• Cancer and thrombosis
• Diagnosis and treatment
• Epidemiology
• Oncology
• Tumors- solid
• Venous thromboembolism prophylaxis

• Humans
• Venous Thromboembolism/epidemiology
• Venous Thromboembolism/etiology
• Incidence
• Neoplasms/complications
• Neoplasms/epidemiology
• Male
• Female
• Global Health
• Risk Factors

• Adolescent health
• Cardiovascular disease
• Gastric cancer
• Young adult
• Young cancer patient

• Humans
• Stomach Neoplasms/epidemiology
• Male
• Female
• Cardiovascular Diseases/epidemiology
• Cardiovascular Diseases/etiology
• Retrospective Studies
• Adolescent
• Young Adult
• Incidence
• Adult
• Risk Factors
• Republic of Korea/epidemiology
• Cancer Survivors/statistics & numerical data

• NRF-2022R1A2C1013119 the Korean goverment
• Seoul National University

• Gastric cancer
• Nomogram
• Venous thromboembolism

• Humans
• Nomograms
• Venous Thromboembolism/epidemiology
• Venous Thromboembolism/etiology
• Venous Thromboembolism/diagnosis
• Stomach Neoplasms/complications
• Retrospective Studies
• Male
• Female
• Middle Aged
• Risk Factors
• Aged
• China/epidemiology
• Risk Assessment/methods
• ROC Curve
• Fibrin Fibrinogen Degradation Products/analysis
• Fibrin Fibrinogen Degradation Products/metabolism
• Adult

• Adjuvant
• Chemotherapy
• Gastric cancer
• Thromboembolic events

• Humans
• Aged
• Retrospective Studies
• Stomach Neoplasms/drug therapy
• Stomach Neoplasms/surgery
• Stomach Neoplasms/complications
• Thromboembolism/chemically induced
• Thromboembolism/epidemiology
• Chemotherapy, Adjuvant/adverse effects
• Oxaliplatin/therapeutic use

• Japan
• Stomach cancer
• Venous thromboembolism

• Adult
• Humans
• Female
• Aged
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/complications
• Venous Thromboembolism/epidemiology
• Venous Thromboembolism/etiology
• Incidence
• Risk Factors
• Neoplasms
• Registries
• Anticoagulants

• Daiichi Sankyo Co., Ltd.

• Asian
• breast neoplasms
• risk factors
• venous thromboembolism

• Deep vein thrombosis
• Khorana score
• Lung cancer
• Prothrombin fragment 1 + 2
• Pulmonary thromboembolism

• biomarkers
• gastrointestinal neoplasms
• molecular targeted therapy
• neutrophil extracellular traps
• quantitation

• Humans
• Extracellular Traps/metabolism
• COVID-19/pathology
• Neutrophils
• Gastrointestinal Neoplasms/metabolism
• Thrombosis/metabolism
• Tumor Microenvironment

• 2022B1001 science and technology plan of Jiangxi Provincial Administration of Traditional Chinese Medicine
• 81860433 National Natural Science Foundation of China
• 82103645 National Natural Science Foundation of China
• 20204BCJ23021 Training Plan for Academic and Technical Young Leaders of Major Disciplines in Jiangxi Province
• 20192BAB215036 the Natural Science Youth Foundation of Jiangxi Province
• 20202BBG73024 the Key Technology Research and Development Program of Jiangxi Province

• cancer
• chemotherapy
• prevalence
• screening
• venous thromboembolism

The development of venous thromboembolism (VTE) is associated with high mortality among gastric cancer (GC) patients. Neutrophil extracellular traps (NETs) have been reported to correlate with the prothrombotic state in some diseases, but are rarely reported in GC patients.

To investigate the effect of NETs on the development of cancer-associated thrombosis in GC patients.

The levels of NETs in blood and tissue samples of patients were analyzed by ELISA, flow cytometry, and immunofluorescence staining. NET generation and hypercoagulation of platelets and endothelial cells (ECs) in vitro were observed by immunofluorescence staining. NET procoagulant activity (PCA) was determined by fibrin formation and thrombin–antithrombin complex (TAT) assays. Thrombosis in vivo was measured in a murine model induced by flow stenosis in the inferior vena cava (IVC).

