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Region Hovedstaden - en del af Københavns Universitetshospital
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"The Timing of Venous Thromboembolism in Ovarian Cancer patients. A Nationwide Danish Cohort Study"

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  • Henriette Strøm Kahr
  • Ole Bjarne Christiansen
  • Signe Juul Riddersholm
  • Inger Lise Gade
  • Christian Torp-Pedersen
  • Aage Knudsen
  • Ole Thorlacius-Ussing
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Background and aim: Venous thromboembolism (VTE) is associated with excess mortality and morbidity in cancer, and is influenced by patient-, tumor-, and treatment-related factors. We aimed to investigate the impact of such factors in a national cohort of patients with epithelial ovarian cancer (EOC). Methods: Patients in the Danish Gynecologic Cancer Database (DGCD) with EOC from 2005 to 2014 were followed from time of diagnosis to VTE, or censoring. Surgery, chemotherapy, and vascular epithelial growth factor (VEGF)-inhibitors were included as time-varying exposures in Cox proportional hazard regression models. Results: A total of 551 VTE events were registered in 4991 EOC patients. Median follow-up time was 2.9 years. The 2-year cumulative incidence of VTE was 7.2%. Patients were at highest risk during the first year after EOC diagnosis. Previous VTE was associated with a hazard ratio (HR) of 3.26 (95% confidence interval [CI] 2.42–4.39). Exposure to major pelvic surgery was associated with a HR of 3.21 (95% CI 2.29–4.50). Exposure to chemotherapy or (VEGF)-inhibitors were associated with HRs of 1.91 (95% CI 1.56–2.33) and 1.05 (95% CI 0.57–1.93), respectively. Hazard ratios for patients with clear cell histopathology was 1.46 (95% CI 0.97–2.20) and 2.42 for International Federation of Gynaecology and Obstetrics stage III--IV (95% CI 1.93–3.03). Conclusions: EOC is associated with a high risk of VTE, particularly within the first year after diagnosis. Major pelvic surgery and chemotherapy were strongly associated with VTE. Person-related risk factors were increasing age and previous VTE. Advanced stage was an independent tumor-related risk factor. These findings support the indication for thrombosis prophylaxis during chemotherapy.

OriginalsprogEngelsk
TidsskriftJournal of thrombosis and haemostasis : JTH
Vol/bind19
Udgave nummer4
Sider (fra-til)992-1000
Antal sider9
ISSN1538-7933
DOI
StatusUdgivet - apr. 2021

ID: 61787298