Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Vienna, Medical University of Vienna, Austria.
Thromb Res. 2012 Apr;129 Suppl 1:S6-9. doi: 10.1016/S0049-3848(12)70008-7.
Venous thromboembolism (VTE) is a common problem in cancer patients. However, the rates of VTE vary widely between different types of malignancies. Furthermore, patient- and treatment-related risk factors contribute to the risk of VTE. The prediction of the individual risk of VTE and the identification of patients with cancer that might benefit from thromboprophylaxis is a major clinical challenge, because the pathogenesis of cancer-associated VTE is multifactorial. Therefore, recent studies have focused on identification of predictive biomarkers for VTE. As there is a close interrelation between cancer and the haemostatic system, which leads to activation of haemostasis and fibrinolysis, biomarkers of the haemostatic system seem to be promising in predicting risk of developing VTE in cancer patients. Some candidate biomarkers or laboratory tests of the haemostatic system including platelet count, soluble P-selectin, tissue factor (TF) and TF-bearing microparticles, coagulation factor VIII, D-dimer, prothrombin fragment 1+2 and the thrombin generation assay have been reported to predict cancer-associated VTE. In addition, it has been shown that risk-scoring models, incorporating clinical parameters and biomarkers, allow risk stratification of cancer patients into groups at high- and at low risk of VTE. The accuracy of a previously established risk scoring model can be improved when it is expanded and biomarkers of the haemostatic system are added. The benefit of a targeted thromboprophylaxis for primary prevention of VTE in cancer patients based on risk assessment by measuring biomarkers or applying risk scoring models has to be shown in interventional clinical trials.
静脉血栓栓塞症（VTE）是癌症患者的常见问题。然而，不同类型的恶性肿瘤之间 VTE 的发生率差异很大。此外，患者和治疗相关的风险因素也会增加 VTE 的风险。预测 VTE 的个体风险以及确定可能受益于血栓预防的癌症患者是一个主要的临床挑战，因为癌症相关 VTE 的发病机制是多因素的。因此，最近的研究集中在识别 VTE 的预测性生物标志物上。由于癌症与止血系统之间存在密切的相互关系，这会导致止血和纤维蛋白溶解的激活，因此止血系统的生物标志物似乎在预测癌症患者发生 VTE 的风险方面具有很大的潜力。一些候选生物标志物或止血系统的实验室检测，包括血小板计数、可溶性 P-选择素、组织因子（TF）和携带 TF 的微粒、凝血因子 VIII、D-二聚体、凝血酶原片段 1+2 和凝血酶生成试验，已被报道可用于预测癌症相关的 VTE。此外，已经表明，纳入临床参数和生物标志物的风险评分模型可将癌症患者分为高风险和低风险 VTE 的组。当扩大先前建立的风险评分模型并添加止血系统的生物标志物时，其准确性可以得到提高。在干预性临床试验中，必须证明基于生物标志物测量或应用风险评分模型进行风险评估，对癌症患者进行靶向性血栓预防以预防 VTE 的一级预防是有效的。
