- Volume 16 Issue 15
DOI QR Code
Incidence and Clinical Characteristic of Venous Thromboembolism in Gynecologic Oncology Patients attending King Chulalongkorn Memorial Hospital over a 10 Year Period
- Oranratanaphan, S ;
- Termrungruanglert, W ;
- Khemapech, N
- Published : 2015.10.06
Background: Venous thromboembolisms (VTEs) constitute a group of diseases including deep vein thrombosis (DVT) and pulmonary embolism (PE). They regarded as the second leading cause of death in cancer patients and several studies have confirmed that VTEs have a negative impact on survival and recurrent rate in both ovarian and endometrial cancer cases. The incidence of VTEs differs worldwide and depends on several risk factors including race, underlying disease, lifestyle, body weight, BMI and genetic risk factors. There is heterogeneity of DVT rates between Asian and Western countries. This study was conducted in order to evaluate the character and incidence of VTEs in gynecologic oncology patients in King Chulalongkorn Memorial Hospital over a 10 year period. Materials and Methods: A retrospective chart review was performed with VTEs defined as objective diagnosis of acute DVT or PE with typical symptoms and signs. Diagnoses were approved byan internist and/or confirmed with imaging studies. Data from both outpatient and inpatient sessions of the affected cases from January 2004 to December 2013 were extracted. General characteristics of the patients were collected with details of the diseases, types of cancer, stage, date of diagnosis of cancer, operative data, treatment outcome, progression free survival and overall survival. Results: Thirty cases of VTEs were identified in a total 2,316 gynecologic oncology cases. The incidence of symptomatic VTEs in total gynecologic oncology patients in our institution is 1.295%. The incidence of VTEs in ovarian cancer patients in our institution was 5.9%. Duration for VTE detection ranged from 13 months before diagnosis of cancer to 33 months after diagnosis of cancer. Most of the VTE cases were detected in ovarian cancer patients (60%). The most common cell type was adenocarcinoma (moderately to poorly differentiated) which accounted for 26.7% of the cases. The second most common cell type was clear cell carcinoma with 23.3% of the cases. Thirty percent of VTE cases developed before cancer was diagnosed, 20% were diagnosed at the same time as cancer detection and fifty percent developed after cancer was diagnosed. Median disease free survival of the gynecologic oncology patients with VTE was 7.5 months. Median overall survival (OS) was 12 months. Median progession free survivals of DVT and PE groups were 11.5 and 5.5 months, respectively. OS of DVT and PE was 12.0 and 11.5 months respectively. Conclusions: The incidence of VTE in Asian countries is believed to be lower than in European or Western countries. From our retrospective review, the incidence of VTEs in all types of gynecologic oncology was 1.295%, much lower than reported in the West. The reason for the lower incidence may genetic differences. Another factor is that VTE in this review was symptomatic, which is less than asymptomatic VTE. More than half of VTEs in this study developed in ovarian cancer patients. The results are compatible with earlier reports that among gynecologic malignancies, the incidence of VTE is highest in ovarian cancer.
Vvenous thromboembolisms;gynecologic cancer;DVT;PE;Thailand
- Ailawadi M, Del Priore G (2001). A comparison of thromboembolic prophylaxis in gynecologic oncology patients. Int J Gynecol Cancer, 11, 354-8. https://doi.org/10.1046/j.1525-1438.2001.01045.x
- Clarke-Pearson DL, DeLong ER, Synan IS, et al (1987). Variables associated with postoperative deep venous thrombosis: a prospective study of 411 gynecology patients and creation of a prognostic model. Obstet Gynecol, 69, 146-50.
- Committee on Practice Bulletins-Gynecology, American College of Obstetricians and Gynecologists (2007). ACOG practice bulletin no. 84: prevention of deep vein thrombosis and pulmonary embolism. Obstet Gynecol, 110, 429-40. https://doi.org/10.1097/01.AOG.0000263919.23437.15
- Del Carmen MG, Birrer M, Schorge JO (2012). Clear cell carcinoma of the ovary: a review of the literature. Gynecol Oncol, 126, 481-90. https://doi.org/10.1016/j.ygyno.2012.04.021
- Donati MB (1995). Cancer and thrombosis: from Phlegmasia alba dolens to transgenic mice. Thromb Haemost, 74, 278-81.
