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Characterization of Risk Factors and Timing of Venous Thromboembolism in Patients With Uterine Serous Carcinoma

Gressel, Gregory M., MD; Turker, Lauren, MD; Dioun, Shayan M., MD; McGinn, Aileen P., PhD; Nevadunsky, Nicole S., MD

doi: 10.1097/AOG.0000000000002932
Cancer: Original Research: PDF Only

OBJECTIVE: To characterize risk factors and timing of venous thromboembolism in women with uterine serous carcinoma.

METHODS: A retrospective cohort study was performed including all women diagnosed with uterine serous carcinoma from 1999 to 2016 at our institution. Clinicopathologic data and information regarding timing of venous thromboembolism were abstracted from the medical record. Logistic regression and Cox proportional hazards modeling were used to examine the association between covariates and risk and timing of venous thromboembolism.

RESULTS: Seventy of the 413 included patients (17%) developed venous thromboembolism, with a median time from presentation to venous thromboembolism of 7.2 months (interquartile range 1.0–24.8) and from surgery to venous thromboembolism of 13.2 months (interquartile range 3.5–33.6). Fifty-nine of the 70 patients (84%) who developed venous thromboembolism were diagnosed either before surgery or greater than 6 weeks postoperatively. Twenty-two of the 70 patients (31%) who developed clots were on chemotherapy at the time of diagnosis. Venous thromboembolism was highly associated with cancer stage and presence of hypertension (P<.01). Cox proportional hazards modeling revealed that only cancer stages III and IV (hazard ratio [HR] 3.20, 95% CI 1.54–6.64 and HR 8.68, 95% CI 4.50–16.73, respectively) and hypertensive or cardiovascular diseases (HR 2.29, 95% CI 1.08–4.85 and HR 1.82, 95% CI 1.05–3.13) were associated with time to venous thromboembolism.

CONCLUSION: Patients with uterine serous carcinoma are at high risk of developing venous thromboembolism even many months after their cancer diagnosis. This study generates the hypothesis that venous thromboembolism prophylaxis may be beneficial in patients with uterine serous carcinoma during other time points along the continuum of disease rather than only in the postoperative period, especially for those with advanced cancer.

Women with uterine papillary serous cancer have a high risk of thromboembolism throughout the continuum of cancer care.

Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center, and the Department of Epidemiology & Population Health and the Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York.

Corresponding author: Gregory M. Gressel, MD, Gynecologic Oncology Fellow, Montefiore Medical Center, Albert Einstein College of Medicine, Department of Obstetrics, Gynecology and Women's Health, 1300 Morris Park Avenue, Belfer 501, Bronx, NY 10461; email: ggressel@montefiore.org.

The research described was supported by the National Institutes of Health and National Center for Advancing Translational Science (NCATS) Einstein-Montefiore CTSA Grant Number UL1 TR001073.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the 2018 Society for Gynecologic Oncology Annual Meeting on Women's Cancer, March 24–27, 2018, New Orleans, Louisiana.

Peer review history is available at http://links.lww.com/AOG/B163.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received June 06, 2018

Received in revised form August 10, 2018

Accepted August 16, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.