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Gastroenterology. 2019 Dec 13. pii: S0016-5085(19)41921-5. doi: 10.1053/j.gastro.2019.12.009. [Epub ahead of print]

Incidence of Venous Thromboembolism in Patients with Newly Diagnosed Pancreatic Cancer and Factors Associated With Outcomes.

Author information

1
Sorbonne Université, INSERM UMRS_1166, Institute of Cardiometabolism And Nutrition, GRC 27 GRECO, F-75013 Paris, France; Assistance Publique Hôpitaux de Paris, Department of Haematology, Pitié-Salpêtrière Hospital, F-75013 Paris, France.
2
University of Toulouse, F-31059 Toulouse, France; CHU de Toulouse, Department of Gastroenterology and Pancreatology, F-31059 Toulouse, France.
3
Université de Montpellier, Institut du Cancer de Montpellier-Unité de Biométrie, F-34298 Montpellier, France.
4
Hematology Division, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
5
Université de Paris, EA 3518, Institut Universitaire d'Hématologie, F-75010 Paris, France; Assistance Publique Hôpitaux de Paris, Saint-Louis Hospital, Internal Medicine, Autoimmune and Vascular Disease Unit, F-75010 Paris, France; Department of Medicine, McGill University, Montreal, Québec, Canada. Electronic address: dominique.farge-bancel@aphp.fr.

Abstract

BACKGROUND & AIMS:

Pancreatic ductal adenocarcinoma (PDAC) is associated with the highest incidence of venous thromboembolism (VTE) of any cancer type. However, little is known about risk factors for VTE or its outcomes in patients with PDAC.

METHODS:

We collected data from a prospective, observational study performed at multiple centers in France from May 2014 through November 2018 (the Base Clinico-Biologique de l'Adénocarcinome Pancréatique [BACAP] study) linked to a database of patients with a new diagnosis of PDAC of any stage. Data were collected from 731 patients at baseline and during clinical follow-up or in the event of symptoms. The primary endpoint was the onset of VTE during follow up. The secondary end points were progression-free survival (PFS) and overall survival (OS) times.

RESULTS:

During a median follow-up of 19.3 months, 152 patients (20.79%) developed a VTE. The median time from PDAC diagnosis to the onset of VTE was 4.49 months. Cumulative incidence values of VTE were 8.07% (95% CI, 6.31-10.29) at 3 months and 19.21% (95% CI, 16.27-22.62) at 12 months. In multivariate analysis, PDAC primary tumor location (isthmus vs head, hazard ratio [HR], 2.06; 95% CI, 1.09-3.91; P=.027) and stage (locally advanced vs resectable or borderline HR, 1.66; 95% CI 1.10-2.51, P=.016 and metastatic vs resectable or borderline HR, 2.50; 95% CI, 1.64-3.79; P<.001) were independent risk factors for onset of VTE. Patients who developed VTE during follow up had shorter times of PFS (HR, 1.74; 95% CI, 1.19-2.54; P=.004) and OS (HR, 2.02; 95% CI, 1.57-2.60; P<.001).

CONCLUSION:

In an analysis of data from the BACAP study, we found that frequent and early onset of VTE after diagnoses of PDAC are associated with significant decreases in times of PFS and OS. Studies are needed to determine whether primary prophylaxis of VTE in patients with PDAC will improve morbidity and mortality related to VTE.

KEYWORDS:

blood clot; complication; pancreatic cancer; prognostic factor

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