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A prospective study on survival in cancer patients with and without venous thromboembolism

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Abstract

Retrospective population-based studies showed that in cancer patients venous thromboembolism (VTE) is associated with reduced survival. Master Oncology is a multicenter study in patients with solid advanced cancer aimed at assessing (1) risk factors for VTE using a case–control design, and (2) survival in cases (patients with VTE) and controls (patients without VTE). Survival data were prospectively collected for at least 10 months. Overall, 237 cases and 339 controls were included in the analysis. The following factors were found to be associated with an increased risk of VTE: body mass index (BMI; OR 2.02; 95 % CI 1.31–3.12 for ≥26 vs. <23 kg/m2), ECOG score (OR 2.14; 95 % CI 1.47–3.11 for grade 1, and 3.32; 95 % CI 1.64–6.00 for grade 2–3, compared to grade 0) and recent diagnosis of cancer (OR 1.90; 95 % CI 1.33–2.71 for <12 vs. ≥12 months). After an average prospective observation of 8.3 months, 136 cases (57.4 %) and 127 controls (37.5 %) died with a median survival of 8.7 (95 % CI 7.5–10.9) and 14.3 months (95 % CI 12.2–18.7), respectively, (Wilcoxon = 27.72, p < 0.001; multivariate hazard ratio 1.55; 95 % CI 1.21–2.00). Median survival time was reduced for both patients with symptomatic (Wilcoxon = 35.22, p < 0.001) and asymptomatic VTE (Wilcoxon = 4.63, p = 0.031). Patients with advanced solid cancer, high BMI, high ECOG score, and recent diagnosis of cancer are associated with an increased risk for VTE. Patients with both symptomatic and asymptomatic VTE have a reduced survival compared to those without VTE.

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Acknowledgements

The Italian MASTER Oncology study was supported by Sanofi; Sanofi had no role in analyzing the data or preparing the manuscript.

Conflict of interest

As for the present study, Drs. Silvano Gallus and Giovanni Apolone served as statistical consultants for Sanofi. All other authors declare no conflicts of interest related to this article.

Author information

Authors and Affiliations

  1. Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy

    Giancarlo Agnelli & Melina Verso

  2. Medical Oncology Unit, Ospedali Riuniti, Bergamo, Italy

    Mario Mandalà & Roberto Labianca

  3. Department of Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy

    Silvano Gallus

  4. Department of Medicine, Vimercate Hospital Azienda, Ospedaliera di Desio E Vimercate, Vimercate, Italy

    Claudio Cimminiello

  5. Direzione Scientifica, Azienda Ospedaliera Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy

    Giovanni Apolone

  6. Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples, Italy

    Giovanni Di Minno

  7. Oncology Unit, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo (FG), Italy

    Evaristo Maiello

  8. Department of Cardiothoracic and Vascular Sciences, Clinica Medica 2, University of Padua, Padua, Italy

    Paolo Prandoni

  9. Humanitas, Cancer Center, Rozzano (MI), Italy

    Armando Santoro

  10. Division of Medical Oncology, Santa Maria Della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy

    Lucio Crinò

Authors
  1. Giancarlo Agnelli
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  2. Melina Verso
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  3. Mario Mandalà
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  4. Silvano Gallus
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  5. Claudio Cimminiello
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  6. Giovanni Apolone
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  7. Giovanni Di Minno
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  8. Evaristo Maiello
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  9. Paolo Prandoni
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  10. Armando Santoro
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  11. Lucio Crinò
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  12. Roberto Labianca
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Corresponding author

Correspondence to Melina Verso.

Additional information

The MASTER Oncology collaborators are listed in the Appendix 1.

Appendix 1

Appendix 1

MASTER Oncology Collaborators (Committees, participating investigators and study sites)

