review · International Journal of Molecular Sciences
Cancer-associated thrombosis causes significant illness and death in cancer patients, but evidence guiding personalised risk stratification in cervical cancer has been inconsistent. A systematic review analysing 25 cervical cancer studies synthesised findings on biological, molecular, genetic, and imaging markers. While D-dimer was the most commonly evaluated biomarker and consistently correlated with blood clot risk, its specificity was limited. Conversely, markers capturing thrombin generation and fibrinolytic activation demonstrated superior mechanistic specificity. Multimarker panels integrating indicators of coagulation, fibrinolysis, endothelial injury, platelet activation, and inflammation achieved better predictive accuracy than individual markers. In addition, emerging biomarkers including circulating tumour DNA, extracellular vesicles, microRNAs, and gene variants in SERPINE1 and F2 were linked to thrombotic risk and adverse outcomes. Standardised prospective trials are needed before clinical implementation.
Blood clots are a leading cause of complications and death in cancer patients. Identifying reliable biological markers helps healthcare providers identify which cervical cancer patients have the highest risk of developing serious clots. This approach supports targeted, personalised preventative therapies, helping prevent avoidable complications while sparing lower-risk individuals from unnecessary medical interventions.
The findings support the development of diagnostic multimarker assays and clinical risk-scoring panels for oncology care teams and diagnostic testing laboratories. Such tools could guide tailored thromboprophylaxis in cervical cancer care. However, the technology remains at an early research stage, as prospective, standardised, and tumour-specific studies are still required before biomarker-directed protocols can enter clinical practice.
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Cancer-associated thrombosis (CAT) is a major cause of morbidity and mortality in patients with malignancy. Biomarkers of hypercoagulability and thromboinflammation may improve risk stratification and support personalised thromboprophylaxis, but evidence remains heterogeneous, particularly in cervical cancer. A systematic review was conducted according to PRISMA 2020. PubMed/MEDLINE, Scopus, Embase, and Web of Science were searched for studies published between January 2009 and March 2025 evaluating biological, molecular, genetic, and imaging biomarkers associated with hypercoagulability and thromboinflammation in women withcervical cancer. Evidence from breast cancer and broader CAT studies was incorporated to provide translational context. Owing to substantial methodological heterogeneity, findings were synthesised qualitatively. Twenty-five cervical cancer studies met eligibility criteria. D-dimer was the most extensively investigated biomarker and was consistently associated with VTE risk, although specificity was limited. Biomarkers of thrombin generation and fibrinolytic activation, including thrombin-antithrombin complexes, prothrombin fragment 1+2, and plasmin-α2-antiplasmin complex, demonstrated greater mechanistic specificity. Multimarker panels integrating coagulation, fibrinolysis, endothelial injury, platelet activation, and inflammation showed superior predictive performance compared with single biomarkers. Emerging biomarkers, including circulating tumour DNA, extracellular vesicles, and microRNAs, further supported tumour-driven thromboinflammation. SERPINE1 and F2 gene variants were associated with thrombotic risk and adverse prognosis. Current evidence supports further evaluation of integrated multimodal biomarker strategies for CAT risk assessment, but prospective, standardised, tumour-specific studies are required before biomarker-guided approaches can be implemented in clinical practice.
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DOI: 10.3390/ijms27167302
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