The timing of venous thromboembolism in ovarian cancer patients: A nationwide Danish cohort study
Background and aim Venous thromboembolism (VTE) is associated with excess mortality and morbidity in cancer, and is influenced by patient‐, tumor‐, and treatment‐related factors. We aimed to investigate the impact of such factors in a national cohort of patients with epithelial ovarian cancer (EOC)....
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| Veröffentlicht in: | Journal of thrombosis and haemostasis 2021-04, Vol.19 (4), p.992-1000 |
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| creator | Strøm Kahr, Henriette Christiansen, Ole B. Juul Riddersholm, Signe Gade, Inger L. Torp‐Pedersen, Christian Knudsen, Aage Thorlacius‐Ussing, Ole |
| description | Background and aim
Venous thromboembolism (VTE) is associated with excess mortality and morbidity in cancer, and is influenced by patient‐, tumor‐, and treatment‐related factors. We aimed to investigate the impact of such factors in a national cohort of patients with epithelial ovarian cancer (EOC).
Methods
Patients in the Danish Gynecologic Cancer Database (DGCD) with EOC from 2005 to 2014 were followed from time of diagnosis to VTE, or censoring. Surgery, chemotherapy, and vascular epithelial growth factor (VEGF)‐inhibitors were included as time‐varying exposures in Cox proportional hazard regression models.
Results
A total of 551 VTE events were registered in 4991 EOC patients. Median follow‐up time was 2.9 years. The 2‐year cumulative incidence of VTE was 7.2%. Patients were at highest risk during the first year after EOC diagnosis. Previous VTE was associated with a hazard ratio (HR) of 3.26 (95% confidence interval [CI] 2.42–4.39). Exposure to major pelvic surgery was associated with a HR of 3.21 (95% CI 2.29–4.50). Exposure to chemotherapy or (VEGF)‐inhibitors were associated with HRs of 1.91 (95% CI 1.56–2.33) and 1.05 (95% CI 0.57–1.93), respectively. Hazard ratios for patients with clear cell histopathology was 1.46 (95% CI 0.97–2.20) and 2.42 for International Federation of Gynaecology and Obstetrics stage III‐‐IV (95% CI 1.93–3.03).
Conclusions
EOC is associated with a high risk of VTE, particularly within the first year after diagnosis. Major pelvic surgery and chemotherapy were strongly associated with VTE. Person‐related risk factors were increasing age and previous VTE. Advanced stage was an independent tumor‐related risk factor. These findings support the indication for thrombosis prophylaxis during chemotherapy. |
| doi_str_mv | 10.1111/jth.15235 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2476559718</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2476559718</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4545-bd0eb58090dbfa399c9bdfa3911b1bebaf60ab9b5c3511cdbb431890adbda7203</originalsourceid><addsrcrecordid>eNp1kMtKxDAUhoMoXkYXvoAE3OhinFyatnEn3kVwM65DbrUZ2mRMWmXe3uioC8HAIf_i4-OcH4BDjM5wfrPF0J5hRijbALuY0Xpa1bTc_Mmc0h2wl9ICIcwZQdtgh9KCoKoku0DOWwsH1zv_AkMD36wPY4JDG0Ovgs3TudRD52F4k9FJD7X02ka4lIOzfkjn8AL6nIN_d8bCK-ldaqEObYgDTMNoVvtgq5Fdsgff_wQ831zPL--mj0-395cXj1NdsIJNlUFWsRpxZFQjKeeaK_MZMFZYWSWbEknFFdOUYayNUgXFNUfSKCMrgugEnKy9yxheR5sG0bukbddJb_NNghRVyRivcJ3R4z_oIozR5-0EYYgTUiJeZOp0TekYUoq2EcvoehlXAiPx2bvIvYuv3jN79G0cVW_NL_lTdAZma-DddXb1v0k8zO_Wyg_-d42T</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2509226094</pqid></control><display><type>article</type><title>The timing of venous thromboembolism in ovarian cancer patients: A nationwide Danish cohort study</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Strøm Kahr, Henriette ; Christiansen, Ole B. ; Juul Riddersholm, Signe ; Gade, Inger L. ; Torp‐Pedersen, Christian ; Knudsen, Aage ; Thorlacius‐Ussing, Ole</creator><creatorcontrib>Strøm Kahr, Henriette ; Christiansen, Ole B. ; Juul Riddersholm, Signe ; Gade, Inger L. ; Torp‐Pedersen, Christian ; Knudsen, Aage ; Thorlacius‐Ussing, Ole</creatorcontrib><description>Background and aim
Venous thromboembolism (VTE) is associated with excess mortality and morbidity in cancer, and is influenced by patient‐, tumor‐, and treatment‐related factors. We aimed to investigate the impact of such factors in a national cohort of patients with epithelial ovarian cancer (EOC).
