The prevalence, risk factors, and prognostic value of venous thromboembolism in ovarian cancer patients receiving chemotherapy: a systematic review and meta-analysis

Abstract

Background Venous thromboembolism (VTE) in ovarian cancer (OC) patients has been widely investigated, but our knowledge on the role of VTE in OC patients receiving chemotherapy is limited. The aim of our study was to investigate the prevalence, risk factors, and prognostic value of chemotherapy-associated VTE in OC. Methods Three databases (PubMed, Embase, and the Cochrane Library) were systematically searched from inception to October 14, 2020. The primary outcome was the prevalence of VTE in OC patients receiving chemotherapy. The risk factors and prognostic value of VTE were the secondary outcomes. The pooled prevalence of VTE was estimated using the generic inverse-variance method. The statistical heterogeneity was evaluated with Cochran’s Q test and I2 statistic. Funnel plot, Begg’s test, and Egger’s test were used to assess the potential publication bias in the meta-analysis. Results A total of eleven observational studies with 4759 OC patients were included. The pooled prevalence of VTE was 9% (95% CI, 0.06–0.12) in OC patients receiving chemotherapy. The results of subgroup analysis and sensitivity analysis were basically consistent with the overall pooled estimate. Multiple significant risk factors associated with VTE were also identified including advanced age, D-dimer > 0.5 mg/mL, and tumor diameter > 10 cm. Only two included studies reported the prognostic value of VTE in OC patients receiving chemotherapy, but with inconsistent results. Funnel plot showed that there existed potential publication bias, which was further verified by statistical test, but the results of the trim-and-fill method showed the pooled estimate kept stable after adding two “missing” studies. Conclusions This current study revealed that the pooled prevalence of chemotherapy-related VTE in OC was approximately 9% in OC patients. Risk factors for chemotherapy-related VTE were also identified which may contribute to targeting potentially preventative measures for VTE in OC.

The ICU-venous thromboembolism score and tumor grade can predict inhospital venous thromboembolism occurrence in critical patients with tumors

“…ICU patients are considered to be at high risk for VTE even after routine prophylactic anticoagulant therapy (upper and lower extremity venous thrombosis, about 10%) [ 16 , 17 ]. In recent years, numerous studies have evaluated the risk factors related to VTE from the aspects of patient factors, tumor factors, and treatment factors [ 3 – 10 , 12 , 13 ], thus developing the thrombosis evaluation scale and model for outpatient and inpatient patients to predict the risk of thrombosis [ 14 , 15 ]. Recently, an ICU-VTE scale was created for ICU inpatients to assess the risk of thrombosis in critically ill patients [ 5 ].…”

“…Patient factors that increase the risk of VTE include female sex, previous VTE history, advanced age, obesity, and ABO blood type [5][6][7][8]10].…”

“…VTE was defined as deep vein thrombosis (DVT), pulmonary embolism (PE), or both. A variety of factors contribute to thrombotic risk in tumor patients, apart from patient-specific factors (age, sex, ethnicity, high body mass index, platelet count, platelet distribution width, hyperlipidemia, ABO blood type, comorbidities) [4][5][6][7][8][9][10] and tumor-specific factors (tumor type, anatomical location, tumor load, gene mutations, tumor stage, and pathologic grade) [1,7,8,11,12]; therapeutic measures, such as chemotherapy, the use of red cell or platelet transfusions, high-risk surgery, indwelling catheter, invasive mechanical ventilation, total parenteral nutrition (TPN), and so on, constitute the other risk factors of VTE [4,8,13].…”

Prognostic value of pretreatment platelet count, fibrinogen and d-dimer levels in osteosarcoma patients: A meta-analysis

“…Previous studies revealed that venous thromboembolism (VTE) is strongly associated with human cancer and orthopedic operations, [6,7] and the combination of these two factors may substantially increase the risk of VTE. [8] Moreover, VTE could lead to a poorer prognosis of tumor patients, [6,9] while some serum indices associated with clotting and thrombosis, such as platelet-to-lymphocyte ratio (PLR) and d-dimer showed good prognostic value in cancer patients. [10,11] However, the prognostic impact of VTE-related indices including platelet, fibrinogen, and d-dimer, has not been validated in osteosarcoma patients.…”

Preoperative plasma D-dimer independently predicts survival in patients with pancreatic ductal adenocarcinoma undergoing radical resection

“…Since Trousseau first described the relationship between cancer and thromboembolic disease in 1865, activation of the coagulation system via hosttumor interactions has been found in almost all types of cancer [11][12][13]. In addition, the tumorinduced hypercoagulation state is not simply an epiphenomenon but is also intrinsically involved in enhanced tumor growth, angiogenesis, metastasis, and the systemic inflammatory response [11,12,14].…”