NETs were likely to form in blood and tissue samples of GC patients compared with healthy individuals. In vitro studies showed that GC cells and their conditioned medium, but not gastric mucosal epithelial cells, stimulated NET release from neutrophils. In addition, NETs induced a hypercoagulable state of platelets by upregulating the expression of phosphatidylserine and P-selectin on the cells. Furthermore, NETs stimulated the adhesion of normal platelets on glass surfaces. Similarly, NETs triggered the conversion of ECs to hypercoagulable phenotypes by downregulating the expression of their intercellular tight junctions but upregulating that of tissue factor. Treatment of normal platelets or ECs with NETs augmented the level of plasma fibrin formation and the TAT complex. In the models of IVC stenosis, tumor-bearing mice showed a stronger ability to form thrombi, and NETs abundantly accumulated in the thrombi of tumor-bearing mice compared with control mice. Notably, the combination of deoxyribonuclease I, activated protein C, and sivelestat markedly abolished the PCA of NETs.

GC-induced NETs strongly increased the risk of VTE development both in vitro and in vivo. NETs are potential therapeutic targets in the prevention and treatment of VTE in GC patients.

• Neutrophil extracellular traps
• Gastric cancer
• Platelet
• Endothelial cells
• Venous thromboembolism

• Animals
• Constriction, Pathologic
• Endothelial Cells/metabolism
• Extracellular Traps/metabolism
• Fibrin
• Mice
• Neutrophils/metabolism
• Stomach Neoplasms/complications
• Stomach Neoplasms/metabolism
• Thrombophilia
• Thrombosis/etiology
• Venous Thromboembolism/etiology
• Venous Thromboembolism/metabolism

Introduction: The relationship between cancers and thromboembolic events is well established. In our study, we aim to determine the burden of thromboembolic events in patients with solid tumors and identify the risk factors related to their development.

Materials & Methods: Data on patients with solid tumors and thromboembolism between January 2013 and September 2014 were collected and analyzed.

Results: During the study period 174 patients were identified. Of which, 172 (98.9%) had venous thrombus embolism, 137 (79%) were diagnosed with deep vein thromboses, 67 (38.5%) with pulmonary embolism, 84 (48.3%) were symptomatic and 90 (51.7) were incidental at diagnosis. The most common patients and disease characteristics were female sex, high body mass index (BMI), metastatic stage, colorectal and breast primaries, and anti-neoplastic therapy.

Conclusion: Our study confirmed the high burden of thromboembolic events in cancer patients and the relevant factors associated with its development.

Blacks/African Americans have a higher incidence, whereas Asians/Pacific Islanders have a lower incidence, of CAT than White Americans.

Race and ethnicity are associated with risk of venous thromboembolism in population-based studies. Blacks/African Americans have a higher incidence, whereas Asians/Pacific Islanders and Hispanics have a lower incidence of venous thromboembolism compared with non-Hispanic Whites. The impact of race/ethnicity on the incidence of cancer-associated thrombosis (CAT), a common complication in patients with malignancy, has not been well defined. Using the California Cancer Registry linked to the California Patient Discharge Dataset and Emergency Department Utilization database, we studied a large, diverse cohort of patients (n = 942 109) from 2005 to 2017 with the 13 most common, first primary malignancies to determine the association between race/ethnicity and incidence of incident and recurrent CAT. Multivariable Cox proportional hazards regression models were performed to determine the effect of race/ethnicity on the risk of overall CAT, specific CAT by location, and recurrent CAT. Blacks/African Americans had a higher incidence of CAT for all tumor types except myeloma, whereas Asians/Pacific Islanders had a consistently lower incidence of CAT compared with non-Hispanic Whites, after adjusting for potential confounders. The main driver for the racial/ethnic differences was incidence of pulmonary embolism. We speculate the association of race/ethnicity with incidence of CAT may be partially because of underlying thrombotic predisposition that varies by ancestry, but we also must consider the impact of social determinants of health on our results.

