Internal and Emergency Medicine

, Volume 9, Issue 5, pp 559–567

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

  • Giancarlo Agnelli
  • Melina Verso
  • Mario Mandalà
  • Silvano Gallus
  • Claudio Cimminiello
  • Giovanni Apolone
  • Giovanni Di Minno
  • Evaristo Maiello
  • Paolo Prandoni
  • Armando Santoro
  • Lucio Crinò
  • Roberto Labianca
IM - ORIGINAL

DOI: 10.1007/s11739-013-0985-z

Cite this article as:
Agnelli, G., Verso, M., Mandalà, M. et al. Intern Emerg Med (2014) 9: 559. doi:10.1007/s11739-013-0985-z

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.

Keywords

Venous thromboembolismCancerDeep venous thrombosisPulmonary embolismSurvival

Copyright information

© SIMI 2013

Authors and Affiliations

  • Giancarlo Agnelli
    • 1
  • Melina Verso
    • 1
  • Mario Mandalà
    • 2
  • Silvano Gallus
    • 3
  • Claudio Cimminiello
    • 4
  • Giovanni Apolone
    • 5
  • Giovanni Di Minno
    • 6
  • Evaristo Maiello
    • 7
  • Paolo Prandoni
    • 8
  • Armando Santoro
    • 9
  • Lucio Crinò
    • 10
  • Roberto Labianca
    • 2
  1. 1.Internal and Cardiovascular Medicine-Stroke UnitUniversity of PerugiaPerugiaItaly
  2. 2.Medical Oncology UnitOspedali RiunitiBergamoItaly
  3. 3.Department of EpidemiologyIstituto di Ricerche Farmacologiche Mario NegriMilanItaly
  4. 4.Department of Medicine, Vimercate Hospital AziendaOspedaliera di Desio E VimercateVimercateItaly
  5. 5.Direzione Scientifica, Azienda Ospedaliera Arcispedale Santa Maria NuovaIRCCSReggio EmiliaItaly
  6. 6.Department of Clinical and Experimental MedicineFederico II University HospitalNaplesItaly
  7. 7.Oncology Unit, IRCCS Casa Sollievo Della SofferenzaSan Giovanni Rotondo (FG)Italy
  8. 8.Department of Cardiothoracic and Vascular Sciences, Clinica Medica 2University of PaduaPaduaItaly
  9. 9.Humanitas, Cancer CenterRozzano (MI)Italy
  10. 10.Division of Medical Oncology, Santa Maria Della Misericordia HospitalAzienda Ospedaliera di PerugiaPerugiaItaly