Significance of venous thromboembolism in women with uterine carcinosarcoma
| Autor: | Joseph L. Kelley, Sosuke Adachi, Mian M.K. Shahzad, Tadayoshi Nagano, Marian S. Johnson, Shiori Yanai, Erin A. Blake, Hiroko Machida, Koji Matsuo, Munetaka Takekuma, Tanja Pejovic, Malcolm S. Ross, Tadao Takano, Yutaka Ueda, Lynda D. Roman, Shinya Satoh, Satoshi Takeuchi, Keita Iwasaki, Masako Shida, Takahito Miyake, Kosei Hasegawa, Frederick R. Ueland, Masato Nishimura, Stephen H. Bush, Dwight D. Im, Takuhei Yokoyama, Merieme Klobocista, Mayu Yunokawa, Yuji Ikeda, Tsukasa Baba, Kohei Omatsu |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Neoplasm Residual Multivariate analysis Population Kaplan-Meier Estimate Gastroenterology Article 03 medical and health sciences Postoperative Complications 0302 clinical medicine Carcinosarcoma Risk Factors Internal medicine medicine Humans Cumulative incidence 030212 general & internal medicine Neoplasm Metastasis education Aged Retrospective Studies education.field_of_study business.industry Surrogate endpoint Incidence (epidemiology) Hazard ratio Obstetrics and Gynecology Retrospective cohort study Venous Thromboembolism Middle Aged medicine.disease Tumor Burden Pulmonary embolism Oncology 030220 oncology & carcinogenesis Uterine Neoplasms Female business |
| Zdroj: | Gynecol Oncol |
| ISSN: | 0090-8258 |
| Popis: | OBJECTIVE: To identify risk factors for venous thromboembolism (VTE) and to examine the association of VTE and survival in women with uterine carcinosarcoma. METHODS: This multicenter retrospective study examined 906 women who underwent primary surgical treatment for stage I-IV uterine carcinosarcoma. Time-dependent analyses were performed for cumulative incidence of VTE after surgery on multivariate models. RESULTS: There were 72 (7.9%) women who developed VTE after surgery with 1-, 2-, and 5-year cumulative incidences being 5.1%, 7.3%, and 10.2%, respectively. On multivariate analysis, older age (hazard ratio [HR] per year 1.03, P = 0.012), non-Asian race (HR 6.28, P< 0.001), large body habitus (HR per kg/m(2) 1.04, P = 0.014), residual disease at surgery (HR 3.04, P = 0.003), tumor size ≥5 cm (HR2.73, P = 0.003), and stage IV disease (HR2.12, P = 0.025) were independently associated with increased risk of developing VTE. A risk pattern analysis identified that obese Non-Asian women with large tumors (13.7% of population) had the highest incidence of VTE (2-year cumulative rate, 26.1%) whereas Asian women with no residual disease (47.1% of population) had the lowest (2-year cumulative rate, 1.6%) (P< 0.001). Presence of carcinoma/sarcoma in metastatic sites was significantly associated with increased risk of VTE compared to carcinoma alone (2-year rates, 31.2% versus 8.4%, P = 0.049). VTE was independently associated with decreased progression-free survival on multivariate models (5-year rates, 24.9% versus 47.2%, HR 1.46,95%CI 1.05–2.04, P = 0.026). CONCLUSION: Our study suggests that VTE represents a surrogate marker of aggressive tumor behavior and diminished patient condition in uterine carcinosarcoma; obese Non-Asian women with large tumors carry a disproportionally high risk of VTE, suggesting that long-term prophylaxis may benefit this population. |
| Databáze: | OpenAIRE |
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