Abstract 4114
Background
Venous thromboembolism (VTE) is a common complication in patients with cancer. Gastric cancer (GC) has been associated with one of the highest risks of VTE. Risk factors for VTE in GC have mainly been investigated in Asian populations and/or in metastasised setting and include: gender, age, body mass index (BMI), stage, primary tumour localisation and chemotherapy, in particular cisplatin. Limited data is available on risk factors for VTE in resectable GC in Western patients. The aim of this study was to identify risk factors for VTE during preoperative chemotherapy in resectable GC patients. In addition, we addressed the question whether VTE was a risk factor for not proceeding to surgery.
Methods
Patients with resectable GC selected from the CRITICS trial (stages Ib-IVa; American Joint Cancer Committee, sixth edition; no distant metastasis) should preoperatively be treated with 3 cycles of 3-weekly epirubicin, cisplatin/oxaliplatin and capecitabine (ECC or EOC). Inclusion criterion for this analysis was start of at least 1 chemotherapy cycle. VTE was defined as any thrombus in the venous system, excluding superficial and/or device related VTE. Risk factors of interest were fitted in a multivariable logistic regression model: age, gender, BMI, ECC/EOC and tumour localisation.
Results
A total of 781 patients were included in this analysis of whom 78 (10%) developed a VTE during the preoperative period. Results of the multivariable analysis are shown in the table. Seventy four patients with VTE proceeded to surgery (95%), compared to 666 patients (95%) without VTE (p = 0.99).Table: 691P
Multivariable analysis
| Variable | No VTE (n = 703) | VTE (n = 78) | OR (95%CI) | p value | |||
|---|---|---|---|---|---|---|---|
| n | % | n | % | ||||
| Age in years | <60 | 287 | 91 | 28 | 9 | * | |
| 60-69 | 261 | 88 | 34 | 12 | 1.31 (0.76-2.23) | 0.329 | |
| 70+ | 155 | 91 | 16 | 9 | 1.01 (0.53-1.94) | 0.970 | |
| Gender | Male | 474 | 91 | 49 | 9 | * | |
| Female | 229 | 89 | 29 | 11 | 1.20 (0.72-1.98) | 0.483 | |
| BMI¤ | <25 | 368 | 92 | 33 | 8 | * | |
| 25-30 | 246 | 90 | 28 | 10 | 1.30 (0.76-2.21) | 0.342 | |
| ≥30 | 88 | 84 | 17 | 16 | 2.16 (1.14-4.09) | 0.018 | |
| ECC/EOC | ECC | 564 | 89 | 68 | 11 | * | |
| EOC | 139 | 93 | 10 | 7 | 0.61 (0.30-1.22) | 0.162 | |
| Tumour localisation | Distal | 223 | 88 | 29 | 12 | * | |
| Middle | 209 | 89 | 26 | 11 | 0.96 (0.54-1.68) | 0.877 | |
| Proximal | 150 | 94 | 10 | 6 | 0.52 (0.24-1.12) | 0.094 | |
| GOJ | 121 | 90 | 13 | 10 | 0.87 (0.43-1.76) | 0.693 |
* reference; ¤ BMI unknown (n = 1); OR= Odds Ratio; CI= Confidence Interval
Conclusions
High BMI (≥30) was the only independent risk factor for developing VTE in resectable GC, preoperatively treated with ECC/EOC. Cisplatin was not identified as a significant risk factor for VTE in this cohort. A diagnosis of VTE did not influence the clinical decision to proceed to surgery.
Clinical trial identification
NCT00407186.
Legal entity responsible for the study
Netherlands Cancer Institute.
Funding
Dutch Cancer Society, Dutch Colorectal Cancer Group, and Hoffmann-La Roche.
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.
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