Cancer is well known as the most important risk factor for the emergence of pulmonary embolism (PE). The incidence of incidental PE (IPE) has increased with widely use of multi-detector-row computed tomography (CT) technology. Simultaneously, more new cancer patients diagnosed concomitantly with IPE are found. No study has examined the presentation and prognosis of incidental pulmonary embolism (IPE) in gastric cancer patients. The aim of this study was to analyse prognostic factors in patients with advanced gastric cancer complicated with IPE.

Ninety patients with histologically confirmed advanced gastric adenocarcinoma diagnosed with IPE were enrolled. Continuous variables were compared using Student’s t-test or the Mann–Whitney U-test if non-normally distributed. The Chi-squared test (or Fisher’s exact test where appropriate) was used to compare categorical variables. The Kaplan–Meier method and the Log rank test were used for survival analysis. Independent prognostic factors for survival were determined using a Cox proportional hazards model. A two-sided P-value < 0.05 was considered statistically significant.

Nineteen patients were diagnosed with IPE concomitantly with gastric cancer. Concurrence of gastric cancer and IPE, lack of anticoagulation therapy, and location of IPE were associated with survival. After adjusting for age and sex, the concurrence of gastric cancer and IPE, lack of anticoagulation, and central IPE independently influenced the survival of advanced gastric cancer patients with IPE. Subgroup analysis of patients with peripheral pulmonary embolisms confirmed that anticoagulant therapy provided a survival benefit.

Concurrence of gastric cancer and IPE may be a prognostic factor for advanced gastric cancer patients with IPE.

• anticoagulation therapy
• gastric cancer
• incidental pulmonary embolism

Venous thromboembolism (VTE) is frequently observed in patients with advanced cancer. The objective of this prospective observational study was to estimate, based on intensive screening, using computed tomography, lower‐extremity ultrasonography, and D‐dimer testing, the prevalence of VTE in patients with advanced cancer.

Patients with metastatic or locally advanced cancer without anticoagulant therapy, who were planning to receive chemotherapy during 4 weeks, were eligible. Evaluations of VTE were performed at pretreatment, 12 weeks, and 24 weeks after the start of chemotherapy. Primary endpoint was cumulative incidence of VTE for 24 weeks. Secondary endpoints included incidence of VTE (pretreatment, 12 weeks, and 24 weeks after the start of chemotherapy), VTE according to primary cancer site, symptomatic VTE, pulmonary thromboembolism (PE), and treatment of VTE.

We enrolled 860 patients with a median age of 68 years, including 34% female and 71% lung cancer. Cumulative incidence of VTE for 24 weeks was 22.6% (95% confidence interval: 19.8%–25.5%) (194 of 860 patients). Incidence of VTE was 11.3% pretreatment, 16.8% 12 weeks, and 14.1% 24 weeks. Symptomatic VTE was observed in 4.0% and PE in 1.0% of patients. By multivariate analysis, sex, D‐dimer level, and platelet count were independent risk factors of VTE for 24 weeks.

This large prospective observational study showed that cumulative incidence of VTE was high in advanced cancer patients, mainly lung cancer. Although most patients showed asymptomatic VTE, intensive screening of VTE may be considered in advanced cancer patients, especially in women with high level of D‐dimer and decreased platelet count (UMIN000015243).