- Diaz ES, Walts AE, Karlan BY, et al (2013). Venous thromboembolism during primary treatment of ovarian clear cell carcinoma is associated with decreased survival. Gynecol Oncol, 131, 541-5. https://doi.org/10.1016/j.ygyno.2013.09.005
- Geerts WH, Pineo GF, Heit JA, et al (2004). Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest, 126, 338-400. https://doi.org/10.1378/chest.126.3_suppl.338S
- Heidrich H, Konau E, Hesse P (2009). Asymptomatic venous thrombosis in cancer patients--a problem often overlooked. Results of a retrospective and prospective study. Vasa, 38, 160-6. https://doi.org/10.1024/0301-1522.214.171.124
- Heit JA, Mohr DN, Silverstein MD, et al (2000). Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med, 160, 761-8. https://doi.org/10.1001/archinte.160.6.761
- Heit JA, O'Fallon WM, Petterson TM, et al (2002). Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med, 162, 1245-8. https://doi.org/10.1001/archinte.162.11.1245
- Kanchanabat B, Stapanavatr W, Meknavin S, et al (2011). Systematic review and meta-analysis on the rate of postoperative venous thromboembolism in orthopaedic surgery in Asian patients without thromboprophylaxis. Br J Surg, 98, 1356-64. https://doi.org/10.1002/bjs.7589
- Kunpalin Y, Triratanachat S, Tantbirojn P (2014). Proportion of ovarian cancers in overall ovarian masses in Thailand. Asian Pac J Cancer Prev, 15, 7929-34. https://doi.org/10.7314/APJCP.2014.15.18.7929
- Lyman GH, Khorana AA, Kuderer NM, et al (2013). American society of clinical oncology clinical practice. venous thromboembolism prophylaxis and treatment in patients with cancer: American society of clinical oncology clinical practice guideline update. J Clin Oncol, 31, 2189-204. https://doi.org/10.1200/JCO.2013.49.1118
- Martino MA, Williamson E, Rajaram L, et al (2007). Defining practice patterns in gynecologic oncology to prevent pulmonary embolism and deep venous thrombosis. Gynecol Oncol, 106, 439-45. https://doi.org/10.1016/j.ygyno.2007.05.001
- Matsuo K, Yessaian AA, Lin YG, et al (2013). Predictive model of venous thromboembolism in endometrial cancer. Gynecol Oncol, 128, 544-51. https://doi.org/10.1016/j.ygyno.2012.12.014
- Matsuura Y, Robertson G, Marsden DE, et al (2007). Thromboembolic complications in patients with clear cell carcinoma of the ovary. Gynecol Oncol, 104, 406-10 https://doi.org/10.1016/j.ygyno.2006.08.026
- Merkow RP, Bilimoria KY, McCarter MD, et al (2011). Postdischarge venous thromboembolism after cancer surgery: extending the case for extended prophylaxis. Ann Surg, 254, 131-7. https://doi.org/10.1097/SLA.0b013e31821b98da
- Montoya TI, Leclaire EL, Oakley SH, et al (2014). Fellows' pelvic research network of the society of gynecologic surgeons. venous thromboembolism in women undergoing pelvic reconstructive surgery with mechanical prophylaxis alone. Int Urogynecol J, 25, 921-6. https://doi.org/10.1007/s00192-013-2315-4
- Oranratanaphan S, Khemapech N (2013). Characteristics and treatment outcomes of patients with malignant transformation arising from mature cystic teratoma of the ovary: experience at a single institution. Asian Pac J Cancer Prev, 14, 4693-7. https://doi.org/10.7314/APJCP.2013.14.8.4693
- Peedicayil A, Weaver A, Li X, et al (2011). Incidence and timing of venous thromboembolism after surgery for gynecological cancer. Gynecol Oncol, 121, 64-9. https://doi.org/10.1016/j.ygyno.2010.11.038
- Prandoni P, Falanga A, Piccioli A (2005). Cancer and venous thromboembolism. Lancet Oncol, 6, 401-10. https://doi.org/10.1016/S1470-2045(05)70207-2
- Prandoni P, Lensing AW, Piccioli A, et al (2002). Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood, 100, 3484-8. https://doi.org/10.1182/blood-2002-01-0108
- Pruemer J (2005). Prevalence, causes, and impact of cancerassociated thrombosis. Am J Health Syst Pharm, 62, 4-6.
- Ramirez PT, Nick AM, Frumovitz M, Schmeler KM (2013). Venous thromboembolic events in minimally invasive gynecologic surgery. J minim Invasive Gynecol, 20, 766-9. https://doi.org/10.1016/j.jmig.2013.06.001
- Rickles FR, Edwards RL (1983). Activation of blood coagulation in cancer: Trousseau's syndrome revisited. Blood, 62, 14-31.
- Rodriguez AO, Gonik AM, Zhou H, et al (2011). Venous thromboembolism in uterine cancer. Int J Gynecol Cancer, 21, 870-6. https://doi.org/10.1097/IGC.0b013e31821a367e
- Rodriguez AO, Wun T, Chew H, et al (2007). Venous thromboembolism in ovarian cancer. Gynocol Oncol, 105, 784-90. https://doi.org/10.1016/j.ygyno.2007.02.024
- Sandhu R, Pan CX, Wun T, et al (2010). The incidence of venous thromboembolism and its effect on survival among patients with primary bladder cancer. Cancer, 116, 2596-603.
- Satoh T, Oki A, Uno K, et al (2007). High incidence of silent venous thromboembolism before treatment in ovarian cancer. Br J Cancer, 97, 1053-7. https://doi.org/10.1038/sj.bjc.6603989
- Streiff MB (2015). Predicting the risk of recurrent venous thromboembolism (VTE). J Thromb Thrombolysis, 39, 353-66. https://doi.org/10.1007/s11239-015-1188-4
- Young A, Chapman O, Connor C, et al (2012). Thrombosis and cancer. Nat Rev Clin Oncol, 9, 437-49. https://doi.org/10.1038/nrclinonc.2012.106
- van den Berg YW, Osanto S, Reitsma PH, et al (2012). The relationship between tissue factor and cancer progression: insights from bench and bedside. Blood, 119, 924-32 https://doi.org/10.1182/blood-2011-06-317685
- Zwicker JI, Liebman HA, Neuberg D, et al (2009). Tumorderived tissue factor-bearing microparticles are associated with venous thromboembolic events in malignancy. Clin Cancer Res, 15, 6830-40. https://doi.org/10.1158/1078-0432.CCR-09-0371
- Risk factors and treatment of venous thromboembolism in perioperative patients with ovarian cancer in China vol.97, pp.31, 2018, https://doi.org/10.1097/MD.0000000000011754