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Int J Gynecol Cancer. 2016 Jun;26(5):924-32. doi: 10.1097/IGC.0000000000000684.

Signs and Symptoms of Venous Thromboembolism and Survival Outcome of Endometrial Cancer.

Author information

1
*Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA; †School of Medicine, Niigata University, Niigata, Japan; ‡Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Los Angeles County Medical Center; and §Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.

Abstract

OBJECTIVE:

This study aimed to evaluate if the presence of venous thromboembolism (VTE) diagnosed with subjective and objective measurements correlates with the survival outcome in patients with endometrial cancer.

METHODS:

A retrospective study was conducted on patients with endometrial cancer who developed VTE between cancer diagnosis and follow-up from 1999 to 2013. Disease-specific survival after VTE diagnosis was evaluated according to VTE symptoms and vital signs.

RESULTS:

Among 827 endometrial cancer cases during the study period, there were 72 (8.7%) patients with VTE identified (pulmonary embolism [PE] with or without deep vein thrombosis [DVT], n = 34; and DVT alone n = 38). In the PE group, decreased disease-specific survival after the diagnosis of VTE was associated with fatigue, systolic blood pressure (BP) less than 120 mm Hg, diastolic BP less than 70 mm Hg, and a heart rate 90 beats per minute or greater (all, P < 0.05) in a univariate analysis. Symptomatic PE was associated with decreased survival as compared to asymptomatic PE (2-year rate; 23.1% vs 77.8%, P < 0.01). In a multivariate analysis controlling for symptoms of VTE, signs, and tumor factors, a diastolic BP less than 70 mm Hg (adjusted-hazard ratio [HR], 10.0; 95% confidence interval, 2.70-37.1; P < 0.01) and HR greater than 90 beats per minute (adjusted-HR, 8.06; 95% confidence interval, 2.36-27.5; P < 0.01) remained as independent prognostic factors for decreased disease-specific survival after PE diagnosis. Patients with PE presenting with low diastolic BP and high heart rate resulted in a dismal survival outcome (diastolic BP < 70 mm Hg/heart rate ≥ 90 beats per minute vs diastolic BP ≥ 70 mm Hg/heart rate < 90 beats per minute; 0% vs 85.7%, P < 0.01). In the group of patients with DVT alone, no signs or symptoms correlated with survival outcome (all, P > 0.05).

CONCLUSIONS:

Our results suggested that both signs and symptoms of PE are important consideration in the management of patients with endometrial cancer with PE.

PMID:
27051051
DOI:
10.1097/IGC.0000000000000684
[Indexed for MEDLINE]

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