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We recently identified an RNA-sequencing profile that associates with CAT in colorectal cancer (CRC) patients, with <jats:italic>REG4<\/jats:italic>, <jats:italic>SPINK4<\/jats:italic>, and <jats:italic>SERPINA1<\/jats:italic> as the top-3 upregulated genes at mRNA level. In the current study, we investigated whether protein expression of REG4, SPINK4 and alpha-1 antitrypsin (A1AT, encoded by <jats:italic>SERPINA1<\/jats:italic>) in the tumor associated with CAT in an independent cohort of CRC patients. From 418 patients with resected CRC, 18 patients who developed CAT were age, sex, and tumor stage-matched to 18 CRC patients without CAT. Protein expression was detected by immunohistochemical staining and scored blindly by assessing the H-score (percentage positive cells*scoring intensity). The association with CAT was assessed by means of logistic regression, using patients with an H-score below 33 as reference group. The odds ratios (ORs) for developing CAT for patients with A1AT<jats:sup>high<\/jats:sup>, REG4<jats:sup>high<\/jats:sup>, SPINK4<jats:sup>high<\/jats:sup> tumors were 3.5 (95%CI 0.8\u201314.5), 2.0 (95%CI 0.5\u20137.6) and 2.0 (95%CI 0.5\u20137.4) when compared to A1AT<jats:sup>low<\/jats:sup>, REG4<jats:sup>low<\/jats:sup>, SPINK4<jats:sup>low<\/jats:sup>, respectively. The OR was increased to 24.0 (95%CI 1.1\u2013505.1) when two proteins were combined (A1AT<jats:sup>high<\/jats:sup>\/REG4<jats:sup>high<\/jats:sup>). This nested case\u2013control study shows that combined protein expression of A1AT and REG4 associate with CAT in patients with colorectal cancer. Therefore, REG4\/A1AT are potential biomarkers to improve the identification of patients with CRC who may benefit from thromboprophylaxis.<\/jats:p>","DOI":"10.1007\/s11239-023-02907-6","type":"journal-article","created":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T22:01:21Z","timestamp":1702072881000},"page":"370-380","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The association of tumor-expressed REG4, SPINK4 and alpha-1 antitrypsin with cancer-associated thrombosis in colorectal cancer"],"prefix":"10.1007","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5816-9739","authenticated-orcid":false,"given":"Jeroen T.","family":"Buijs","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"van Beijnum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rayna J. 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All other authors have reported no potential conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}