Methods
Patients in the Danish Gynecologic Cancer Database (DGCD) with EOC from 2005 to 2014 were followed from time of diagnosis to VTE, or censoring. Surgery, chemotherapy, and vascular epithelial growth factor (VEGF)‐inhibitors were included as time‐varying exposures in Cox proportional hazard regression models.
Results
A total of 551 VTE events were registered in 4991 EOC patients. Median follow‐up time was 2.9 years. The 2‐year cumulative incidence of VTE was 7.2%. Patients were at highest risk during the first year after EOC diagnosis. Previous VTE was associated with a hazard ratio (HR) of 3.26 (95% confidence interval [CI] 2.42–4.39). Exposure to major pelvic surgery was associated with a HR of 3.21 (95% CI 2.29–4.50). Exposure to chemotherapy or (VEGF)‐inhibitors were associated with HRs of 1.91 (95% CI 1.56–2.33) and 1.05 (95% CI 0.57–1.93), respectively. Hazard ratios for patients with clear cell histopathology was 1.46 (95% CI 0.97–2.20) and 2.42 for International Federation of Gynaecology and Obstetrics stage III‐‐IV (95% CI 1.93–3.03).
Conclusions
EOC is associated with a high risk of VTE, particularly within the first year after diagnosis. Major pelvic surgery and chemotherapy were strongly associated with VTE. Person‐related risk factors were increasing age and previous VTE. Advanced stage was an independent tumor‐related risk factor. These findings support the indication for thrombosis prophylaxis during chemotherapy.</description><identifier>ISSN: 1538-7933</identifier><identifier>ISSN: 1538-7836</identifier><identifier>EISSN: 1538-7836</identifier><identifier>DOI: 10.1111/jth.15235</identifier><identifier>PMID: 33420762</identifier><language>eng</language><publisher>England: Elsevier Limited</publisher><subject>Carcinoma, Ovarian Epithelial - epidemiology ; Chemotherapy ; Cohort analysis ; Cohort Studies ; deep vein thrombosis ; Denmark - epidemiology ; Diagnosis ; epithelial ovarian cancer ; Female ; Fibroblast growth factor 2 ; Humans ; Incidence ; Morbidity ; Obstetrics ; Ovarian cancer ; Ovarian Neoplasms - drug therapy ; Ovarian Neoplasms - epidemiology ; Patients ; Prophylaxis ; Pulmonary Embolism ; Pulmonary embolisms ; Regression analysis ; Risk Factors ; Surgery ; Thromboembolism ; Thrombosis ; Vascular endothelial growth factor ; venous thromboembolism ; Venous Thromboembolism - diagnosis ; Venous Thromboembolism - epidemiology ; venous thromboprophylaxis</subject><ispartof>Journal of thrombosis and haemostasis, 2021-04, Vol.19 (4), p.992-1000</ispartof><rights>2021 International Society on Thrombosis and Haemostasis</rights><rights>2021 International Society on Thrombosis and Haemostasis.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4545-bd0eb58090dbfa399c9bdfa3911b1bebaf60ab9b5c3511cdbb431890adbda7203</citedby><cites>FETCH-LOGICAL-c4545-bd0eb58090dbfa399c9bdfa3911b1bebaf60ab9b5c3511cdbb431890adbda7203</cites><orcidid>0000-0003-0914-7677 ; 0000-0003-0533-5531</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33420762$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Strøm Kahr, Henriette</creatorcontrib><creatorcontrib>Christiansen, Ole B.</creatorcontrib><creatorcontrib>Juul Riddersholm, Signe</creatorcontrib><creatorcontrib>Gade, Inger L.</creatorcontrib><creatorcontrib>Torp‐Pedersen, Christian</creatorcontrib><creatorcontrib>Knudsen, Aage</creatorcontrib><creatorcontrib>Thorlacius‐Ussing, Ole</creatorcontrib><title>The timing of venous thromboembolism in ovarian cancer patients: A nationwide Danish cohort study</title><title>Journal of thrombosis and haemostasis</title><addtitle>J Thromb Haemost</addtitle><description>Background and aim
Venous thromboembolism (VTE) is associated with excess mortality and morbidity in cancer, and is influenced by patient‐, tumor‐, and treatment‐related factors. We aimed to investigate the impact of such factors in a national cohort of patients with epithelial ovarian cancer (EOC).
Methods
Patients in the Danish Gynecologic Cancer Database (DGCD) with EOC from 2005 to 2014 were followed from time of diagnosis to VTE, or censoring. Surgery, chemotherapy, and vascular epithelial growth factor (VEGF)‐inhibitors were included as time‐varying exposures in Cox proportional hazard regression models.
