Korean J Gastroenterol.  2023 Mar;81(3):109-120. 10.4166/kjg.2022.137.

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

• Jeong HT
• Bae JH
• Kim HG
• Han J

• KMID: 2540953
• DOI: http://doi.org/10.4166/kjg.2022.137

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.

Keyword

Pancreatic cancer; Thromboembolism; Survival analysis; Incidence; Risk factors

Figure

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  Fig. 1 Flowchart of the study population. PDAC, pancreatic ductal adenocarcinoma; VTE, venous thromboembolism. aOther malignancies included six colorectal cancers, four thyroid cancers, three renal cell carcinomas, three hematologic malignancies, two gallbladder cancers, two breast cancer, one hepatocellular carcinoma, one lung cancer, one Klatskin tumor, one cervical cancer, and one prostate cancer.

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  Fig. 2 Cumulative incidence of venous thromboembolism in patients with pancreatic cancer.

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  Fig. 3 Overall survival of patients with pancreatic cancer according to venous thromboembolism. VTE, venous thromboembolism.

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  Fig. 4 Overall survival of patients with venous thromboembolism according to symptom.

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