Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University Portland, OR, USA.
Front Oncol. 2012 Sep 10;2:115. doi: 10.3389/fonc.2012.00115. eCollection 2012.
Cancer induces a hypercoagulable state, and patients with cancer who suffer a thrombotic event have a worse prognosis than those who do not. Recurrent pathologic thrombi in patients with cancer are clinically managed with anticoagulant medications; however, anticoagulant prophylaxis is not routinely prescribed owing to a complex variety of patient and diagnosis related factors. Early identification of patients at risk for cancer-associated thrombosis would allow for personalization of anticoagulant prophylaxis and likely reduce morbidity and mortality for many cancers. The environment in which a thrombosis develops in a patient with cancer is complex and unique from patients without cancer, which creates therapeutic challenges but may also provide targets for the development of clinical assays in this context. Circulating tumor cells (CTCs) may play a role in the association between cancer and thrombosis. Cancer metastasis, the leading cause of cancer-related deaths, is facilitated by the hematogenous spread of CTCs, and CTCs accompany metastatic disease across all major types of carcinomas. The role of CTCs in the pathogenesis of thrombosis has not been studied due to the previous difficulty in identifying these rare cells, but the interaction between these circulating cells and the coagulation system is an area of study that demands attention. The development of CTC detection platforms presents a new tool by which to characterize the role for CTCs in cancer-related hypercoagulability. In addition, this area of study presents a new avenue for assessing the risk of cancer-associated thrombosis and represents a potential tool for predicting which patients may benefit from anticoagulant prophylaxis. In this review, we will discuss the evidence in support of CTC induced hypercoagulability, and highlight areas where CTC-detection platforms may provide prognostic insight into the risk of developing thrombosis for patients with cancer.
癌症会导致高凝状态，患有血栓形成事件的癌症患者的预后比未患有血栓形成事件的患者差。癌症患者反复出现病理性血栓需要用抗凝药物进行临床治疗；然而，由于患者和诊断相关因素的复杂多样性，通常不常规开具抗凝预防药物。早期识别有发生癌症相关血栓风险的患者，可以实现抗凝预防的个体化，可能会降低许多癌症的发病率和死亡率。癌症患者中血栓形成的环境复杂且与非癌症患者不同，这带来了治疗挑战，但也可能为该背景下的临床检测方法的开发提供了靶点。循环肿瘤细胞（CTCs）可能在癌症与血栓形成之间的关联中发挥作用。癌症转移是癌症相关死亡的主要原因，是由 CTC 的血行播散促成的，CTC 伴随着转移性疾病出现在所有主要类型的癌中。由于之前难以识别这些稀有细胞，CTC 在血栓形成发病机制中的作用尚未得到研究，但这些循环细胞与凝血系统之间的相互作用是一个需要关注的研究领域。CTC 检测平台的发展提供了一种新工具，可以用于描述 CTC 在癌症相关高凝状态中的作用。此外，该研究领域为评估癌症相关血栓形成风险提供了新途径，并代表了一种预测哪些患者可能受益于抗凝预防的潜在工具。在这篇综述中，我们将讨论支持 CTC 诱导高凝状态的证据，并强调 CTC 检测平台可能为癌症患者发生血栓形成风险提供预后见解的领域。
