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More than 10% of cancer patients have venous thromboembolism (VTE). There is a clear relationship between VTE and several types of solid tumors; VTE negatively impacts survival. This disorder is the second leading cause of death in cancer patients. Some studies have reported that the solid tumor with the highest rate of VTE is ovarian cancer. Few studies have evaluated the contribution of VTE timing to survival in patients with solid tumors. A substantial proportion of deaths in cancer patients may be preventable with improved and tailored thromboprophylaxis.The aim of this retrospective study was to evaluate the effect of VTE on survival in patients with epithelial ovarian cancer (EOC) and to determine how the chronology of VTE events with respect to surgery impacts survival. A chart review was performed for data from patients treated for EOC [at a single medical center between 1996 and 2011]. Associations between VTE and the primary outcomes of progression-free survival (PFS) and overall survival (OS) were assessed using a Cox proportional hazards model. Data were adjusted for diagnosis, age, stage, histology, performance status, and residual disease.A total of 586 patients were treated for EOC met study criteria. Median patient age was 63 years (range, 17-94 years), and median body mass index was 27.1 kg/m 2 (range, 13.7-67.0 kg/m 2 ). Most patients (75.4%) had advanced stage (III/IV) disease; 68.3% had high-grade serous histology. Twenty-one patients (3.7%) had preoperative VTE, and 74 (13.2%) had postoperative VTE. Preoperative VTE was predictive of OS (adjusted hazard ratio [aHR], 3.1; 95% confidence interval [CI], 1.6-6.1; P = 0.001) but not PFS (P = 0.55). Postoperative VTE was predictive of both PFS (aHR, 1.45; 95% CI, 1.04-2.02; P = 0.03) and OS (aHR, 1.8; 95% CI, 1.3-2.6; P = 0.001). When VTE timing was modeled, preoperative VTE was predictive of OS (aHR, 3.5; 95% CI, 1.8-6.9; P < 0.001).but postoperative VTE was predictive of OS only when occurring after completion of primary therapy (aHR, 2.3; 95% CI, 1.4-3.6; P = 0.001).These findings demonstrate that both preoperative and postoperative VTE are independent predictors of poor survival in women with EOC. Postoperative VTE attenuates PFS when modeled as a binary variable but is not associated with PFS when VTE timing is modeled. Venous thromboembolism is potentially preventable. Further studies are needed to determine whether improved VTE prophylaxis and treatment can increase survival.

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Our study shows a median OS of 23 months, which is less than what was documented in the literature. Despite the use of modern chemoradiation therapy, most of the cohort died within 3 years. The low OS presented in our study highlights the limitations of the current treatment regimens and the need for identification of for more effective therapy.

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