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Elevated TFPI in malignant disease: relation to cancer type and hypercoagulation
N Iversen1, A K Lindahl, U Abildgaard
1Haematological Research Laboratory, Aker Hospital, Oslo, Norway.
British Journal of Haematology
|September 12, 1998
Summary
High levels of tissue factor pathway inhibitor (TFPI) are linked to solid tumors but not hematological malignancies. In acute nonlymphocytic leukemia (ANLL), elevated TFPI indicates disseminated intravascular coagulation (DIC).
Area of Science:
- Hematology
- Oncology
- Coagulation research
Background:
- Previously reported high levels of tissue factor pathway inhibitor (TFPI) in gastrointestinal cancer patients.
- TFPI is not an acute-phase reactant, but elevated levels are seen in sepsis and disseminated intravascular coagulation (DIC).
Purpose of the Study:
- To investigate the relationship between TFPI levels and various types of malignancies.
- To determine TFPI's role in solid tumors versus hematological malignancies.
Main Methods:
- Plasma samples from 214 patients with various malignancies were analyzed for TFPI activity.
- A subset of 83 patients had additional measurements of total and free TFPI antigen, protein C, antithrombin, fibrin monomer, and D-dimer.
Main Results:
- Elevated TFPI activity and antigens were observed in approximately 50% of patients with solid tumors.
- Elevated TFPI was infrequent in hematological malignancies (12%).
- In acute nonlymphocytic leukemia (ANLL) patients, elevated free TFPI was exclusively found in those with concurrent DIC; no correlation with fibrin monomer or D-dimer was observed.
Conclusions:
- Elevated TFPI in ANLL is associated with the presence of DIC.
- In solid tumors, increased TFPI may potentially inhibit fibrin formation, though the exact mechanism requires further investigation.