The members of the MASTER Oncology study were as follows: Steering Committee—Agnelli G. (Chairman), Labianca R. (Co-Chairman), Cimminiello C., Crinò L., Di Minno G., Maiello G., Prandoni P., Santoro A.;Central Independent Adjudication Committee—Moia M., Mandalà M., Palareti G., Ageno W., Imberti D., Fagnani D., Falanga A.;MASTER Oncology investigators (at least one patient enrolled) Tagliabue P—U.O.S. Vimercate Oncologia A.O. Osp. Civile, Vimercate; Quadri A—Unità Operativa di Oncologia Medica Ospedali Riuniti, Bergamo; Cavanna L—”Dipartimento di Oncologia” Ospedale G. da Saliceto, Piacenza; Bertolini A—Struttura Complessa di Oncologia Medica Ospedale, Sondrio; Corgna E—Az. Osp. di Perugia Ospedale S. M. Misericordia, Perugia; Comandone A—U.O. di Oncologia Ospedale Gradenigo, Torino; Racca P—A.O.U. Le Molinette U.O. di Oncologia Medica, Turin; Gebbia V—Unità Operativa di Oncologia Medica Clinica “La Maddalena”, Palermo; Ciuffreda L—Azienda Ospedaliero-Universitaria S. Giovanni Battista- Le Molinette, Turin; Di Micco C—Reparto di Oncologia Medica Ospedale RCSS, S. Giovanni Rotondo—Foggia; Clerico M.—Dipartimento di Oncologia Ospedaliera degli Infermi di Biella—Biella; Passalacqua R—Istituti Ospitalieri di Cremona, Cremona; Aitini E—Oncologia, Azienda Ospedaliera C. Poma, Mantova; Luppi G—Oncologia Policlinico di Modena, Modena; Ficorella C—U.O. di Oncologia Medica, Ospedale San Salvatore, L’Aquila; Masci G—U.O. di Oncologia Medica ed Ematologia—Ist. Humanitas, Rozzano-Milan; Pastorelli D—U.O. di Onc. Medica I IRCCS Ist. Oncologico Veneto, Padua; Artioli F—U.O. di Medicina Oncologica, Ospedale B. Ramazzini, Carpi; Pinotti G—Unità Operativa di Oncologia Medica, Fondazione Macchi, Varese; Alabiso O—Ospedale Maggiore della Carità, Novara; Di Costanzo F—Unità Operativa di Oncologia Medica Azienda Ospedaliera-Universitaria, Careggi, Florence; Crispino S—Day Hospital Oncologia Ospedaliera Val d’Elsa, Campostaggia, Siena; Ardizzoia A—A.O. di Lecco U.O. di Oncologia, Lecco; Ferrau F—U.O. di oncologia Medica Presidio Ospedaliero S. Vincenzo, Taormina; Amoroso D—U.O.C. di Oncologia Medica Osp. Versilia, Lido di Camaiore—Lucca; Garufi C—U.O. di Oncologia Medica Istituto Regina Elena, Rome; Massidda B—Azienda Ospedaliero-Universitaria di Cagliari, Monserrato-Cagliari; Cognetti F—Oncologia Medica A, Istituto Regina Elena, Rome; Carrozza G—Ospedale Caldarelli, U.O. di Oncologia Contrada Tappino, Campobasso; Verusio C—U.O. di Oncologia Medica, Saronno; Fregoni V—Oncologia Medica I Fond. Maugeri, Pavia; Tabiadon D—Unità Operativa di Oncologia, Ospedale San Carlo Borromeo, Milan; Iacobelli S—Clinica Oncologica P.O. SS. Annunziata, Chieti; Gamucci T—Unità Operativa Complessa di Oncologia Medica Ospedale SS. Trinità, Sora—Frosinone; De Marinis F—Azienda Ospedaliera Camillo Forlanini, Unità Operativa di Pneumologia Oncologica, Rome; Lorusso V—Ospedale Vito Fazi, Lecce; Palazzo S—U.O. di Oncologia Medica P.O. Mariano Santo, Cosenza; Mattioli R—Unità Operativa di Oncologia Medica Ospedale Santa Croce, Fano; Bordonaro R—Unità Operativa di Oncologia Medica P.O. Garibaldi, Nesima Catania; Nardi M—Unità Operativa di Oncologia, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria; Daniele B—Ospedale Rummo, Benevento; Manzione L—U.O. di Oncologia Ospedale San Carlo, Potenza; Cinieri S—P. Operativo “A. Perrino”, Oncologia Medica, Brindisi; Testore F—Struttura Complessa di Oncologia, Ospedale Cardinal Massaia, Asti; Caruso M—U. Funzionale di Oncologia Medica, Humanitas, Catania; De Placido S—A.U.O. Federico II, Naples; Marsico S—A.O. Monaldi, Naples; Francini G—U.O.C di Oncologia Medica, Ospedale S. Maria alle Scotte, Siena; Scambia G—U.O. di Ginecologia e Ostetricia Policlinico Universitario “A. Gemelli”, Rome; Gasparro D—U.O. di Oncologia Medica Day Hospital Azienda Ospedaliero-Universitaria, Parma; Iacono C—O.C. di Oncologia Azienda ospedaliera, Ospedale Civile “M. Paternò Arezzo”, Ragusa.

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Agnelli, G., Verso, M., Mandalà, M. et al. A prospective study on survival in cancer patients with and without venous thromboembolism. Intern Emerg Med 9, 559–567 (2014). https://doi.org/10.1007/s11739-013-0985-z

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  • DOI: https://doi.org/10.1007/s11739-013-0985-z

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