Characterization of Risk Factors and Timing of Venous Thromboembolism in Patients With Uterine Serous Carcinoma

Abstract

OBJECTIVE: To characterize risk factors and timing of venous thromboembolism in women with uterine serous carcinoma. METHODS: A retrospective cohort study was performed including all women diagnosed with uterine serous carcinoma from 1999 to 2016 at our institution. Clinicopathologic data and information regarding timing of venous thromboembolism were abstracted from the medical record. Logistic regression and Cox proportional hazards modeling were used to examine the association between covariates and risk and timing of venous thromboembolism. RESULTS: Seventy of the 413 included patients (17%) developed venous thromboembolism, with a median time from presentation to venous thromboembolism of 7.2 months (interquartile range 1.0–24.8) and from surgery to venous thromboembolism of 13.2 months (interquartile range 3.5–33.6). Fifty-nine of the 70 patients (84%) who developed venous thromboembolism were diagnosed either before surgery or greater than 6 weeks postoperatively. Twenty-two of the 70 patients (31%) who developed clots were on chemotherapy at the time of diagnosis. Venous thromboembolism was highly associated with cancer stage and presence of hypertension (P<.01). Cox proportional hazards modeling revealed that only cancer stages III and IV (hazard ratio [HR] 3.20, 95% CI 1.54–6.64 and HR 8.68, 95% CI 4.50–16.73, respectively) and hypertensive or cardiovascular diseases (HR 2.29, 95% CI 1.08–4.85 and HR 1.82, 95% CI 1.05–3.13) were associated with time to venous thromboembolism. CONCLUSION: Patients with uterine serous carcinoma are at high risk of developing venous thromboembolism even many months after their cancer diagnosis. This study generates the hypothesis that venous thromboembolism prophylaxis may be beneficial in patients with uterine serous carcinoma during other time points along the continuum of disease rather than only in the postoperative period, especially for those with advanced cancer.

Characterization of risk factors and timing of venous thromboembolism in patients with uterine carcinosarcoma

“…Our study also suggests that the risk of venous thromboembolism in women with uterine carcinosarcoma may be greater than the risk of venous thromboembolism in other uterine tumor histologies. Venous thromboembolism has been evaluated at our institution for women with uterine serous carcinoma, which reported an incidence of venous thromboembolism of 17% [10]. It is possible that the specific histological features or disease patterns associated with carcinosarcoma may put women at a higher risk for venous thromboembolism.…”

“…Although the incidence of venous thromboembolism in women with uterine carcinosarcoma has been previously reported as 8%, no studies have examined the timing of venous thromboembolism throughout the disease course or the efficacy of venous thromboembolism risk prediction tools such as the Khorana score [8,9]. Because the risk of venous thromboembolism remains high for up to one year after initial surgical staging, previous studies have hypothesized that long-term prophylaxis may be beneficial in preventing venous thromboembolism in women with high-grade uterine tumors [10].…”