{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T10:47:23Z","timestamp":1782816443470,"version":"3.54.5"},"reference-count":37,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Cancer-associated thrombosis is a major complication in pancreatic cancer; however, its true burden and prognostic significance remain unclear, largely owing to under-detection of asymptomatic events. In addition, the clinical relevance of cancer-related hypercoagulability and neutrophil extracellular traps (NETs), which may link thrombosis and tumor biology, has not been adequately evaluated in advanced pancreatic cancer. Methods: In this prospective study, newly diagnosed patients with unresectable pancreatic ductal adenocarcinoma underwent systematic screening for venous thromboembolism (VTE) at baseline, followed by longitudinal surveillance. Circulating coagulation markers and NET-related biomarkers were analyzed. Associations among VTE, hypercoagulability, NET-related biomarkers, and overall survival (OS) were evaluated. Results: Among 134 patients, VTE was detected at diagnosis in 28.4%, with the majority being asymptomatic. Hypercoagulability and NET-related biomarkers were significantly associated with VTE occurrence. Patients with baseline VTE (6.2 vs. 12.1 months, p = 0.002) and hypercoagulability (7.7 vs. 15.2 months, p = 0.002) demonstrated shorter OS. In multivariate analysis, hypercoagulability, but not baseline VTE, remained independently associated with inferior OS (hazard ratio 2.03, 95% confidence interval 1.27\u20133.27). Notably, the adverse prognostic impact of hypercoagulability was consistently observed across nearly all predefined clinical subgroups. Furthermore, a reduction in or normalization of D-dimer levels following anticoagulant therapy was associated with prolonged survival. Conclusions: Hypercoagulability, rather than overt thrombotic events, independently predicts survival outcomes in advanced pancreatic cancer. These findings support a biology-driven approach to thrombosis assessment and indicate that monitoring and therapeutic modulation of hypercoagulability may improve risk stratification and clinical management in this population.<\/jats:p>","DOI":"10.3390\/cancers18132120","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T10:01:17Z","timestamp":1782813677000},"page":"2120","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hypercoagulability Predicts Survival and Reflects NET-Associated Thromboinflammation in Advanced Pancreatic Cancer"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1005-5606","authenticated-orcid":false,"given":"Lingaku","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatology, NHO Kyushu Cancer Center, Fukuoka 811-1395, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4896-5157","authenticated-orcid":false,"given":"Masami","family":"Miki","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatology, NHO Kyushu Cancer Center, Fukuoka 811-1395, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayuki","family":"Hijioka","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatology, NHO Kyushu Cancer Center, Fukuoka 811-1395, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4965-086X","authenticated-orcid":false,"given":"Terumasa","family":"Hisano","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatology, NHO Kyushu Cancer Center, Fukuoka 811-1395, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rie","family":"Sugimoto","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatology, NHO Kyushu Cancer Center, Fukuoka 811-1395, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayuki","family":"Furukawa","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatology, NHO Kyushu Cancer Center, Fukuoka 811-1395, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1111\/j.1538-7836.2007.02374.x","article-title":"Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy","volume":"5","author":"Khorana","year":"2007","journal-title":"J. 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