Annals of Oncology Advance Access published online on July 28, 2007
Annals of Oncology, doi:10.1093/annonc/mdm284
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© 2007 European Society for Medical Oncology
Venous thromboembolism predicts poor prognosis in irresectable pancreatic cancer patients
1 Unit of Medical Oncology, Ospedali Riuniti, Bergamo
2 Division of Medical Oncology, San Raffaele Hospital, Milan
3 Clinica di Oncologia Medica, Università Politecnica delle Marche; Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Umberto I, Lancisi, Salesi, Ancona
4 Division of Medical Oncology, Treviglio Hospital, Treviglio
5 Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
* Correspondence to: Dr M. Mandalà, Unit of Medical Oncology, Ospedali Riuniti Bergamo, Largo Barozzi 1, 24100 Bergamo, Italy. Tel: +39-035-269858; Fax: +39-035-266849; E-mail: mariomandala{at}tin.it
Background: The aim was to investigate the outcomes associated with venous thromboembolism (VTE) among irresectable pancreatic cancer patients.
Methods: This is a follow-up study of consecutive irresectable cancer patients, treated and followed up in clinical trials between December 2001 and December 2004 in order to evaluate the prognostic impact of symptomatic VTE on clinical outcomes, such as response to treatment, progression-free survival (PFS) and overall survival (OS).
Results: Among 227 irresectable pancreatic cancer patients, with Eastern Cooperative Oncology Group performance status (ECOG-PS) 
2, 59 (26.0%) patients developed a VTE. A synchronous VTE occurred in 28 (12.3%) patients, while a VTE during chemotherapy was observed in 15 (6.6%) patients, and 16 (7.0%) patients experienced both events. Presence of synchronous VTE was associated with a higher probability of not responding to treatment (odds ratio 2.98, 95% CI 1.42–6.27, P = 0.004), but showed no effect on both PFS and OS at least at multivariate analysis. Occurrence of a VTE during chemotherapy showed a statistically significant effect on PFS (hazard ratio [HR] 2.59, 95% CI 1.69–3.97, P < 0.0001) and OS (HR 1.64, 95%CI 1.04–2.58, P = 0.032).
Conclusions: Our data suggest that the occurrence of VTE may be associated with a reduced response rate and a shorter PFS and OS among patients with irresectable pancreatic cancer. In these patients the development of VTE may reflect the presence of a biologically more aggressive cancer that in turn leads to a worse prognosis.
venous thromboembolism, prognosis, pancreatic cancer
Received for publication February 15, 2007. Revision received May 10, 2007. Accepted for publication May 14, 2007.