The Survival Detriment of Venous Thromboembolism With Epithelial Ovarian Cancer

Abstract

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.

Tissue Factor–Factor VII Complex as a Key Regulator of Ovarian Cancer Phenotypes

“…53 Indeed, later studies showed that VTE is frequent in ovarian cancer patients 12,13,25 and correlates with reduced survival rates. 54,55 Accumulating experimental evidence suggests that the histological type of EOC with the highest incidence of VTE is CCC. [24][25][26][27][56][57][58] It is conceivable that TF plays a major role in VTE in ovarian cancer patients, given that TF can be highly expressed in EOC tissues.…”

Dilemmas in anticoagulation and use of inferior vena cava filters in venous thromboembolism; a survey of Respiratory Physicians, Haematologists and Medical Oncologists and a review of the literature

“…The development of VTE has a negative impact on overall survival with PE being the leading cause of death in ovarian malignancy. 28,29 The type and timing of therapeutic anticoagulation has to be balanced against the perioperative bleeding risk and the risk of further VTE. Two retrospective case series have shown reduced rates of PE with the use of IVCFs preoperatively in gynaecological and other malignancies.…”

Ovarian Cancer Presenting as Cryptogenic Stroke from Patent Foramen Ovale

“…VTE negatively impacts survival, which may indicate that thrombotic signaling promotes a more aggressive tumor behavior. 9,16 Risk factors for VTE in ovarian cancer are advanced stage (III, IV), clear cell histology, chemotherapy, extensive cyto-reductive surgery, high-grade serous adenocarcinoma. 10 Patients with VTE during primary treatment for ovarian cancer (clear cell) had a 3.9-fold increase in risk of recurrence and a 6.3-fold increase in risk of death, and VTE remained an independent prognostic factor for death, even after controlling the disease.…”

“…3,6 VTE disease (pulmonary embolism [PE] and deep vein thrombosis [DVT]) are significantly associated with ovarian cancer 7 and adversely impact patient survival. [7][8][9][10] This case report outlines the discovery of occult ovarian cancer in a patient who exhibited acute cerebrovascular events with an incidental detection of patent foramen ovale (PFO).…”