Results
A total of 551 VTE events were registered in 4991 EOC patients. Median follow‐up time was 2.9 years. The 2‐year cumulative incidence of VTE was 7.2%. Patients were at highest risk during the first year after EOC diagnosis. Previous VTE was associated with a hazard ratio (HR) of 3.26 (95% confidence interval [CI] 2.42–4.39). Exposure to major pelvic surgery was associated with a HR of 3.21 (95% CI 2.29–4.50). Exposure to chemotherapy or (VEGF)‐inhibitors were associated with HRs of 1.91 (95% CI 1.56–2.33) and 1.05 (95% CI 0.57–1.93), respectively. Hazard ratios for patients with clear cell histopathology was 1.46 (95% CI 0.97–2.20) and 2.42 for International Federation of Gynaecology and Obstetrics stage III‐‐IV (95% CI 1.93–3.03).
Conclusions
EOC is associated with a high risk of VTE, particularly within the first year after diagnosis. Major pelvic surgery and chemotherapy were strongly associated with VTE. Person‐related risk factors were increasing age and previous VTE. Advanced stage was an independent tumor‐related risk factor. These findings support the indication for thrombosis prophylaxis during chemotherapy.</description><subject>Carcinoma, Ovarian Epithelial - epidemiology</subject><subject>Chemotherapy</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>deep vein thrombosis</subject><subject>Denmark - epidemiology</subject><subject>Diagnosis</subject><subject>epithelial ovarian cancer</subject><subject>Female</subject><subject>Fibroblast growth factor 2</subject><subject>Humans</subject><subject>Incidence</subject><subject>Morbidity</subject><subject>Obstetrics</subject><subject>Ovarian cancer</subject><subject>Ovarian Neoplasms - drug therapy</subject><subject>Ovarian Neoplasms - epidemiology</subject><subject>Patients</subject><subject>Prophylaxis</subject><subject>Pulmonary Embolism</subject><subject>Pulmonary embolisms</subject><subject>Regression analysis</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Thromboembolism</subject><subject>Thrombosis</subject><subject>Vascular endothelial growth factor</subject><subject>venous thromboembolism</subject><subject>Venous Thromboembolism - diagnosis</subject><subject>Venous Thromboembolism - epidemiology</subject><subject>venous thromboprophylaxis</subject><issn>1538-7933</issn><issn>1538-7836</issn><issn>1538-7836</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kMtKxDAUhoMoXkYXvoAE3OhinFyatnEn3kVwM65DbrUZ2mRMWmXe3uioC8HAIf_i4-OcH4BDjM5wfrPF0J5hRijbALuY0Xpa1bTc_Mmc0h2wl9ICIcwZQdtgh9KCoKoku0DOWwsH1zv_AkMD36wPY4JDG0Ovgs3TudRD52F4k9FJD7X02ka4lIOzfkjn8AL6nIN_d8bCK-ldaqEObYgDTMNoVvtgq5Fdsgff_wQ831zPL--mj0-395cXj1NdsIJNlUFWsRpxZFQjKeeaK_MZMFZYWSWbEknFFdOUYayNUgXFNUfSKCMrgugEnKy9yxheR5sG0bukbddJb_NNghRVyRivcJ3R4z_oIozR5-0EYYgTUiJeZOp0TekYUoq2EcvoehlXAiPx2bvIvYuv3jN79G0cVW_NL_lTdAZma-DddXb1v0k8zO_Wyg_-d42T</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Strøm Kahr, Henriette</creator><creator>Christiansen, Ole B.</creator><creator>Juul Riddersholm, Signe</creator><creator>Gade, Inger L.</creator><creator>Torp‐Pedersen, Christian</creator><creator>Knudsen, Aage</creator><creator>Thorlacius‐Ussing, Ole</creator><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0914-7677</orcidid><orcidid>https://orcid.org/0000-0003-0533-5531</orcidid></search><sort><creationdate>202104</creationdate><title>The timing of venous thromboembolism in ovarian cancer patients: A nationwide Danish cohort study</title><author>Strøm Kahr, Henriette ; Christiansen, Ole B. ; Juul Riddersholm, Signe ; Gade, Inger L. ; Torp‐Pedersen, Christian ; Knudsen, Aage ; Thorlacius‐Ussing, Ole</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4545-bd0eb58090dbfa399c9bdfa3911b1bebaf60ab9b5c3511cdbb431890adbda7203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Carcinoma, Ovarian Epithelial - epidemiology</topic><topic>Chemotherapy</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>deep vein thrombosis</topic><topic>Denmark - epidemiology</topic><topic>Diagnosis</topic><topic>epithelial ovarian cancer</topic><topic>Female</topic><topic>Fibroblast growth factor 2</topic><topic>Humans</topic><topic>Incidence</topic><topic>Morbidity</topic><topic>Obstetrics</topic><topic>Ovarian cancer</topic><topic>Ovarian Neoplasms - drug therapy</topic><topic>Ovarian Neoplasms - epidemiology</topic><topic>Patients</topic><topic>Prophylaxis</topic><topic>Pulmonary Embolism</topic><topic>Pulmonary embolisms</topic><topic>Regression analysis</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Thromboembolism</topic><topic>Thrombosis</topic><topic>Vascular endothelial growth factor</topic><topic>venous thromboembolism</topic><topic>Venous Thromboembolism - diagnosis</topic><topic>Venous Thromboembolism - epidemiology</topic><topic>venous thromboprophylaxis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Strøm Kahr, Henriette</creatorcontrib><creatorcontrib>Christiansen, Ole B.