Venous thromboembolism in metastatic pancreatic cancer

• Published in: European journal of haematology Vol. 110; no. 6; pp. 706 - 714
• Main Authors: Laderman, Lauren, Sreekrishnanilayam, Krishnalatha, Pandey, Ramesh K., Handorf, Elizabeth, Blumenreich, Aryeh, Sorice, Kristen A., Lynch, Shannon M., Cheema, Khadija, Nagappan, Lavanya, Sosa, Iberia R., Dotan, Efrat, Vijayvergia, Namrata
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-06-2023
• Subjects: anticoagulant; Anticoagulants - adverse effects; Diagnosis; Female; Humans; Incidence; Male; Metastases; Metastasis; metastatic pancreatic cancer; Pancreatic cancer; Pancreatic Neoplasms; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - epidemiology; Retrospective Studies; Risk assessment; Risk Factors; Solid tumors; Survival; Survival analysis; Thromboembolism; thromboprophylaxis; venous thromboembolism; Venous Thromboembolism - diagnosis; Venous Thromboembolism - epidemiology; Venous Thromboembolism - etiology; anticoagulant; venous thromboembolism; metastatic pancreatic cancer; thromboprophylaxis
• ISSN: 0902-4441; 1600-0609
• DOI: 10.1111/ejh.13955

Background
Pancreatic cancer (PC) carries a high risk of venous thromboembolism (VTE). Several risk assessment models (RAMs) predict benefit of thromboprophylaxis in solid tumors; however, none are verified in metastatic pancreatic cancer (mPC).
Methods
A retrospective mPC cohort treated at an academic cancer center from 2010 to 2016 was investigated for VTE incidence (VTEmets). Multivariable regression analysis was used to assess multiple VTE risk factors. Overall survival (OS) was compared between mPC groups with and without VTE. Survival was analyzed using Kaplan–Meier survival plots and Cox proportional hazards regressions.
Results
400 mPC patients (median age 66; 52% males) were included. 87% had performance status of ECOG 0–1; 70% had advanced stage at PC diagnosis. Incidence of VTEmets was 17.5%; median time of occurrence 3.48 months after mPC diagnosis. Survival analysis started at median VTE occurrence. Median OS was 10.5 months in VTEmets vs. 13.4 in non‐VTE group. Only advanced stage (OR 3.7, p = .001) correlated with increased VTE risk.
Conclusions
The results suggest mPC carries a significant VTE burden. VTE predicts poor outcomes from the point of median VTE occurrence. Advanced stage disease is the strongest risk factor. Future studies are needed to define risk stratification, survival benefit, and choice of thromboprophylaxis.