• advanced cancer
• chemotherapy
• deep vein thrombosis
• pulmonary thromboembolism
• venous thromboembolism

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols/adverse effects
• Female
• Follow-Up Studies
• Humans
• Incidence
• Japan/epidemiology
• Male
• Middle Aged
• Neoplasms/drug therapy
• Neoplasms/pathology
• Prognosis
• Prospective Studies
• Risk Factors
• Venous Thromboembolism/chemically induced
• Venous Thromboembolism/diagnosis
• Venous Thromboembolism/epidemiology

• cancer-associated thrombosis
• gastrectomy
• gastric cancer
• preoperative chemotherapy
• venous thromboembolism

• catheter-related deep vein thrombosis
• gastric cancer
• infectious adverse events
• long-term complications
• totally implantable vascular access devices

• Bleeding
• Direct oral anticoagulants
• Gastric cancer
• Hypoalbuminemia
• Venous thromboembolism

• Adenocarcinoma/drug therapy
• Adenocarcinoma/secondary
• Administration, Oral
• Adult
• Aged
• Aged, 80 and over
• Anticoagulants/administration & dosage
• Antineoplastic Combined Chemotherapy Protocols/adverse effects
• Female
• Follow-Up Studies
• Humans
• Hypoalbuminemia/chemically induced
• Hypoalbuminemia/epidemiology
• Incidence
• Lymphatic Metastasis
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Risk Factors
• Stomach Neoplasms/drug therapy
• Stomach Neoplasms/pathology
• Survival Rate
• Venous Thromboembolism/diagnosis
• Venous Thromboembolism/drug therapy
• Venous Thromboembolism/etiology

• Cancer
• Elderly
• Hospitalized
• Risk factors
• Venous thromboembolism

• Aged
• Aged, 80 and over
• Female
• Hospitalization
• Humans
• Incidence
• Male
• Middle Aged
• Prospective Studies
• Risk Factors
• Venous Thromboembolism/epidemiology

• grant no.04-2012-003 Seoul National University Bundang Hospital

• East Asian
• bidirectional relationship
• cancer
• epidemiological study
• venous thromboembolism

• head and neck neoplasm
• risk factors
• thrombolytic therapy
• thromboprophylaxis
• venous thromboembolism

• Deep venous thrombosis
• Gastric cancer
• Pulmonary thromboembolism
• Ultrasonography

To investigated the incidence and risk factors of venous thromboembolism (VTE) in patients with advanced gastric cancer (AGC) receiving chemotherapy.

All consecutive chemotherapy-naïve patients with AGC who would receive palliative chemotherapy between November 2009 and April 2012 in our hospital were recruited. Their pretreatment clinical and laboratory variables, including D-dimer, were recorded. The frequency of VTE development and survival rates during each chemotherapy cycle and regularly thereafter were assessed.

A total of 241 patients enrolled between November 2009 and April 2012 were analyzed. During a median follow-up duration of 10.8 mo (95%CI: 9.9-11.7), 27 patients developed VTE and the incidence of VTE was 17.5% (95%CI: 10.5-24.0, 12.0 events/100 person-years). The 6-mo and 1-year cumulative incidences were 7.8% (95%CI: 4.2%-11.4%) and 12.4% (95%CI: 7.3-17.2), respectively. Thirteen (48.1%) patients were symptomatic and the other 14 (51.9%) patients were asymptomatic. In multivariate analysis, pretreatment D-dimer level was the only marginally significant risk factor associated with VTE development (hazard ratio = 1.32; 95%CI: 1.00-1.75, P = 0.051).

The incidence of VTE is relatively high in patients with AGC receiving chemotherapy, and pretreatment D-dimer level might be a biomarker for risk stratification of VTE.

• Advanced gastric cancer
• D-dimer
• Venous thromboembolism

• Asian
• Cancer
• Thrombosis

Venous thromboembolism (VTE) is a clinically significant complication that is well documented among Caucasian cancer patients. However, evidence regarding VTE incidence and treatment among Asian cancer patients is very limited. The objective of this study is to investigate the incidence, risk factors and management of VTE among Taiwanese cancer patients.

Using Taiwan’s National Health Insurance Research Database, we identified 43,855 newly diagnosed cancer patients between 2001 and 2008. Two alternative algorithms for identifying VTE event were explored to better quantify a range of incidence rates of VTE in our cancer patients. Multivariable logistic regression models were used to explore VTE risk factors.

