1670P - Tumoral and non-tumoral thrombosis associated with pancreatic ductal adenocarcinoma (PDAC): Survival impact, assessment of predictive scales and rethrombosis

Background

PDAC is highly associated with thrombotic risk, with reported incidences up to 40%. Although tumoral (TT) and non-tumoral thrombosis (nonTT) are frequently treated equally, they might have different impact in prognosis and survival. Khorana and ONKOTEV score can predict thrombotic risk in this scenario.

Methods

Retrospective study that includes 204 patients with PDAC treated with chemotherapy and visited in the Medical Oncology Department of a third-level hospital in Barcelona between January 2014 and December 2021. The main objective was to describe the frequency of TT and nonTT, the ability to predict thrombotic risk by predictive scores using ROC curve and to analyze survival associated with thrombosis and rethrombosis.

Results

We identified 62 patients with thrombosis (30.4%) of a total of 204. Median age was 70 years (48-92), 54.8% were males, and 62% presented stage IV at diagnosis. TT involved 71% of thrombotic events being the most frequent in all stages (80% in resectable, 83.3% in borderline, 75% in locally advanced and 66.7% in metastatic disease). Predominant thrombotic events were splenic (39%) and superior mesenteric vein (32%) for TT and deep vein thrombosis (DVT) in lower extremities and pulmonary embolisms in non-tumoral scenario (56% and 22.2% respectively). The ONKOTEV score presented better predictive capacity compared to Khorana for nonTT (AUC 0.731 vs 0,670 in ROC curves). Neither of both scores demonstrated predictive capacity for TT (AUC 0.540 vs 0.495). Thromboembolic events were associated with reduced overall survival (OS; HR 0.71, p 0.034). Median OS was 12.5 months in patients who presented nonTT vs 7.2 months for those with TT (HR 0.48, p=0.326). Rethrombosis occurred in 8% (5 cases), 2 of them being on anticoagulant therapy. All were in the same location as previously.

Conclusions

TT was more frequent than nonTT in our cohort. Thromboembolic events, including TT and nonTT, were detrimental for survival without statistically significant differences between them. ONKOTEV score has a greater capacity to predict nonTT compared to Khorana, in order to identify patients who could potentially benefit from prophylactic anticoagulation.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Hospital de la Santa Creu i Sant Pau.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.