Splanchnic venous thrombosis is a marker of cancer and a prognostic factor for cancer survival

Abstract

Key Points• SVT is a marker of occult cancer, in particular myeloproliferative neoplasms, liver cancer, and pancreatic cancer.• SVT is a prognostic factor for short-term survival in patients diagnosed with liver or pancreatic cancer.It is unknown if splanchnic venous thrombosis (SVT) is a marker of occult cancer and a prognostic factor for cancer survival. Using Danish medical registries, we conducted a nationwide cohort study including all patients with first-time SVT (n 5 1191) between 1994 and 2011. We followed the patients for subsequent cancer diagnoses and calculated absolute risks and standardized incidence ratios (SIRs). We formed a matched comparison cohort of cancer patients without SVT, and assessed the prognostic impact of SVT on cancer survival by applying the Kaplan-Meier method and Cox regression. We followed the patients for a median of 1.6 years, and found that SVT was a marker of occult cancer. The 3-month cancer risk was 8.0% and the SIR was 33 (95% confidence interval, 27-40), compared with the general population. Increased risk was mainly found for liver cancer (risk 5 3.5%; SIR 5 1805), pancreatic cancer (risk 5 1.5%; SIR 5 256), and myeloproliferative neoplasms (risk 5 0.7%; SIR 5 764). The overall SIR remained increased twofold after 1 or more years of follow-up. SVT was also a prognostic factor for survival in patients with liver and pancreatic cancer. The clinical impact may be a more thorough diagnostic work-up in patients presenting with SVT. (Blood. 2015;126(8):957-963)

Splanchnic vein thrombosis in myeloproliferative neoplasms: risk factors for recurrences in a cohort of 181 patients

“…22 The most frequent site of thrombosis was the portal-mesenteric axis and BCS accounted for 17% this latter frequency is slightly higher than the value observed in the general population, where BCS accounts for 5 to 12% of SVT. 13, 23, 24 The majority of patients were young females (65%), with a median age of 48 years, in agreement with previous MPN series 16, 19, 25 and contrasting with the gender and older median age observed in the general population. 13, 23 …”

Cerebral and Splanchnic Vein Thrombosis: Advances, Challenges, and Unanswered Questions

“…Among local risk factors for SVT, liver cirrhosis is responsible for 24-27% of SVT [54,58], whereas the prevalence of SVT in cirrhosis was reported to be 17%, although asymptomatic and incidentally detected in 43% of them [61]. Solid cancer is found in 22-27% of SVT [54,58] and, in addition, approximately 8% of SVT patients are diagnosed with cancer within the first 3 months of follow-up [62]. Other local risk factors are recent abdominal surgery and abdominal infections or inflammation (e.g., pancreatitis, cholecystitis, appendicitis, diverticulitis, liver abscesses, inflammatory bowel diseases).…”

Venous thrombosis in unusual sites: A practical review for the hematologist

“…Of the splanchnic vein thromboses, isolated occult mesenteric vein thrombosis is the least likely to be associated with malignancy or MPNs. Søgaard and colleagues examined a data set containing 126 patients with occult mesenteric vein thrombosis and found only one associated malignancy and no associated MPNs . Other small series have noted about 25% of patients will have an associated intra‐abdominal malignancy .…”