PROGNOSTIC IMPACT OF AN ACTIVATION OF COAGULATION IN LUNG-CANCER

Background. There is evidence that activation of coagulation by influe ncing tumour biology may have impact on clinical course of lung cancer . Patients and methods. We measured the activation markers thrombin-an tithrombin complex (TAT) and prothrombin fragment F1+2 in 99 lung canc er patients immediately after diagnosis, before antineoplastic treatme nt. Outcome was assessed at the end of appropriate standard primary th erapy (four to six courses of chemotherapy, surgery or radiation). Res ults and conclusions. The activation markers (means +/- SEM) were lowe r in the 33 responders (RSP; complete or partial remission) than in th e 66 non-responders (NRSP): TAT 3.96 +/- 0.48 vs. 9.69 +/- 1.57 mu g/l (P < 0.001), and F1+2 1.09 +/- 0.09vs. 1.64 +/- 0.25 nmol/l (P < 0.05 ). TAT levels were > 6 mu g/l in 30 of 66 (45%) NRSP, but only 4 of 33 (12%) RSP. 88% of patients with TAT less than or equal to 6 mu g/l ac hieved remission, and 45% with TAT > 6 mu g/l (P = 0.0014). In the sub group of 46 patients with advanced disease, the six RSP showed lower T AT than the 40 NRSP: 4.65 +/- 0.94 vs. 11.92 +/- 2.49 mu g/l (P < 0.01 ); one of six (17%) RSP, but 21 of 40 (53%) NRSP showed TAT > 6 mu g/l . These data suggest that in lung cancer the activation of coagulation is an independent prognostic factor, since TAT levels were different between RSP and NRSP, also within the homogeneously unfavourable metas tatic subgroup. It should be further studied, whether TAT can identify patients, whose prognosis could be improved by anticoagulation as an adjunct to standard antineoplastic therapy.