The relationship between thrombosis and cancer is based on evidence that cancer promotes prothrombotic changes in the host hemostatic system. The activation of blood coagulation is closely linked to tumor growth and dissemination.
To evaluate whether quantifications of plasma circulation tumor deoxyribonucleic acid (DNA) and thrombin-antithrombin complex could act as predictors for thrombotic events and death in patients with gastric or colorectal adenocarcinomas, while also evaluating the Karnofsky Performance Status.
Eighty-two patients were included in the study and divided into three groups: controls (n=20), gastric adenocarcinomas (n=21), and colorectal adenocarcinomas (n=41). In order to calculate the Karnofsky index, information was collected to measure the patient’s ability to perform common daily tasks. The following serum measurements were conducted: complete blood count, platelet count, extracellular deoxyribonucleic acid, and thrombin-antithrombin complex.
Ten patients (16%) experienced thrombosis during treatment. Patients with thrombin-antithrombin complex levels greater than 0.53 had a five-times higher risk of thrombosis. Lower Karnofsky Performance Status was also a risk factor for the event in this population. Neither thrombin-antithrombin complex nor plasma circulation tumor DNA were predictors of death after multivariate adjustment. Thus, Karnofsky index signaled a better overall survival prognosis for colorectal and gastric adenocarcinoma patients.
Thrombin-antithrombin complex acts as a marker for thrombosis in patients with colorectal and gastric adenocarcinomas. We recommend prophylactic anticoagulation when the Karnofsky value is low and/or the thrombin-antithrombin complex concentration is greater than 0.53 ng/ml.
Hepatosplenic schistosomiasis is an endemic disease prevalent in tropical countries and is associated with a high incidence of portal vein thrombosis. Inflammatory changes caused by both parasitic infection and portal thrombosis can lead to the development of chronic liver disease with potential carcinogenesis.
To assess the incidence of portal vein thrombosis and hepatocellular carcinoma in patients with schistosomiasis during long-term follow-up.
A retrospective study was conducted involving patients with schistosomiasis followed up at our institution between 1990 and 2021.
A total of 126 patients with schistosomiasis were evaluated in the study. The mean follow-up time was 16 years (range 5–31). Of the total, 73 (57.9%) patients presented portal vein thrombosis during follow-up. Six (8.1%) of them were diagnosed with hepatocellular carcinoma, all with portal vein thrombosis diagnosed more than ten years before.
The incidence of hepatocellular carcinoma in patients with schistosomiasis and chronic portal vein thrombosis highlights the importance of a systematic long-term follow-up in this group of patients.
Hepatic artery thrombosis is an important cause of graft loss and ischemic biliary complications. The risk factors have been related to technical aspects of arterial anastomosis and non-surgical ones.
To evaluate the risk factors for the development of hepatic artery thrombosis.
The sample consisted of 1050 cases of liver transplant. A retrospective and cross-sectional study was carried out, and the variables studied in both donor and recipient.
Univariate analysis indicated that the variables related to hepatic artery thrombosis are: MELD (p=0.04) and warm time ischemia (p=0.005). In the multivariate analysis MELD=14.5 and warm ischemia time =35 min were independent risk factors for hepatic artery thrombosis. In the prevalence ratio test for analysis of the anastomosis as a variable, it was observed that patients with continuous suture had an increase in thrombosis when compared to interrupted suture.
Prolonged warm ischemia time, calculated MELD and recipient age were independent risk factors for hepatic artery thrombosis after liver transplantation in adults. Transplanted patients with continuous suture had an increase in thrombosis when compared to interrupted suture. Re-transplantation due to hepatic artery thrombosis was associated with higher recipient mortality.
As the coronavirus disease 2019 (COVID-19) pandemic spreads throughout the world, new clinical manifestations are being reported. In addition to the respiratory manifestations, acute renal failure3, hypercoagulability9, vomiting and diarrhea5 have been described.
The Cancer Institute of the São Paulo State (ICESP) has already performed over 8500 surgeries for colorectal cancer in the last 10 years. It is one of the hospitals associated with the University of São Paulo School of Medicine, which has already admitted over 3000 patients with moderate or severe COVID-19 for in-hospital treatment. We present a case of intestinal perforation caused by microcirculatory thrombosis in the colon in a patient undergoing surgery for colorectal cancer.
A 92-year-old male patient with a diagnosis of rectal adenocarcinoma sought emergency care in April 2020 due to intestinal subocclusion. He had a personal history of hypertension and nondialysis chronic kidney disease. Chest and abdomen CT scans showed no pulmonary changes; multiple liver metastases, the largest one measuring 3.0 cm and distension of the colon and small intestine. He underwent exploratory laparotomy, and a tumor was found in the upper rectum, causing bowel obstruction. A rectosigmoidectomy was performed with blind-ending closure of the rectal stump and terminal colostomy.