</creatorcontrib><creatorcontrib>Juul Riddersholm, Signe</creatorcontrib><creatorcontrib>Gade, Inger L.</creatorcontrib><creatorcontrib>Torp‐Pedersen, Christian</creatorcontrib><creatorcontrib>Knudsen, Aage</creatorcontrib><creatorcontrib>Thorlacius‐Ussing, Ole</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of thrombosis and haemostasis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Strøm Kahr, Henriette</au><au>Christiansen, Ole B.</au><au>Juul Riddersholm, Signe</au><au>Gade, Inger L.</au><au>Torp‐Pedersen, Christian</au><au>Knudsen, Aage</au><au>Thorlacius‐Ussing, Ole</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The timing of venous thromboembolism in ovarian cancer patients: A nationwide Danish cohort study</atitle><jtitle>Journal of thrombosis and haemostasis</jtitle><addtitle>J Thromb Haemost</addtitle><date>2021-04</date><risdate>2021</risdate><volume>19</volume><issue>4</issue><spage>992</spage><epage>1000</epage><pages>992-1000</pages><issn>1538-7933</issn><issn>1538-7836</issn><eissn>1538-7836</eissn><abstract>Background and aim
Venous thromboembolism (VTE) is associated with excess mortality and morbidity in cancer, and is influenced by patient‐, tumor‐, and treatment‐related factors. We aimed to investigate the impact of such factors in a national cohort of patients with epithelial ovarian cancer (EOC).
Methods
Patients in the Danish Gynecologic Cancer Database (DGCD) with EOC from 2005 to 2014 were followed from time of diagnosis to VTE, or censoring. Surgery, chemotherapy, and vascular epithelial growth factor (VEGF)‐inhibitors were included as time‐varying exposures in Cox proportional hazard regression models.
Results
A total of 551 VTE events were registered in 4991 EOC patients. Median follow‐up time was 2.9 years. The 2‐year cumulative incidence of VTE was 7.2%. Patients were at highest risk during the first year after EOC diagnosis. Previous VTE was associated with a hazard ratio (HR) of 3.26 (95% confidence interval [CI] 2.42–4.39). Exposure to major pelvic surgery was associated with a HR of 3.21 (95% CI 2.29–4.50). Exposure to chemotherapy or (VEGF)‐inhibitors were associated with HRs of 1.91 (95% CI 1.56–2.33) and 1.05 (95% CI 0.57–1.93), respectively. Hazard ratios for patients with clear cell histopathology was 1.46 (95% CI 0.97–2.20) and 2.42 for International Federation of Gynaecology and Obstetrics stage III‐‐IV (95% CI 1.93–3.03).
Conclusions
EOC is associated with a high risk of VTE, particularly within the first year after diagnosis. Major pelvic surgery and chemotherapy were strongly associated with VTE. Person‐related risk factors were increasing age and previous VTE. Advanced stage was an independent tumor‐related risk factor. These findings support the indication for thrombosis prophylaxis during chemotherapy.</abstract><cop>England</cop><pub>Elsevier Limited</pub><pmid>33420762</pmid><doi>10.1111/jth.15235</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0914-7677</orcidid><orcidid>https://orcid.org/0000-0003-0533-5531</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Carcinoma, Ovarian Epithelial - epidemiology Chemotherapy Cohort analysis Cohort Studies deep vein thrombosis Denmark - epidemiology Diagnosis epithelial ovarian cancer Female Fibroblast growth factor 2 Humans Incidence Morbidity Obstetrics Ovarian cancer Ovarian Neoplasms - drug therapy Ovarian Neoplasms - epidemiology Patients Prophylaxis Pulmonary Embolism Pulmonary embolisms Regression analysis Risk Factors Surgery Thromboembolism Thrombosis Vascular endothelial growth factor venous thromboembolism Venous Thromboembolism - diagnosis Venous Thromboembolism - epidemiology venous thromboprophylaxis |
| title | The timing of venous thromboembolism in ovarian cancer patients: A nationwide Danish cohort study |
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