title: Silent venous thromboembolism before treatment in endometrial cancer and the risk factors.
abstract: Venous thromboembolism (VTE) often occurs after surgery and can even occur before surgery in patients with gynaecological malignancies. We investigated the incidence of VTE before treatment of endometrial cancer and associated risk factors. Plasma D-dimer (DD) levels before initial treatment were examined in 171 consecutive patients with endometrial cancer. Venous ultrasound imaging (VUI) of the lower extremities was performed in patients with DD >or=1.5 microg ml(-1), as the negative predictive value of DD for VTE is extremely high. For patients with deep vein thrombosis (DVT), pulmonary scintigraphy was performed to ascertain the presence of pulmonary thromboembolism (PTE). Risk factors for VTE were analysed using univariate and multivariate analyses for 171 patients. Of these, 37 patients (21.6%) showed DD >or=1.5 microg ml(-1), 17 (9.9%) displayed DVT by VUI and 8 (4.7%) showed PTE on pulmonary scintigraphy. All patients with VTE were asymptomatic. Univariate analysis for various risk factors revealed older age, non-endometrioid histology and several variables of advanced disease as significantly associated with VTE before treatment. Obesity, smoking and diabetes mellitus were not risk factors. Multivariate analysis confirmed extrauterine spread and non-endometrioid histology as independently and significantly associated with risk of VTE. These data suggest that silent or subclinical VTE occurs before treatment in at least around 10% of patients with endometrial cancer. Risk factors for VTE before treatment might not be identical to those after starting treatment.
authors.affiliation: Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan. toyomi-s@md.tsukuba.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Satoh
authors.forename: K
authors.initials: K
authors.lastname: Matsumoto
authors.forename: K
authors.initials: K
authors.lastname: Uno
authors.forename: M
authors.initials: M
authors.lastname: Sakurai
authors.forename: S
authors.initials: S
authors.lastname: Okada
authors.forename: M
authors.initials: M
authors.lastname: Onuki
authors.forename: T
authors.initials: T
authors.lastname: Minaguchi
authors.forename: Y O
authors.initials: YO
authors.lastname: Tanaka
authors.forename: S
authors.initials: S
authors.lastname: Homma
authors.forename: A
authors.initials: A
authors.lastname: Oki
authors.forename: H
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D016889:Endometrial Neoplasms / Q000150:complications*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015999:Multivariate Analysis; D011877:Radionuclide Imaging; D012307:Risk Factors; D014463:Ultrasonography; D054556:Venous Thromboembolism / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
references.citation: Aust N Z J Obstet Gynaecol. 1983 Nov;23(4):216-9
references.pmid: 6585196
references.citation: Int J Gynecol Cancer. 2006 Jan-Feb;16 Suppl 1:458-71
references.pmid: 16515646
references.citation: J Nucl Med. 1993 Jun;34(6):896-8
references.pmid: 8509855
references.citation: Int J Clin Oncol. 2005 Dec;10(6):444-6
references.pmid: 16369752
references.citation: Obstet Gynecol. 2007 Aug;110(2 Pt 1):429-40
references.pmid: 17666620
references.citation: Cancer. 1996 Nov 15;78(10):2157-63
references.pmid: 8918409
references.citation: Ann Surg. 2006 Jan;243(1):89-95
references.pmid: 16371741
references.citation: Br J Cancer. 2007 Jan 29;96(2):290-5
references.pmid: 17211468
references.citation: Thromb Haemost. 2006 Apr;95(4):715-9
references.pmid: 16601844
references.citation: Gynecol Oncol. 1996 Mar;60(3):412-7
references.pmid: 8774649
references.citation: Am J Obstet Gynecol. 1984 Aug 15;149(8):830-4
references.pmid: 6540521
references.citation: Clin Hemorheol Microcirc. 2000;22(2):107-30
references.pmid: 10831062
references.citation: BMJ. 2002 Oct 19;325(7369):887-90
references.pmid: 12386044
references.citation: Am J Obstet Gynecol. 1983 Mar 1;145(5):606-13
references.pmid: 6338722
references.citation: Thromb J. 2005 Nov 19;3:18
references.pmid: 16297244
references.citation: Circulation. 2008 Jan 1;117(1):93-102
references.pmid: 18086925
references.citation: Chest. 2001 Jan;119(1 Suppl):132S-175S
references.pmid: 11157647
references.citation: N Engl J Med. 2003 Sep 25;349(13):1227-35
references.pmid: 14507948
references.citation: Int Angiol. 2001 Mar;20(1):1-37
references.pmid: 11342993
references.citation: Lancet. 1991 Jan 26;337(8735):196-200
references.pmid: 1670841
references.citation: Int J Gynecol Pathol. 2001 Jul;20(3):252-9
references.pmid: 11444201
references.citation: Br J Cancer. 2007 Oct 22;97(8):1053-7
references.pmid: 17895896