Role of Hypercoagulable State for Predictive Ovarian Malignancy in Women with a Pelvic Mass
Marut Yanaranop MD*,**
Affiliation : * Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand ** College of Medicine, Rangsit University, Bangkok, Thailand
Background : Ovarian cancer (OC) is an important malignancy in women worldwide and is associated with hypercoagulable
state and high risk of venous thromboembolism (VTE).
Objective : To assess the performance of preoperative blood coagulability in discriminating between OCs and benign gynecologic
diseases in women presenting with a pelvic mass, and to study the incidence of postoperative thromboembolic events.
Material and Method: Preoperative coagulation tests (platelet count, prothrombin time, activated partial thromboplastin
time, thrombin time, fibrinogen and D-dimer levels), and serum cancer antigen 125 (CA125) were investigated in women
over 18 years old with clinically diagnosed pelvic or adnexal mass who underwent elective surgery at Rajavithi Hospital
between January 2012 and December 2013. After a 9-week post-operation period, these patients were followed-up for VTE
events.
Results : Of 196 women, 99 had OC and 97 had benign ovarian diseases. Platelet count, fibrinogen and D-dimer levels were
significantly elevated in women with OC; however, only plasma fibrinogen level was a significant predictive factor for OC.
Fibrinogen and CA125 displayed similar effectiveness (areas under receiver operating characteristic curve [ROC-AUCs],
76.0% vs. 77.7%) in OC prediction. A logistic model of combined fibrinogen and CA125 showed the best performance for OC
prediction (ROC-AUC, 90.1%). Postoperatively, one deep vein thrombosis event in OC patients was found, while none
appeared in patients with benign gynecologic diseases.
Conclusion : Women with OC are significantly more associated with hypercoagulable state than those with benign gynecologic
diseases. Plasma fibrinogen level was the significant predictive factor for OC, and only 1 post-operative VTE event occurred.
Keywords : Hypercoagulable state, Platelet, Fibrinogen, D-dimer, Ovarian cancer
