Clinical and prognostic significance of coagulation assays in melanoma

Abstract

The activation of coagulation and fibrinolysis is frequently found among cancer patients. Such tumors are considered to be associated with a higher risk of invasion, metastases, and eventually worse outcome. The aim of this study is to explore the clinical and prognostic value of blood coagulation tests for melanoma patients. Pretreatment blood coagulation tests including prothrombin time (PT), activated partial thromboplastin time (APTT), prothrombin activity (PTA), international normalized ratio (INR), D-dimer (DD), fibrinogen (F) levels, and platelet (PLT) counts were carried out. This prospective study included 61 melanoma patients [stage I-II (n=10), stage III (n=14), stage IV (n=37), M1c (n=26) disease], and 50 healthy controls. It included 34 (56%) men, median age 53 years, range 16-88 years. Over half of the patients (54%) were in the metastatic stage and most of them (70%) had M1c. The plasma level of pretreatment blood coagulation tests including DD, F, APTT, INR levels, and PLT counts showed a statistically significant difference between the patient and the control group (P<0.001 for all, but P=0.049 for INR). The levels of INR, DD, F, and PLT counts were higher and APTT was lower in the melanoma group, whereas the PT and PTA levels did not show any significant difference. There was a significant association between PT, PTA, INR, and PLT levels and the age of the patient. Patients with node metastasis in M0 disease had higher levels of PTA and PLT counts (P=0.002 and 0.048, respectively) and lower levels of PT and INR (P=0.056 and 0.046, respectively). The M1c patients tended to have higher plasma F levels (437 vs. 297 mg/dl, P=0.055) than M1a and M1b patients. The 1-year survival rate for all patients was 70%. In association with distant metastasis, advanced metastatic stage (M1c), elevated lactate dehydrogenase, and erythrocyte sedimentation rate, only elevated plasma F levels had a significantly adverse effect on survival among the coagulation parameters (P=0.031). The 1-year survival rates for patients with high and normal F levels were 58 and 88%, respectively. In conclusion, changes in the coagulation-fibrinolytic system are often present in melanoma and elevation in the plasma F level is associated with decreased survival.

D‐dimers in malignant melanoma: Association with prognosis and dynamic variation in disease progress

“…Activated coagulation in cancer patients is implicated both in tumor progression and in development of VTE . While several studies have linked activated coagulation with many different cancer types, there are only few publications in malignant melanoma . To our knowledge, this is the first large‐scale cohort study examining the association between coagulation and survival in malignant melanoma patients.…”

“…In contrast to this work another study published by Tas et al . including 61 melanoma patients [stage I–II ( n = 10), stage III ( n = 14), stage IV ( n = 37)] showed higher D‐dimer levels in the melanoma group compared to control patients, but they could not find a correlation to the metastatic stage and see no significant effect on survival (1‐year follow‐up) . Both studies fall short in size and variation of the study population, as the study from Bottasso et al .…”

Elevated erythrocyte sedimentation rate is associated with metastatic disease and worse survival in patients with cutaneous malignant melanoma

“…A limited number of our previously performed trials, which included small sample sizes (<100 patients), were focused specifically on melanoma and yielded similar confirmative results (12-15). The P-values in those studies were significantly low, namely P<0.001 (12,14), P=0.001 (13) and P=0.002 (15). The association of systemic inflammation and patient survival may have implications for immune modulation in melanoma.…”

“…However, increased ESR levels have been identified as an adverse prognostic factor for survival in melanoma patients as a secondary finding when different parameters were investigated in our previously published trials (12)(13)(14)(15).…”

D-Dimer: Not Just an Indicator of Venous Thrombosis but a Predictor of Asymptomatic Hematogenous Metastasis in Gastric Cancer Patients

“…Additionally, a number of studies have reported that D-dimer levels are associated with tumor stage, tumor prognosis, lymph node involvement, and overall survival in patients with solid tumors, such as lung cancer [11], [12], breast cancer [13], esophageal cancer [10], gastric cancer [14], colon cancer [15], and gynecological malignancies [16]. Plasma D-dimer levels were shown to be high in advanced tumor stage patients and can be used to predict clinical outcome in cancer patients [17], [18], [19], [20], [21]. Moreover, most of the advanced tumor stage patients harbored asymptomatic hematogenous metastases.…”