Enhanced fibrinolysis and thrombin generation in ovarian cancer patients with than without metastasis

Abstract

Ovarian cancer is one of the most severe gynaecological malignancies due to its long asymptomatic course of the disease displaying advanced stage at the time of diagnosis. It accounts for between 30 and 40% for 5-year survival rate. We studied 24 patients who were diagnosed to have F1GO stage Ill/IV ovarian cancer compared to nine subjects with FIGO Stage I/II disease for their systemic levels of fibrinolysis and inhibitors. Nine of the patients with Stage 11I/IV succumbed to the disease between 3.5 and 24 months and one (age 71 years) in stage 1C at 11 months after diagnosis. There were no significant differences in t-PA, u-PA, PAI-1 and uPAR levels between the two groups, even though t-PA activity and uPAR levels had higher mean trends, they did not reach statistical significance, probably due to the wide variation in levels noted. However, significantly reduced ATIII levels (P = 0.004) in stage III/1V vs Stage I/II group (activity 86.8 ±12% vs 104 ±11%; antigen 0.201 ±0.03 g/L vs 0.246 ±0.03 g/L) were seen with elevated D-dimer (P = 0.005)(mean 8.65 mg/ml vs 1.36 mg/ml). These suggest that there was enhanced thrombin generation and t'ibrinolysis in patients with metastastic ovarian cancer; indicating an overly active disseminated intravascular coagulation in this group of patients compared to those with non-metastasis, although the D-dimer levels were higher in both groups than normal subjects.