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Dear Editor, Cancer patients with venous thromboembolism (VTE) have poor survival rates [1, 2]. In addition to well-known coagulation biomarkers, microparticles (MPs) in patients with cancer have recently been studied [3]. MPs are typically defined as membrane vesicles 0.1–1.0 μm in diameter, formed by exocytic budding from cells during cell activation or apoptosis. We postulated that the initial levels of hemostatic biomarkers at cancer diagnosis would be useful in predicting and managing the clinical course of cancer in these patients. We analyzed coagulation profiles and circulating MPs in patients at the initial diagnosis of cancer and determined the clinical course and survival of these patients over two years. This study was approved by the Institutional Review Board of the Catholic Medical Center (UC14SISI0100), Korea. Between May and December 2014, we included 67 consecutive patients diagnosed as having solid tumors in this prospective study and received their informed consent. Cancer sites included the stomach (N=13), colorectum (N=13), lung (N=9), head and neck (N=9), biliary tract (N=8), esophagus (N=4), breast (N=4), bladder (N=3), pancreas (N=2), and cervix (N=2). Survival and the occurrence of VTE were monitored at diagnosis and after two years. Coagulation biomarkers were analyzed at the initial cancer diagnosis. MPs were quantified by flow cytometry as previously described [4]. Particles that stained with annexin V (BD Biosciences, San Jose, CA, USA) and CD41 (BD Biosciences) were called platelet-derived microparticles (PMPs), whereas those that stained with annexin V and CD31 (BD Biosciences) were called endothelial cell-derived microparticles (EMPs). MPs in the MP gate (<1 μM, determined using 1-μM beads) were counted [5]. Prothrombin time (PT), activated partial thromboplastin time (aPTT), Clauss fibrinogen, D-dimer, and fibrinogen degradation product (FDP) levels were determined using a CS5100 analyzer (Sysmex Corporation, Kobe, Japan). Protein C and protein S activity were measured using a STA R Max analyzer (Diagnostica Stago, Parsippany, NJ, USA). The program G*Power indicated a requirement of 67 samples for a power of 80% [6]. Student’s independent sample t-, Mann-Whitney U, chi-square, and Fisher’s exact tests were performed as appropriate. Receiver operating characteristic (ROC) curves were analyzed to define cutoffs to differentiate the nonsurvival group. Mean survival time (MST) based on the biomarkers was estimated by Kaplan-Meier analysis. All statistical analyses were performed by using the MedCalc program (MedCalc Software bvba, Mariakerke, Belgium). The survival rate was 52.2% (35/67). Levels of D-dimers, fi-

Circulating Microparticles and Coagulation Profiles in Patients with Advanced Stage Solid Tumors