ELSEVIER Clinica Chimica Acta 244 (1996) 69-81 High plasma level of plasmin-a2-plasmin inhibitor complex is predictor of poor prognosis in patients with lung cancer Osamu Taguchi*, Esteban C. Gabazza, Masamichi Yoshida, Tomoya Yamakami, Hiroyasu Kobayashi, Teruo Shima The Third Department of Internal Medicine, Mie University School of Medicine, 514 Edobashi, 2 cho-me 174 banchi, Mie Prefecture, Tsu-city, Japan Received 27 June 1995; revision received 25 September 1995; accepted 5 October 1995 Abstract The occurrence of thrombotic complications is commonly associated with poor prognosis in patients with malignancy. However, the prognostic significance of the subclinical activation of the clotting system, frequently observed in cancer patients, is unknown. The purpose of the present study was to evaluate the value of the pre-thrombotic state for predicting survival of lung cancer patients. This investigation comprised 70 lung cancer patients without clinical or laboratory diagnosis of intravascular coagulation. There were 49 cases with non-small and 21 with small cell carcinomas. Samples taken in controls were available for comparison. The clot- ting system was assessed measuring thrombin-antithrombin III complex (TAT) and plasmin- c~2-plasmin inhibitor complex (PAP). The independent value of these clotting markers to pre- dict survival was evaluated in relation with previously well-established prognostic factors for lung cancer patients. Plasma concentration of each parameter was significantly higher in cancer patients as compared to that of controls. The plasma level of PAP was a predictor of survival independently from the stage of disease, sex, age, histological type, performance status, tumor size and the presence of distant metastasis. Discriminant analysis of PAP plasma concentration identified 2 groups with significant difference in survival rate in all patients, cases in advanced stages of disease and in those with small and non-small cell lung cancer. The results of the present study showed prognostic significance of the subclinical activation of the clotting system, particularly of the fibrinolytic pathway, in lung cancer. Newly developed markers of fibrinolysis might be potentially applicable for predicting outcome in malignancy. * Corresponding author, Tel.: +81 592 321 i I I; Fax: + 81 592 315 223. 0009-8981/96/$15.00 © 1996 Elsevier Science B.V. All rights reserved SSDI 0009-8981(95)06 196-K