Elsevier

Thrombosis Research

Volume 125, Issue 6, June 2010, Pages 490-493
Thrombosis Research

Review article
Venous thromboembolism and prognosis in cancer

https://doi.org/10.1016/j.thromres.2009.12.023Get rights and content

Abstract

Venous thromboembolism (VTE) is a frequent complication of malignancy, and its incidence has increased markedly in recent years. VTE itself can directly lead to patient mortality, and is the second leading cause of death in patients with cancer. Furthermore, emerging data suggest that activation of coagulation in malignancy is integrally linked with tumor biology, particularly with angiogenesis. The development of the clinical hypercoagulable state is also linked with adverse prognosis in patients with cancer, including patients receiving systemic chemotherapy. This review focuses on the clinical evidence documenting a link between VTE and adverse short-term and long-term prognosis in patients with cancer.

Section snippets

VTE as a Proximate Cause of Death in the Cancer Patient

PE can directly lead to death in patients with cancer, as can arterial events. There are a lack of recent data identifying causes of death in patients with cancer. We were able to clarify this issue in a recent analysis of causes of death in cancer patients receiving chemotherapy in a prospective observational study [12]. Of 4,466 patients enrolled in this study, 141 (3.2%) patients died during the period of observation (median, 75 days). As might be expected, a majority of patients died of

VTE and Its Effect on Short-Term Prognosis

A recent prospective observational cohort study of cancer patients initiating a new chemotherapy regimen has shed light on the association of VTE and early mortality during chemotherapy [14]. The study evaluated 4,458 adult cancer patients with solid tumors or malignant lymphoma between 2002 and 2006 at 115 United States sites. VTE occurred in 93 (2.1%) patients at a median of 38 days following initiation of chemotherapy. One hundred and thirty-seven patients died during the period of

VTE and Its Effect on Long-Term Prognosis

Data regarding the effect of VTE on long-term prognosis in patients with cancer come primarily from large population-based databases. In an analysis of the Danish Cancer Registry, 668 cancer patients with DVT were compared to 5,371 matched control cancer patients [17]. In the group with cancer at the time of VTE, the one-year survival rate was 12%, as compared with 36% in the control group (P < 0.001), and the mortality ratio for the entire follow-up period was 2.2 (95%CI, 2.05 to 2.40). These

Conclusions

VTE is a frequent complication of the natural history of cancer and anti-cancer therapies. VTE itself may be directly responsible for death in patients with cancer; in the most recent available data, thrombosis is believed to account for 9% of cancer-related deaths. Even more importantly, the development of VTE serves as a harbinger of poor outcomes for patients with cancer. Cancer patients with VTE have an elevated risk of early mortality during chemotherapy, as well as increased risk of tumor

Conflict of interest

There are no conflicts of interest for this paper.

Acknowledgements

Dr. Khorana is supported by grants from the National Cancer Institute K23 CA120587, the National Heart, Lung and Blood Institute 1R01HL095109-01 and the V Foundation.

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