During the postoperative (PO) period, the patient received food and had intestinal transit until the 3rd PO day, when he started to present coughing and fever. Laboratory testing showed increased C-reactive protein (CRP), as shown in Figure 1. Chest CT scan revealed consolidation in the right lung base. Assessment by the infectious disease team indicated a clinical and radiological profile compatible with bacterial pneumonia. Antibiotic therapy with piperacillin-tazobactam was initiated and maintained for five days with good response, after which the patient started receiving levofloxacin. He was discharged on the 8th PO day, with clinical improvement, decreased CRP levels, good acceptance of food and a functioning colostomy.
After two days, on the 10th PO day, he returned to the emergency room complaining of diffuse abdominal pain, oliguria and coughing. Abdominal examination showed a nonfunctioning colostomy and abdominal pain upon palpation, without signs of peritonitis. In the laboratory analysis, the patient had leukocytosis of 19,000 cells/mm³, with 92% neutrophils and a CRP level of 110 mg/l (normal range <5.0 mg/l) in addition to renal dysfunction with an increase in creatinine levels from 1.58 mg/dl to 3.7 mg/dl and an increase in urea from 56 mg/dl to 110 mg/dl. A CT scan of the abdomen showed pneumoperitoneum without free fluid collections and with diffuse distension of small bowel loops. Exploratory laparotomy was indicated and showed punctiform perforation of the descending colon at 5 cm from the colostomy, with fecal peritonitis blocked by small bowel loops. The perforated descending colon segment located at 5 cm from the colostomy was resected, followed by exhaustive washing of the cavity, terminal colostomy and introduction of antibiotic therapy with meropenem.
Due to the concomitant pulmonary manifestations, the patient was referred to the ICU intubated with vasoactive drugs, a nasogastric tube, antibiotic therapy and parenteral nutrition. He maintained high nasogastric tube output. Starting on the 1st PO day, he received anticoagulant therapy for the prophylaxis of thromboembolic events. He was extubated on the 3rd PO day and discharged from the ICU. On the 5th PO day, worsening of the respiratory condition was observed, with discomfort, decreased oxygen saturation and increased CRP. The chest CT scan, Figure 2, showed multiple bilateral ground-glass opacities. A D-dimer level of 3225 ng/ml and DHL of 638 U/l were observed. A nasopharyngeal and oropharyngeal swab was collected to screen for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Due to the decrease in oxygen saturation even with 100% oxygen supplementation by mask, the patient was again admitted to the ICU, immediately subjected to orotracheal intubation, and kept on mechanical ventilation and in isolation.
Regarding the clinical evolution, the swab was positive, with worsening of general conditions: adynamic ileus, acute renal failure with creatinine reaching 5.0 mg/dl, need for high doses of vasoactive drugs and antibiotic therapy with meropenem, vancomycin and anidulafungin. The patient was extubated on the 28th PO day after improvement of the respiratory condition. He was discharged from the ICU on the 30th PO day but progressed to a coma vigil, according to the neurologist. Death occurred on the 36th PO day.
An anatomopathological assessment of the surgical specimen revealed thrombotic changes in the microcirculation of the perforated descending colon (Figure 3).
Ductal adenocarcinoma of the pancreas is the fourth most common cancer-associated cause of death in the Western world. The presence of circulating tumor cells (CTCs) can be considered a potential prognostic factor, as these cells represent tumor progression, allowing monitoring of therapeutic efficacy.
The objectives of this study were to explore the morphological, molecular, and phenotypic characteristics of CTCs from the blood of patients with pancreatic carcinoma and to correlate the findings with response to treatment, progression-free survival, overall survival (OS), and deep vein thrombosis (DVT).
Peripheral blood (10 mL) was analyzed before the beginning of treatment after 60 and 120 days. CTCs were detected by using ISET® and characterized by immunocytochemistry. For microRNAs (miRNAs) analysis, peripheral leukocytes from the same patients and healthy individuals (controls) were collected in parallel at baseline. The expression of miRNAs was evaluated (in pool) using TaqMan® Array Human MicroRNA Cards v2.0.
Only nine patients were included. The proteins, namely, matrix metalloproteinase-2 (MMP2) and TGFβ-RI, were highly expressed (77.7%) in CTCs at baseline; at the first follow-up, MMP2 was predominant (80%) and, at the second follow-up, MMP2 and vimentin were predominant (50%). Circulating tumor microemboli (CTMs) were found in two patients and both presented DVT. The miR-203a-3p was highly expressed in CTCs. The miR-203a-3p is involved in the stimulation of epithelial-to-mesenchymal transition (EMT) and is related to worse OS in pancreatic cancer (TCGA data).
Due to the low number of patients and short follow-up, we did not observe a correlation between CTCs and response to treatment. However, there was a correlation between CTM and DVT and also miR-203a-3p was highly expressed in CTCs, corroborating the findings of EMT proteins. This study opens the perspectives concerning the dynamic change in the pattern of proteins expressed along with treatment and the use of miRNAs as new targets in pancreatic carcinoma.
Desenvolvido por Surya MKT