cancers-logo

Journal Browser

Journal Browser

Novel Insights into Mechanisms of Cancer-Associated Thrombosis

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Clinical Research of Cancer".

Deadline for manuscript submissions: closed (31 August 2025) | Viewed by 2313

Special Issue Editor


E-Mail Website
Guest Editor
Department of Haematology, Imperial College of Science Technology and Medicine, London, UK
Interests: immunology; inflammation

Special Issue Information

Dear Colleagues,

Cancer-associated thrombosis (CAT) represents a major cause of mortality in cancer patients and presents a significant clinical challenge. The pathophysiology of CAT involves a multifaceted interplay of cancer-related factors, including the enhanced expression and release of procoagulant proteins such as the Von Willebrand Factor and tissue factor and alterations in blood flow due to tumour burden. The pathophysiology may then be further exacerbated by surgery, chemotherapy and novel therapies such as proteasome inhibitors and CAR-T cell therapy. While venous thrombosis is the most common type of CAT, patients can also experience arterial thrombosis and in extreme cases disseminated intravascular coagulation and thrombotic microangiopathy.  Anticoagulation therapy is the cornerstone of management, with low-molecular-weight heparin (LMWH) being the preferred agent due to its efficacy and lower bleeding risk compared to traditional vitamin K antagonists. Clinical guidelines recommend prophylactic anticoagulation in high-risk patients, especially during periods of hospitalization or following major surgeries. Ongoing research is required to elucidate the precise mechanisms of CAT further and refine treatment protocols, emphasizing personalized approaches to optimize patient outcomes and mitigate the complications associated with CAT in the cancer population. This Special Issue will highlight our current understanding of the mechanisms behind CAT from the molecular level through to patient cohorts.

Dr. Tom A J Mckinnon
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cancer
  • thrombosis
  • venous
  • arterial

Benefits of Publishing in a Special Issue

  • Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
  • Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
  • Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
  • External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
  • Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review

14 pages, 975 KB  
Article
Comparative Evaluation of Risk Assessment Models for Predicting Venous Thromboembolic Events in Cancer Patients with Implanted Central Venous Access Devices
by Mohammad Ma’koseh, Heba Farfoura, Mahmoud Abunasser, Maryam El-Atrash, Anas Zayed, Renad Hamdan-Mansour, Zaid Abdel Rahman, Tala Ghatasheh, Mohammad Alshobaki, Mohammed J. Al-Jaghbeer and Hikmat Abdel-Razeq
Cancers 2025, 17(20), 3308; https://doi.org/10.3390/cancers17203308 - 14 Oct 2025
Viewed by 345
Abstract
Background/Objectives: Cancer patients using implanted venous access devices (ICVADs) for chemotherapy are at increased risk of venous thromboembolism (VTE), but the performance of risk assessment models (RAMs) in this setting is understudied. This study evaluated VTE incidence, risk factors, and the predictive performance [...] Read more.
Background/Objectives: Cancer patients using implanted venous access devices (ICVADs) for chemotherapy are at increased risk of venous thromboembolism (VTE), but the performance of risk assessment models (RAMs) in this setting is understudied. This study evaluated VTE incidence, risk factors, and the predictive performance of the Khorana, COMPASS-CAT, and ONKOTEV models. Methods: We retrospectively reviewed records of adult cancer patients treated with chemotherapy via ICVADs. The cumulative incidence (CI) of VTEs was estimated using the Fine–Gray method, and RAM performance was assessed by sensitivity, specificity, predictive values, accuracy, and AUC. Overall survival (OS) was analyzed using Kaplan–Meier and log-rank tests. Results: A total of 446 patients were included. The most common cancers were colorectal (29.6%), gastric (26%), pancreatic (18.4%), and breast (13.9%). During a median follow-up of 16.5 months, VTEs occurred in 82 patients (18.4%), including 43 (9.6%) that were ICVAD-related. Median time to VTE was 117 days and 68 days for ICVAD-related events. The CI of VTEs was 9% at 1 year and 18.4% at 2 years. ONKOTEV showed the best performance (accuracy of 74.4%, specificity of 85.7%, and AUC of 0.607), with 1-year incidence higher in the high-risk group (28.5% vs. 12.4%, p < 0.001). In contrast, all RAMs showed limited ability for ICVAD-related VTEs. VTE was independently associated with inferior OS (HR 1.39, p = 0.037). Conclusions: Cancer patients with ICVADs face a substantial risk of early VTEs. Among evaluated RAMs, ONKOTEV performed best for overall but not ICVAD-related events. Prospective studies are needed to guide prophylaxis strategies using validated RAMs. Full article
(This article belongs to the Special Issue Novel Insights into Mechanisms of Cancer-Associated Thrombosis)
Show Figures

