Assessment of Protein C, Protein S, and prothrombin levels in gastrointestinal carcinoma with and without metastasis

Background: A hypercoagulable or prothrombotic state of malignancy with metastasis occurs due to the ability of tumor cells to activate the coagulation system. It has been hypothesized that hypercoagulation contributes to the significant percentage of morbidity in cancer patients due to their role in metastasis. Materials and Methods: A total of 80 patients with gastrointestinal carcinoma such as malignant carcinoma rectum, malignant carcinoma esophagus, and malignant carcinoma colon with and without metastasis from Surgical Gastroenterology Department C.S.M. Medical University, Lucknow, UP, India, were studied in order to evaluate the presence and extent of hemostatic abnormalities in case of gastrointestinal carcinoma. Results: The average prothrombin time, activated partial thromboplastin time, Protein C, and Protein S in patients of gastrointestinal carcinoma was less as compared with control. The mean level of Protein C and Protein S ranged from 55% to 90% and 48% to 95%, respectively. Out of the total 80 patients, 7 were Protein C deficient and 5 were Protein S deficient. However, three were Protein C and S both deficient. The Protein C level was significantly lower (P < 0.0001) in Protein C deficient patients with metastasis compared with patients without metastasis. Similarly, the Protein S level was significantly lower (P < 0.0001) in Protein S deficient patients with metastasis as compared with patients without metastasis. The Protein C and S levels were also lower in those who were deficient with metastasis. Conclusion: Our study infers that activated Protein C resistance in gastrointestinal carcinoma with metastasis may contribute to thrombotic episodes in these patients. Cancer patients including GI malignancy are at increased risk for the development of thrombotic events that contribute significantly to the morbidity and mortality of malignancy in these patients.