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High peripheral monocyte count is associated with increased risk of venous thromboembolism in patients with advanced pancreatic cancer
Background
Venous thromboembolism (VTE) represents a major cause of morbidity and mortality in patients (pts) with pancreatic ductal adenocarcinoma (PDAC). Previous studies reported that 80% of all VTE events occur in advanced stages of the disease and in older pts, thus prophylactic anticoagulation is recommended in this population. Nonetheless, many pts with advanced PDAC will not develop clinically relevant VTE, reinforcing the need for other thrombosis predictive markers. It is recognized that PDAC induces a systemic inflammatory response and a hypercoagulable state that may lead to VTE. Some authors reported that high baseline serum levels of D-dimer, tissue factor activity, plasminogen activator inhibitor-1 and soluble platelet selectin are predictive of thrombosis and prognostic for increased mortality. However, these markers are not easily accessible worldwide. The aim of this study is to assess the potential of easily accessible inflammatory-related biomarkers in predicting VTE in advanced PDAC pts.
Methods
This retrospective analysis included patients with advanced PDAC (UICC/AJCC 8th edition) that received any systemic treatment, followed at an Oncology Department between 2016 and 2021. Inflammatory biomarkers analyzed included baseline absolute count of leukocytes, neutrophils, lymphocytes, monocytes and platelets. Cut-off points were obtained through receiver operating characteristic (ROC) analysis. Statistical analyses were performed using the SPSS version 26.0.
Results
A total of 112 pts met the aforementioned criteria. Most pts were female (n=59, 52.7%), with a median age at diagnosis of 71 years old (34-88). 86 pts (76.8%) had metastatic disease at diagnosis, and the remaining 26 (23.2%) locally advanced disease. 27 VTE events (24.1%) were documented: 40.7% (n=11) in deep veins of lower limbs, 25.9% (n=7) in the mesenteric venous system and 22.2% (n=6) were pulmonary embolism. Median follow-up time was 8.7 months. In our analysis, baseline absolute count of peripheral monocytes was predictive of venous thrombosis. A cut-off value of 0.605x10ˆ9/L was set through ROC analysis. For pts with baseline monocytes < 0.605x10ˆ9/L the odds for a VTE event was 0.414, versus 1.628 for pts with baseline monocytes ≥ 0.605x10ˆ9/L (OR 3.929; CI 95% 1.492-10.347; p=0.004). Absolute baseline count of leukocytes, neutrophils, lymphocytes and platelets did not show statistical significance in predicting VTE in our sample.
Conclusions
In our study, the odds of pts with baseline monocytes ≥ 0.605x10ˆ9/L to develop a thrombotic event is 3.93 times higher than those with baseline monocytes < 0.605x10ˆ9/L. These findings are in agreement with the previously described role of monocytes in the pathophysiological pathways leading to cancer-associated thrombosis. Additionally, other authors reported higher monocyte counts in hospitalized cancer pts with clinically symptomatic thrombosis. In lung cancer pts with VTE, high peripheral monocyte count seems to predict refractoriness to anticoagulation and poor prognosis. Larger studies are needed to validate our results and the potential value of baseline monocyte count as a predictor of VTE in advanced PDAC pts.
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
