Incidence and risk factors for venous thromboembolism in patients with pretreated advanced pancreatic carcinoma

// Shunsuke Kondo 1, 2 , Mitsuhito Sasaki 1, 3 , Hiroko Hosoi 1 , Yasunari Sakamoto 1 , Chigusa Morizane 1 , Hideki Ueno 1 and Takuji Okusaka 1 1 Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan 2 Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan 3 Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Chiba, Japan Correspondence to: Shunsuke Kondo, email: shkondo@ncc.go.jp Keywords: fibrin degradation product; incidence; pancreatic carcinoma; survival; venous thromboembolism Received: November 22, 2017     Accepted: February 28, 2018     Published: March 30, 2018 ABSTRACT Patients with pancreatic carcinoma are at an increased risk of venous thromboembolism (VTE), which is a major cause of morbidity and mortality in various types of cancer. The aim of this study was to determine the incidence and clinical significance of VTE in patients with pancreatic carcinoma, and to identify biomarkers for the detection of VTE in these patients. The eligibility criteria were chemo-naive patients with primary pancreatic carcinoma, an Eastern Cooperative Oncology Group performance status of 0–2, and adequate organ function. All patients were screened for VTE using compression ultrasonography and dynamic computed tomography. The primary endpoint was the incidence of VTE, which we hypothesized would be between 10.0–20.0% for symptomatic and asymptomatic patients combined. Associations between clinical presentation and VTE were evaluated. VTE-associated markers were also investigated for their role in predicting prognosis. In total, 103 patients met the eligibility criteria. The overall cumulative incidence rate of VTE in patients with previously untreated pancreatic carcinoma was 16.5%. VTE occurrence was strongly associated with elevated serum D-dimer, fibrin degradation product, thrombin/antithrombin III complex, and prothrombin fragment 1 + 2 levels. The median overall survival time of VTE-positive and VTE-negative patients was 427 and 515 days, respectively. Approximately one-sixth of patients with advanced pancreatic carcinoma experienced VTE, although most were asymptomatic. Measurement of serum D-dimer, fibrin degradation product, thrombin/antithrombin III complex, and prothrombin fragment 1 + 2 levels may be useful for the early detection of VTE in patients with advanced pancreatic carcinoma.