers were assessed: thrombin-antithrombin III complex (TAT), prothrombin activation fragment F1 + 2, plasmin-alpha2-antiplasmin complex (PAP) and the split product from cross-linked fibrin, D-dimer. The first sample was obtained before receiving any specific antineoplastic treatment. The patients were followed thereafter until treatment was terminated. There was no difference in activation markers between patients with SCLC and NSCLC. Comparing patients with limited discase to those with extensive discase, there were significant differences in TAT (median 3.0 (1.9-9.8) vs 5.3 (1.8-35.6) mug/l, P = 0.021) and D-dimer (569 (135-1948) vs 1288 (120-2221) mug/l, P = 0.014). According to the response to subsequent treatment, those who achieved complete or partial tumour remission had significantly lower baseline levels samples than non-responders (TAT 2.9 (1.9-4.0) vs 4.7 (1.8-35.6) mug/l, P = 0.0047; D-dimer 527 (135-1149) vs 1242 (120-2221) mug/l, P = 0.0013). Thus, the increase of TAT and D-dimer appears to be related to tumour spread. The results suggest that high levels of these markers might be a sign of unfavourable prognosis in patients with lung cancer. The possible predictive value and the relevance of these markers in supporting diagnostic and therapeutic decisions should be further evaluated.