Abstract
Predicting survival accurately in patients with advanced cancer is important in guiding interventions and planning future care. Objective tools are therefore needed. Blood biomarkers are appealing due to their rapid measurement and objective nature. Thrombosis is a common complication in cancer. Recent data indicate that tumor-induced neutrophil extracellular traps (NETs) are pro-thrombotic. We therefore performed a comprehensive investigation of circulating markers of neutrophil activation, NET formation, coagulation and fibrinolysis in 106 patients with terminal cancer. We found that neutrophil activation and NET markers were prognostic in terminal cancer patients. Interestingly, markers of coagulation and fibrinolysis did not have a prognostic value in this patient group, and there were weak or no correlations between these markers and markers of neutrophil activation and NETs. This suggest that NETs are linked to a poor prognosis through pathways independent of coagulation. Additional studies are needed to determine the utility of circulating neutrophil activation and NET markers, alone or in concert with established clinical parameters, as objective and reliable prognostic tools in advanced cancer.
Highlights
Predicting survival accurately in patients with advanced cancer is important in guiding interventions and planning future care
This study shows a clear association of markers of neutrophil activation and neutrophil extracellular traps (NETs) with poor prognosis in patients with terminal cancer
We did not find an association between markers of coagulation and fibrinolysis and poor prognosis, despite the well-known association between cancer and thrombosis
Summary
Predicting survival accurately in patients with advanced cancer is important in guiding interventions and planning future care. We performed a comprehensive investigation of circulating markers of neutrophil activation, NET formation, coagulation and fibrinolysis in 106 patients with terminal cancer. We found that neutrophil activation and NET markers were prognostic in terminal cancer patients. Additional studies are needed to determine the utility of circulating neutrophil activation and NET markers, alone or in concert with established clinical parameters, as objective and reliable prognostic tools in advanced cancer. Objective prognostic tools are needed to assist clinicians in assessing prognosis in patients with advanced cancer. We and others recently showed that markers of neutrophil activation, including citrullinated histone H3 (H3Cit), a marker of NETs, are associated with poor clinical outcome in patients with terminal cancer[27,32]. NETs have been shown to contribute to enhanced coagulation[33], a well-known phenomenon in cancer p atients[34]
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