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. 2020 Sep;18(9):2220-2231.
doi: 10.1111/jth.14891. Epub 2020 Aug 11.

Thrombin generation predicts early recurrence in breast cancer patients

Marina Marchetti  1 , Cinzia Giaccherini  1 , Giovanna Masci  2 , Cristina Verzeroli  1 , Laura Russo  1 , Luigi Celio  3 , Roberta Sarmiento  4 , Sara Gamba  1 , Carmen J Tartari  1 , Erika Diani  1 , Alfonso Vignoli  1 , Paolo Malighetti  5 , Daniele Spinelli  5 , Nicole M Kuderer  6 , Federico Nichetti  3 , Mauro Minelli  7 , Carlo Tondini  8 , Sandro Barni  8 , Francesco Giuliani  9 , Fausto Petrelli  10 , Andrea D'Alessio  11 , Giampietro Gasparini  4 , Roberto Labianca  12 , Armando Santoro  2 , Filippo De Braud  3 , Anna Falanga  1   13 ; HYPERCAN Investigators
Collaborators, Affiliations
Free article

Thrombin generation predicts early recurrence in breast cancer patients

Marina Marchetti et al. J Thromb Haemost. 2020 Sep.
Free article

Abstract

Background: Cancer patients present with a hypercoagulable state often associated with poor disease prognosis.

Objectives: This study aims to evaluate whether thrombin generation (TG), a global coagulation test, may be a useful tool to improve the identification of patients at high risk of early disease recurrence (ie, E-DR within 2 years) after breast cancer surgery.

Patients/methods: A cohort of 522 newly diagnosed patients with surgically resected high-risk breast cancer were enrolled in the ongoing prospective HYPERCAN study. TG potential was measured in plasma samples collected before starting systemic chemotherapy. Significant predictive hemostatic and clinic-pathological parameters were identified in the derivation cohort by Cox regression analysis. A risk prognostic score for E-DR was generated in the derivation and tested in the validation cohort.

Results: After a median observation period of 3.4 years, DR occurred in 51 patients, 28 of whom were E-DR. E-DR subjects presented with the highest TG values as compared to both late-DR (from 2 to 5 years) and no relapse subjects (P < .01). Multivariate analysis in the derivation cohort identified TG, mastectomy, triple negative and Luminal B HER2-neg molecular subtypes as significant independent predictors for E-DR, which were utilized to generate a risk assessment score. In the derivation and validation cohorts, E-DR rates were 2.3% and 0% in the low-risk, 10.1% and 6.3% in the intermediate-risk, and 18.2% and 16.7%, in the high-risk categories, respectively.

Conclusions: Inclusion of TG in a risk-assessment model for E-DR significantly helps the identification of operated breast cancer patients at high risk of very early relapse.

Keywords: breast cancer; disease recurrence; hypercoagulability; risk model; thrombin generation.

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References

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