Figure 1

13 pages, 462 KB  
Article
Risk Assessment Models for Predicting Venous Thromboembolism in Patients with Pancreatic Cancer
by Corinne Frere, Sophie Gourgou, Audrey Winter, Ludovic Gauthier, Cindy Canivet, Benjamin Crichi, Zora Marjanovic, Alexandra Yannoutsos, Okba Bensaoula, Louis Buscail, Barbara Bournet and Dominique Farge
Cancers 2025, 17(4), 597; https://doi.org/10.3390/cancers17040597 - 10 Feb 2025
Viewed by 1224
Abstract
Background: Data on the performance of the Khorana, PROTECHT, and ONKOTEV risk assessment models (RAMs) to predict venous thromboembolism (VTE) in patients with pancreatic cancer (PC) receiving outpatient chemotherapy remain limited. We performed a head-to-head comparison of these RAMs in patients with newly [...] Read more.
Background: Data on the performance of the Khorana, PROTECHT, and ONKOTEV risk assessment models (RAMs) to predict venous thromboembolism (VTE) in patients with pancreatic cancer (PC) receiving outpatient chemotherapy remain limited. We performed a head-to-head comparison of these RAMs in patients with newly diagnosed PC enrolled in the nationwide, multicenter, and prospective BACAP cohort. Methods: The Khorana, PROTECHT, and ONKOTEV scores were calculated at enrollment prior to chemotherapy. Patients were stratified into intermediate- and high-VTE-risk groups according to each RAM. The primary study outcome was VTE at a 6-month follow-up. The accuracy and discriminatory performance of the scores were assessed by calculating time-dependent Brier scores and c-indexes. Sub-distribution hazard ratios (SHRs) between high- and intermediate-risk patients were estimated. Results: Of 762 PC patients, 73 developed VTE within 6 months. In the competing risk analysis, the cumulative incidence of VTE at 6 months was 16.4% (95% CI, 13.8–19.1). The time-dependent Brier score was 0.14 (95% CI, 0.12–0.15) for all scores, indicating well-calibrated predictions. The respective time-dependent c-index of the Khorana, the PROTECHT, and the ONKOTEV scores was 0.50 (95% CI, 0.46–0.55), 0.50 (95% CI, 0.49–0.51), and 0.53 (95% CI, 0.48–0.58), indicating poor discrimination. The SHRs between high- and intermediate-risk patients ranged from 1.05 (95% CI, 0.76–1.44) for the ONKOTEV score to 1.06 (95% CI, 0.77–1.45) for the Khorana score. Conclusion: In newly diagnosed PC patients receiving outpatient chemotherapy, the Khorana, PROTECHT, and ONKOTEV scores demonstrated a poor performance in predicting VTE at 6 months, highlighting the need for new tools to guide thromboprophylaxis decisions. Full article
(This article belongs to the Special Issue Novel Insights into Mechanisms of Cancer-Associated Thrombosis)
Show Figures

Figure 1

Review

Jump to: Research

30 pages, 2059 KB  
Review
Thrombotic Risk and Coagulation Imbalance in Cirrhosis and Hepatocellular Carcinoma: Clinical Implications and Management
by Leonardo Stella, Matteo De Siati, Rosa Talerico, Maria Pallozzi, Lucia Cerrito, Silvia Sorrentino, Antonio Gasbarrini, Erica De Candia, Roberto Pola and Francesca Romana Ponziani
Cancers 2025, 17(21), 3413; https://doi.org/10.3390/cancers17213413 - 23 Oct 2025
Viewed by 338
Abstract
Hepatocellular carcinoma (HCC) is characterized by a complex disruption of hemostatic balance, increasing the risk of both thrombotic and hemorrhagic events. Thrombotic complications, most notably portal vein thrombosis (PVT) and venous thromboembolism (VTE), have a significant impact on clinical outcomes and therapeutic strategies. [...] Read more.
Hepatocellular carcinoma (HCC) is characterized by a complex disruption of hemostatic balance, increasing the risk of both thrombotic and hemorrhagic events. Thrombotic complications, most notably portal vein thrombosis (PVT) and venous thromboembolism (VTE), have a significant impact on clinical outcomes and therapeutic strategies. Cirrhosis contributes to the precarious equilibrium between pro- and anticoagulant forces through impaired synthesis of coagulation factors, endothelial dysfunction, and systemic inflammation. In the presence of HCC tumor-driven mechanisms, such as tissue factor expression, extracellular vesicle release, platelet activation, and suppression of fibrinolysis exacerbate this prothrombotic state. In this scenario, advanced diagnostic tools such as thrombin generation assay (TGA) and rotational thromboelastometry (ROTEM) offer a more accurate assessment of coagulation dynamics than conventional tests, enabling better risk stratification especially for therapeutic purposes. Anticoagulant therapy has demonstrated clinical benefit in selected cases of non-malignant PVT and VTE, particularly when liver function is preserved. While prophylactic strategies are still under investigation, data suggest they may be safely implemented in selected surgical patients. In the setting of immunotherapy, especially regimens involving anti-VEGF agents, anticoagulation may be considered with careful management of bleeding risk due to portal hypertension. An individualized approach to anticoagulation, supported by functional coagulation testing, is gaining acceptance as a means to safely reduce thrombotic burden and potentially improve outcomes in patients with HCC. Full article
(This article belongs to the Special Issue Novel Insights into Mechanisms of Cancer-Associated Thrombosis)
Show Figures

Figure 1

Back to TopTop