Significance and prognostic value of the coagulation profile in patients with glioblastoma: implications for personalized therapy

BACKGROUND: Coagulation is an important aspect of the vascular microenvironment in which brain tumors evolve. Tumor patients often show aberrant coagulation and fibrinolysis activation. In particular, Glioblastoma (GBM), the most aggressive primary brain tumor, is associated with a state of hypercoagulability, and venous thromboembolism (VTE) is a common complication of this cancer and its treatment. Our study aims to investigate the clinical and prognostic significance of routine laboratory tests to assess the coagulative state of patients with brain tumors, in order to identify potential new prognostic factors and targets for personalized therapy. METHODS: Blood samples were collected from GBM (n=58) and meningioma (MNG, n=22) patients, before any treatment. The parameters analysed were: prothrombin time (PT), activated partial thromboplastin time (aPTT), D-Dimer (DD), fibrinogen (FB), von Willebrand factor (VWF), leukocyte count and haemoglobin levels. RESULTS: Plasma levels of PT and aPTT were significantly reduced in GBMs compared to MNGs (p <0.05), whereas DD, VWF:Ag levels, and leukocyte count were significantly higher in GBMs than MNGs (p <0.01). Furthermore, we observed that GBM patients with reduced PT and aPTT and high levels of DD e VWF, defined as hypercoagulable patients, showed reduced overall survival (p<0.05) compared to non-hypercoagulable patients. CONCLUSION: Our data support the assumption that GBM patients show a plasma hypercoagulable profile and that coagulation profile is related to adverse outcome in patients with GBM. If confirmed, hypercoagulability could play an important role as a prognostic factor of the disease and in the decision of an antithrombotic prophylaxis.