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    Poster Networking

    Hemostatic Systems in Cancer, Inflammation and Immunity

    Poster Networking Session

    PB0709 - Thrombin generation (TG) and D-dimer significantly predict early-disease recurrence (E-DR) in high-risk breast cancer

    Monday, June 26, 2023
    18:30 – 19:30 ET
    Room: Exhibition

      Presenting Author(s)

    • Marina Marchetti, PhD (she/her/hers)

      Hemostasis Lab Director
      Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

      • Co-Author(s)

    • Patricia Gomez Rosas, MD

      Hematologist
      Hospital Pappa Giovanni XXIII
      Bergamo, Lombardia, Italy

    • CG

      Cinzia Giaccherini

      Researcher
      Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • CV

      Cristina Verzeroli

      Researcher
      Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • LR

      Laura Russo

      Researcher
      Department of Immunohematology and Transfusion Medicine, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • SG

      Sara Gamba

      Researcher
      Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • CT

      Carmen Julia Tartari

      Researcher
      Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • SB

      Silvia Bolognini

      Researcher
      Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • FS

      Francesca Schieppati

      Hematologist
      Department of Immunohematology and Transfusion Medicine, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • RS

      Roberta Sarmiento

      Oncologist
      Oncology Unit, Hospital San Filippo Neri, Rome, Italy
      Rome, Lazio, Italy

    • GM

      Giovanna Masci

      Oncologist
      Oncology Unit, IRCCS Humanitas Institute, Rozzano, Italy
      Milan, Lombardia, Italy

    • CT

      Carlo Tondini

      Oncologist
      Oncology Unit, “Papa Giovanni XXIII” Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • FP

      Fausto Petrelli

      Oncologist
      Oncology Unit, Hospital Treviglio-Caravaggio, Treviglio, Italy
      Teviglio, Lombardia, Italy

    • FG

      Francesco Giuliani

      Oncologist
      Oncology Unit, IRCCS Cancer Institute Giovanni Paolo II, Bari, Italy
      Bari, Puglia, Italy

    • AD

      Andrea D'Alessio

      Hematologist
      Medical Oncology and Internal Medicine, Policlinico San Marco, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • FD

      Filippo De Braud

      Oncologist
      Oncology Unit, IRCCS National Cancer Institute, Milan, Italy
      Milan, Lombardia, Italy

    • AS

      Armando Santoro

      Oncologist
      Oncology Unit, IRCCS Humanitas Institute, Rozzano, Italy
      Milan, Lombardia, Italy

    • RL

      Roberto Labianca

      Oncologist
      Department Oncology Bergamo Province, “Papa Giovanni XXIII” Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • GG

      Giampietro Gasparini

      Oncologist
      Oncology Unit, Hospital San Filippo Neri, Rome, Italy
      Rome, Lazio, Italy

    • Anna Falanga, MD (she/her/hers)

      Professor of Hematology
      Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    Background: Hemostatic biomarkers are being increasingly explored as possible predictors of specific cancer outcomes. In a previous study of 522 surgically resected high-risk breast cancer patients, we found that pre-chemotherapy TG significantly predicts E-DR, i.e., within 2 years from starting chemotherapy (Marchetti, JHT 2020).

    Aims: By expanding our prospective cohort of breast cancer patients, to about a double that of the previous one, we aim to established whether prechemotherapy TG stands as a significant predictor of E-DR.

    Methods: 955 patients (F941/M14, median age 53 years) with surgically resected high-risk breast cancer were analyzed (HYPERCAN study, ClinicalTrials.gov ID#NCT02622815). Pre-chemotherapy samples were tested for TG by both the ST-Genesia system (STG-ThromboScreen reagent), and the calibrated automated thrombogram (CAT) at 5pM TF. D-dimer, fibrinogen, prothrombin fragment 1+2 (F1+2), and proteins C and S were also evaluated.

    Results: After a median follow-up of 413 days (IC95%, 200-713), 53 (6%) patients experienced an E-DR while 902 remained disease-free (DF). E-DR patients were more frequently triple-negative and less often Luminal-B/HER2-positive molecular subtypes compared to DF patients (p < 0.05). In addition, E-DR subjects were characterized by increased pre-chemotherapy levels of D-dimer (p=0.004), fibrinogen (p=0.054), and peak of TG by both Genesia (p=0.001) and CAT (p < 0.001) assays. The remaining coagulation parameters were not significantly different between the two groups. Multivariate analysis identified D-dimer and TG peak (by both methods) as independent risk factors for E-DR. A risk score based on D-dimer and TG (ROC, AUC < 0.001) was established that significantly (Log-rank < 0.001) stratified high-risk (HR 23%, IC95% 10-36%) vs low-risk E-DR (HR 0%) patients (Figure.1).

    Conclusion(s): Our data, in this large cohort of surgically resected high-risk breast cancer patients, confirm the utility of TG in identifying subjects at risk of E-DR. In addition, TG together with D-dimer were useful for the creation of a risk assessment model for E-DR prediction.