Effects of tumor-expressed coagulation factors on cancer progression and venous thrombosis: is there a key factor?

Since the 19(th) century an association between cancer and thromboembolic events has been described, with a poorer survival prognosis. Production and secretion of procoagulant factors affect tumor biology and cancer-associated thrombosis. Tissue factor (TF) exerts coagulant and protease activated receptor (PAR)-dependent signaling effects, both of which can contribute to tumor progression. Tumor cells are also capable of shedding TF-positive microparticles, suggesting a contribution to cancer-associated thrombosis at a distance from the tumor. Selected tumors are capable of ectopically expressing FVII and/or FX, which may lead to increased procoagulant features of tumors. Alternatively spliced TF (asTF) may affect tumor progression by inducing tumor growth and angiogenesis in an integrin dependent manner. Ectopic thrombin production also affects tumor progression by influencing proliferation rate, angiogenesis, invasion and metastasis. However, the roles of these coagulation factors in tumor progression and cancer-associated thrombosis are still not fully understood. In this review we will discuss several coagulation factors and their contribution on cancer progression and venous thromboembolism.