Venous thromboembolism (VTE) is a common complication in patients with pancreatic cancer. VTE in Asian patients with cancer is known to be less prevalent than in Western patients; however, few studies have reported the epidemiology and clinical outcomes of VTE in Asian patients with pancreatic cancer. This study investigated the incidence, risk factors, and clinical outcome of VTE in patients with pancreatic cancer who underwent palliative chemotherapy.
Medical records of VTE incidence in patients after initiation of chemotherapy for newly diagnosed locally advanced or metastatic pancreatic cancer from 2010 to 2016 at four institutes in Taiwan were retrospectively reviewed. The clinical characteristics of 838 patients were analyzed to identify independent predictors of VTE and survival outcome.
With a median follow-up period of 7.7 months (0.6–55.6), VTE occurred in 67 (8.0%) of the 838 patients. The 6-, 12-, 24-, and 36-month cumulative incidences of VTE were 5.0%, 8.9%, 19.4%, and 24.5%, respectively. Of the 67 patients who developed VTE, 26.9%, 53.8%, and 70.2% of VTE occurred within 2, 4, and 6 months of chemotherapy initiation, respectively. Predictors of VTE were white blood cell count >11,000/μL of peripheral blood and presence of liver metastases. Khorana risk score was not a significant predictor of VTE. Patients with VTE were not significantly associated with a poorer survival outcome than were those without VTE. However, occurrence of VTE within 2 months after the initiation of chemotherapy was an independent poor prognostic factor for overall survival.
This was the largest study to evaluate the incidence, predictors, and effects of VTE in Asian patients with pancreatic cancer that underwent palliative chemotherapy. The incidence of VTE in Asian patients was found to be half that in Western patients. Only patients with early onset VTE had a poorer prognosis than those without VTE. Awareness of the clinical characteristics and survival outcome of patients with VTE may assist clinicians and patients in choosing the appropriate prophylaxis and management of VTE for Asian patients with pancreatic cancer.
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The authors would like to thank all members in the Chang Gung Memorial Hospital Cancer Center for their help in data collection. We would also like to extend our gratitude to Ms. Vengi Ho for her invaluable contribution in data collection and statistical analysis.
All authors have declared no conflicts of interest.