The incidence rates of VTE were 9.9 (algorithm 1) and 3.4 (algorithm 2) per 1,000 person-years, respectively. The incidence rates were higher in certain cancers, particularly liver, pancreas, and lung. Significant risk factors for VTE were site of cancer, prior history of VTE, chemotherapy and major surgeries. Long-term anticoagulant therapy was initiated in 64.1% patients with VTE and 72.2% of them received warfarin alone. Approximately two-thirds of patients with VTE received ≤ 3 months of anticoagulant therapy.

Incidence of cancer-related VTE is lower among Taiwanese compared to Caucasian populations. Nevertheless, risk factors for cancer-related VTE found in our study were consistent with current literature.

Multiple myeloma (MM) is the third most common hematologic malignancy in Korea. Historically, the incidence of MM in Korea has been lower than that in Western populations, although there is growing evidence that the incidence of MM in Asian populations, including Korea, is increasing rapidly. Despite advances in the management of MM, patients will ultimately relapse or become refractory to their current treatment, and alternative therapeutic options are required in the relapsed/refractory setting. In Korea, although lenalidomide/dexamethasone is indicated for the treatment of relapsed or refractory MM (RRMM) in patients who have received at least one prior therapy, lenalidomide is reimbursable specifically only in patients with RRMM who have failed bortezomib-based treatment. Based on evidence from pivotal multinational clinical trials as well as recent studies in Asia, including Korea, lenalidomide/dexamethasone is an effective treatment option for patients with RRMM, regardless of age or disease status. Adverse events associated with lenalidomide/dexamethasone, including hematologic toxicity, venous thromboembolism, fatigue, rash, infection, and muscle cramps, are largely predictable and preventable/manageable with appropriate patient monitoring and/or the use of standard supportive medication and dose adjustment/interruption. Lenalidomide/dexamethasone provides an optimal response when used at first relapse, and treatment should be continued long term until disease progression. With appropriate modification of the lenalidomide starting dose, lenalidomide/dexamethasone is effective in patients with renal impairment and/or cytopenia. This review presents updated evidence from the published clinical literature and provides recommendations from an expert panel of Korean physicians regarding the use of lenalidomide/dexamethasone in patients with RRMM.

• Guideline
• Korea
• Lenalidomide
• Multiple myeloma
• Refractory
• Relapsed

• chemotherapy
• esophagogastric cancer
• venous thromboembolism

This study evaluated the efficacy for preventing venous thromboembolism (VTE) and adverse effects of low-molecular-weight heparin (LMWH) in order to launch a prospective clinical trial in Korea.

We reviewed the medical records of 108 consecutive patients who underwent gastric cancer surgery. These patients were divided into 2 groups according to the type of thromboprophylaxis: group A, LMWH combined with intermittent pneumatic compression (IPC); group B, IPC alone. The postoperative outcomes of the two groups were compared.

Symptomatic VTE was observed in only 1 patient (0.9%) from group B. Postoperative bleeding was more common in group A than in group B (10.9% vs. 7.5%), although the difference was not significant (P = 0.055). Most bleeding episodes were minor and managed conservatively without intervention. Only a high body mass index was associated with a significantly increased risk of postoperative bleeding (odds ratio, 1.45; 95% confidence interval, 1.12-2.43; P = 0.051).

A 40 mg of enoxaparin sodium is a safe and feasible dose for prevention of VTE. With the results of this study, we are planning a prospective randomized clinical trial to investigate the clinical efficacy of LMWH thromboprophylaxis in gastric cancer patients in Korea.

• Feasibility
• Korea
• Low-molecular-weight heparin
• Stomach cancer
• Thromboembolism

• Adult
• Aged
• Aged, 80 and over
• Anticoagulants/adverse effects
• Anticoagulants/therapeutic use
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Neoplasms/blood
• Neoplasms/drug therapy
• Neoplasms/epidemiology
• Prognosis
• Prospective Studies
• Recurrence
• Risk Factors
• Survival Analysis
• Venous Thromboembolism/drug therapy
• Venous Thromboembolism/epidemiology
• Venous Thromboembolism/etiology