Occult cancer in patients with unprovoked venous thromboembolism: A nested case-control study

• Published in: American journal of clinical pathology 2024-05, Vol.161 (5), p.501-511
• Main Authors: Sánchez-López, Verónica, Marín-Romero, Samira, Ferrer-Galván, Marta, Elías-Hernández, Teresa, Lobo Beristain, José Luis, Ballaz Quincoces, Aitor, Jara-Palomares, Luis, Rodríguez Martorell, Francisco Javier, Castro, María José, Marín Hinojosa, Carmen, López-Campos, José Luis, Otero-Candelera, Remedios
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biomarkers, Tumor - blood; Case-Control Studies; Female; Fibrin Fibrinogen Degradation Products - analysis; Fibrin Fibrinogen Degradation Products - metabolism; Humans; Male; Middle Aged; Neoplasms - complications; Neoplasms, Unknown Primary - complications; Neoplasms, Unknown Primary - diagnosis; Original; P-Selectin - blood; Prospective Studies; Venous Thromboembolism - blood; Venous Thromboembolism - diagnosis
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1093/ajcp/aqad178

Detecting occult cancer in patients with unprovoked venous thromboembolism (VTE) remains a significant challenge. Our objective was to investigate the potential predictive role of coagulation-related biomarkers in the diagnosis of occult malignancies. We conducted a nested case-control study with a 1-year prospective cohort of 214 patients with unprovoked VTE, with a focus on identifying occult cancer. At the time of VTE diagnosis, we measured various biomarkers, including soluble P-selectin (sP-selectin), dimerized plasmin fragment D (D-dimer), platelets, leukocytes, hemoglobin, total extracellular vesicles (EVs), EVs expressing tissue factor on their surface (TF+EVs), and EVs expressing P-selectin on their surface (Psel+EVs) in all participants. We observed statistically significant increased levels of sP-selectin (P = .015) in patients with occult cancer. Despite an increase in Psel+EVs, TF+EVs, D-dimer, and platelets within this group, however, no significant differences were found. When sP-selectin exceeded 62 ng/mL and D-dimer surpassed 10,000 µg/L, the diagnosis of occult cancer demonstrated a specificity of up to 91% (95% CI, 79.9%-96.7%). The combination of sP-selectin and D-dimer can be a valuable biomarker in detecting occult cancer in patients with unprovoked VTE. Further research is necessary to ascertain whether easily measurable biomarkers such as sP-selectin and D-dimer can effectively distinguish between patients who have VTE with and without hidden malignancies.