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Haemostatic gene variations in cervical cancer-associated venous thrombosis: considerations for clinical strategies

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Abstract

Venous thromboembolism (VTE) is a life-threatening haemostatic disease frequently diagnosed among the cancer population. The Khorana Score is currently the primal risk assessment model to stratify oncological patients according to their susceptibility to VTE, however, it displays a limited performance. Meanwhile, intensive research on VTE pathophysiology in the general population has uncovered a range of single-nucleotide polymorphisms (SNPs) associated with the condition. Nonetheless, their predictive ability concerning cancer-associated thrombosis (CAT) is controversial. Cervical cancer (CC) patients undergoing chemoradiotherapy often experience VTE, which negatively affects their survival. Thus, aiming for an improvement in thromboprophylaxis, new thrombotic biomarkers, including SNPs, are currently under investigation. In this study, the predictive capability of haemostatic gene SNPs on CC-related VTE and their prognostic value regardless of VTE were explored. Six SNPs in haemostatic genes were evaluated. A total of 401 CC patients undergoing chemoradiotherapy were enrolled in a retrospective cohort study. The implications for the time to VTE occurrence and overall survival (OS) were assessed. CAT considerably impacted the CC patients’ OS (log-rank test, P < 0.001). SERPINE1 rs2070682 (T > C) showed a significant association with the risk of CC-related VTE (CC/CT vs. TT, log-rank test, P = 0.002; C allele, Cox model, hazard ratio (HR) = 6.99 and P = 0.009), while F2 rs1799963 (G > A) demonstrated an important prognostic value regardless of VTE (AA/AG vs. GG, log-rank test, P = 0.020; A allele, Cox model, HR = 2.76 and P = 0.026). For the remaining SNPs, no significant associations were detected. The polymorphisms SERPINE1 rs2070682 and F2 rs1799963 could be valuable tools in clinical decision-making, aiding in thromboprophylaxis and CC management, respectively.

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Data availability

The data presented in this study are available on request from the corresponding author.

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Acknowledgements

The authors would like to thank Ministério da Saúde de Portugal, Portuguese Institute of Oncology of Porto (IPO Porto), Portuguese League Against Cancer (NRNorte) and Fundação para a Ciência e Tecnologia (FCT).

Funding

This study was funded by the Portuguese Institute of Oncology of Porto (IPO Porto) (CI-IPOP-22-2015), Portuguese League Against Cancer (NRNorte) and Fundação para a Ciência e Tecnologia (FCT). B.V.N. is a research fellow (Grant reference: LPCC-NRN2023-BVN) supported by the Portuguese League Against Cancer (NRNorte). V.T. is a PhD scholarship holder (Grant reference: 2020.08969.BD; https://doi.org/10.54499/2020.08969.BD) supported by FCT, co-financed by European Social Funds (FSE) and national funds of MCTES. The institutions had no implications in the decision to conduct the study, nor did they contribute to the writing or publication of this manuscript.

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Authors and Affiliations

  1. Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/Pathology and Laboratory Medicine Dep, Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC), Porto, 4200-072, Portugal

    Beatriz Vieira Neto, Valéria Tavares, Inês Soares Marques & Rui Medeiros

  2. Research Department, Portuguese League Against Cancer (NRNorte), Porto, 4200-172, Portugal

    Beatriz Vieira Neto & Rui Medeiros

  3. Faculty of Medicine, University of Porto (FMUP), Porto, 4200-072, Portugal

    Valéria Tavares, Joana Liz-Pimenta & Rui Medeiros

  4. Instituto de Ciências Biomédicas Abel Salazar, ICBAS, Universidade do Porto, Porto, Portugal

    Valéria Tavares & Rui Medeiros

  5. Oncology Department, Portuguese Institute of Oncology of Porto (IPOP), Porto, 4200-072, Portugal

    José Brito da Silva & Deolinda Pereira

  6. Department of Medical Oncology, Centro Hospitalar de Trás-os-Montes e Alto Douro (CHTMAD), Vila Real, 5000-508, Portugal

    Joana Liz-Pimenta

  7. External Radiotherapy Department, Portuguese Institute of Oncology of Porto (IPOP), Porto, 4200-072, Portugal

    Lurdes Salgado, Luísa Carvalho & Rui Medeiros

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  1. Beatriz Vieira Neto
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Contributions

All authors had a significant role in the manuscript writing. Conceptualization, V.T and R.M.; Funding acquisition, B.V.N, V.T., I.S.M. and R.M.; Investigation, B.V.N., V.T., J.B.d.S., L.C., L.S. and R.M.; Supervision, V.T, D.P. and R.M.; Writing of original draft, B.V.N.; manuscript review and editing, B.V.N., V.T., I.S.M, J.B.d.S., J.L.-P., L.C., L.S., D.P. and R.M.

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Correspondence to Rui Medeiros.

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The study was approved by the Ethics Committee of the Portuguese Institute of Oncology of Porto (CES IPO:287 A/014).

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Neto, B.V., Tavares, V., da Silva, J.B. et al. Haemostatic gene variations in cervical cancer-associated venous thrombosis: considerations for clinical strategies. J Thromb Thrombolysis (2024). https://doi.org/10.1007/s11239-024-02983-2

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