Venous Thromboembolism in Patients with Advanced Pancreatic Cancer Receiving Palliative Chemotherapy: Incidence and Effect on Prognosis

Abstract

Background/Aims: This study evaluated the incidence of venous thromboembolism (VTE) in patients with advanced pancreatic ductal adenocarcinoma (PDAC) at the authors' institution and analyzed the risk factors associated with VTE and the overall survival (OS). Methods: One hundred and seventy patients with locally advanced or metastatic PDAC who received palliative chemotherapy at Daegu Catholic University Medical Center from January 2011 to December 2020 were included. Results: During a median follow-up period of 341 days, 24 patients (14.1%) developed VTE. Cumulative incidence values of VTE were 4.7% (95% confidence interval [CI], 2.39-9.22) at 90 days, 9.9% (95% CI, 6.14-15.59) at 180 days, and 16.9% (95% CI, 11.50-24.36) at 360 days. Multivariate analysis showed that a carbohydrate antigen 19-9 (CA 19-9) level over 1,000 U/mL (hazard ratio [HR], 2.666; 95% CI, 1.112-6.389; p=0.028) and a history of alcohol consumption (HR, 0.327; 95% CI, 0.109-0.981; p=0.046) were significant factors associated with VTE. Patients with VTE showed a shorter median survival (347 days vs. 556 days; p=0.041) than those without VTE. Multivariate analysis revealed VTE (HR, 1.850; 95% CI, 1.049-3.263; p=0.033) and CA 19-9 level over 1,000 U/mL (HR, 1.843; 95% CI, 1.113-3.052; p=0.017) to be significant risk factors associated with OS. Conclusions: The cumulative incidence of VTE in patients with advanced PDAC was 16.9% at 360 days. While a history of alcohol consumption was a protective factor, a high CA19-9 level was a risk factor for VTE. In addition, the occurrence of VTE was associated with poor prognosis.

Prognostic value of venous thromboembolism in patients with advanced pancreatic cancer: a systematic review and meta-analysis

“…The sample sizes in these studies ranged from 170 to 838. Among the ten studies, 1,903 Asian patients ( 17 , 18 , 20 , 22 , 23 ) and 1,242 European and American patients ( 14 – 16 , 19 , 21 ) were enrolled. The majority of the patients were middle-aged and elderly individuals diagnosed with advanced pancreatic cancer.…”

“…The majority of the patients were middle-aged and elderly individuals diagnosed with advanced pancreatic cancer. Treatment modalities included chemotherapy ( 14 – 16 , 18 – 20 , 22 , 23 ) or chemoradiotherapy ( 17 , 21 ). Our research aimed to assess the predictive value of VTE in patients with advanced pancreatic cancer by combining OS and DFS data.…”

“…Our research aimed to assess the predictive value of VTE in patients with advanced pancreatic cancer by combining OS and DFS data. Six studies provided the HR with 95% CI directly ( 14 – 18 , 22 ), and the rest four only presented survival curves that required independent extraction ( 19 – 21 , 23 ). NOS scores for studies were above seven, indicating their quality satisfying the eligibility criteria.…”

Competitive Risk Analysis of Prognosis in Older Adults with Sigmoid Colon Adenocarcinoma: A Population-Based Study

“…Evidence from various studies suggests that chemotherapy can provide a survival benefit in some cases, but its use in the elderly population requires a nuanced approach to balance potential benefits and risks. 42 – 44 …”