Thromb Haemost 2011; 106(02): 371-378
DOI: 10.1160/TH10-12-0789
Cellular Proteolysis and Oncology
Schattauer GmbH

Symptomatic and incidental thromboembolism are both associated with mortality in pancreatic cancer

Laurel A. Menapace
1  James P. Wilmot Cancer Center, and the Department of Medicine, University of Rochester, Rochester, New York, USA
,
Derick R. Peterson
1  James P. Wilmot Cancer Center, and the Department of Medicine, University of Rochester, Rochester, New York, USA
2  Department of Biostatistics, University of Rochester, Rochester, New York, USA
,
Andrea Berry
1  James P. Wilmot Cancer Center, and the Department of Medicine, University of Rochester, Rochester, New York, USA
2  Department of Biostatistics, University of Rochester, Rochester, New York, USA
,
Tarek Sousou
1  James P. Wilmot Cancer Center, and the Department of Medicine, University of Rochester, Rochester, New York, USA
,
Alok A. Khorana
1  James P. Wilmot Cancer Center, and the Department of Medicine, University of Rochester, Rochester, New York, USA
› Author Affiliations
Further Information

Publication History

Received: 15 December 2010

Accepted after major revision: 03 May 2011

Publication Date:
25 November 2017 (online)

Summary

Pancreatic cancer is known to be associated with VTE, but contemporary rates of incidental and symptomatic VTE events and their association with mortality are incompletely understood. We conducted a retrospective cohort study of consecutive pancreatic adenocarcinoma patients at the University of Rochester from 2006–2009. Data were analysed using a Cox model with time-dependent covariates. A total of 1,151 radiologic exams of 135 patients were included. Forty-seven patients (34.8%) experienced VTE including 12 pulmonary emboli (PE), 28 deep-vein thromboses (DVTs) and 47 visceral vein events. Incidental events comprised 33.3% of PEs, 21.4% of DVTs and 100% of visceral VTE. Median (95% CI) conditional survival beyond three months was 233 (162–322) more days for those without VTE, which was significantly greater than 12 (3–60) days for those with DVT as first event (p<0.0001) and 87 (14–322) days with visceral first events (p=0.022). In multivariate analysis, DVT (HR 25, 95% CI 10–63, p <0.0001), PE (HR 8.9, 95% CI 2.5–31.7, p = 0.007) and incidental visceral events (HR 2.6, 95% CI 1.6–4.2, p =0.0001) were all associated with mortality, though anticoagulants reduced these risks by 70% (26–88%, p = 0.009). In conclusion, VTE occurs in over one-third of contemporary pancreatic cancer patients and, whether symptomatic or incidental, is strongly associated with worsened mortality. The role of anticoagulation in treating incidental or visceral VTE warrants further study.

Note: The abstract of this manuscript was presented at the Annual Meeting of the American Society of Hematology, Orlando, FL, USA on December 5, 2010.