High risk of venous thrombosis in patients with pancreatic cancer: A cohort study of 202 patients

Abstract

Epidemiology A B S T R A C TTo estimate the risk of venous thrombosis associated with pancreatic malignancies we followed a cohort of patients with pancreatic cancer (n = 202). We calculated incidence rates of venous thrombosis and compared this with population rates using a Standardised Morbidity Ratio (SMR). The effects of location, histology and treatment were assessed by Coxmodelling. The incidence of venous thrombosis was 108.3/1000 patient-years (95% confidence interval (CI) 64.4-163.8), 58.6-fold increased (SMR 58.6, 95% CI 36.9-92.9).Patients with a tumour of the corpus/cauda had a 2-fold increased risk compared with those with a tumour of the caput. Patients treated with chemotherapy had a 4.8-fold increased risk (HR adj 4.8, 95% CI 1.1-20.8), whereas radiotherapy did not increase the risk.In a postoperative period of 30 d, patients had a 4.5-fold increased risk of venous thrombosis (HR adj 4.5, 95% CI 0.5-40.9). The risk was 1.9-fold increased in the presence of distant metastases (HR adj 1.9, 95% CI 0.7-5.1). Anti-thrombotic prophylaxis seems warranted in the first month after surgery, during and after treatment with chemotherapy, and when distant metastases have been diagnosed.

ABO blood group, hepatitis B viral infection and risk of pancreatic cancer

“…A case-control study showed that the risk of thrombosis increased with increasing vWF or factor VIII concentration and was higher in subjects of non-O blood groups than in those of group O. 44 Moreover, venous thrombosis is not only a complication of pancreatic cancer, 45 but also may be associated with a 6-fold excess risk of occult pancreatic cancer. 46 A clotting process is involved in fibrogenesis.…”

Microparticle‐associated tissue factor activity: a link between cancer and thrombosis?

“…The incidence of thrombosis is high in adenocarcinomas such as ovarian, prostate and gastro-intestinal carcinoma [2,3], but is particularly high (up to 57%) in patients with pancreatic cancer [4][5][6]. However, the cause of this association is still unknown.…”

Excess premature (3-month) mortality in advanced pancreatic cancer could be related to fatal vascular thromboembolic events. A hypothesis based on a systematic review of phase III chemotherapy studies in advanced pancreatic cancer

“…This is specifically of concern since there is some evidence that chemotherapy perse and possibly some of the newer anti-angiogenic agents that may become useful in advanced pancreatic cancer do carry a risk of exacerbating the thrombophilic state. How much chemotherapy contributes to thrombosis-related early death cannot be gauged through the methodological approach of our review but a recent epidemiological study by Blom et al has attempted to quantify this risk and has determined that distant metastases raise the risk of vascular thromboembolic events by 1.9 fold (which may relate to the higher 'early death burden' we document in this setting in Table III), but chemotherapy had a notable 4.8 fold increase in the risk of venous thromboembolism [39]. This statistic gives serious impetus to the need to include vascular thromboembolic events as potential chemotherapyrelated causes of 'toxic death', specifically in advanced pancreatic cancer, but also to the need to consider anti-thrombotic prophylaxis in patients undergoing chemotherapy.…”