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Early venous thromboembolism is a strong prognostic factor in patients with advanced pancreatic ductal adenocarcinoma

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Background

There are still controversial data regarding the prognostic value of Venous ThromboEmbolism (VTE) in advanced Pancreatic Ductal AdenoCarcinoma (PDAC) and thromboprophylaxis is poorly prescribed despite international recommendations.

Methods

Medical charts of patients consecutively treated for advanced PDAC from 2010 to 2019 were retrospectively reviewed. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan–Meier method. Prognostic Factors were identified using a multivariate Cox’s proportional hazard model. Early VTE was defined as VTE occurring within the three months following the PDAC diagnosis.

Results

A total of 174 patients were included (median age: 67 years; males: 55.2%; performance status (PS) 0–1: 88.5%) with metastatic disease in 74.7%. At baseline, Khorana score was high (≥ 3) in the vast majority of cases (93.7%). The cumulative incidences of VTE were 12.4% (95% CI 7.3–17.2) at 3 months, 20.4% (95% CI 13.9–26.4) at 6 months and 28.1% (95% CI 20.0–35.3) at 12 months. Patients who experienced early VTE had shorter PFS (3.8 months vs. 7.1 months; HR = 2.02; 95% CI 1.21–3.37; p = 0.006) and shorter OS (8.0 months vs. 14.1 months; HR = 2.42; 95% CI 1.37–4.30; p = 0.002) compared to the others, independently of prognostic factors such as PS, liver metastases, carcinomatosis, and chemotherapy regimen.

Conclusion

early VTE is a strong prognostic factor in advanced PDAC and occurs in about one in 10 patients.

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Data availability statement

Research data are not shared.

Abbreviations

BMI:

Body mass index

CI:

Confidence interval

CRP:

C-Reactive protein

DOAC:

Directoral anticoagulant

ECOG:

Eastern Cooperative Oncology Group

LMWHs:

Low Molecular Weight Heparins

NPV:

Negative predictive value

OS:

Overall survival

PDAC:

Pancreatic ductal adenocarcinoma

PFS:

Progression-free survival

PPV:

Positive predictive value

PS:

Performance status

RECIST:

Response Evaluation Criteria in Solid Tumors

ROC:

Receiver operating characteristic

Se:

Sensibility

Sp:

Specificity

VTE:

Venous thromboembolism

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Authors and Affiliations

  1. University Hospital of Saint-Etienne, Saint-Priest en Jarez, France

    Mathilde Barrau, Khawla Maoui, Bertrand Le Roy, Xavier Roblin, Patrick Mismetti, Jean-Marc Phelip & Nicolas Williet

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  1. Mathilde Barrau
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  2. Khawla Maoui
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  3. Bertrand Le Roy
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  4. Xavier Roblin
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  7. Nicolas Williet
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Correspondence to Nicolas Williet.

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Barrau, M., Maoui, K., Le Roy, B. et al. Early venous thromboembolism is a strong prognostic factor in patients with advanced pancreatic ductal adenocarcinoma. J Cancer Res Clin Oncol 147, 3447–3454 (2021). https://doi.org/10.1007/s00432-021-03590-x

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