Survival in patients with malignancy and venous thromboembolism by tumour subtype and thrombus location.
BACKGROUND
Although the association between malignancy and venous thromboembolism (VTE) is firmly established, less is known about the survival following VTE among different malignant subtypes.


OBJECTIVE
We sought to estimate survival from first VTE in consecutive patients with known malignancy receiving extended low molecular weight heparin therapy.


METHODS
Five hundred and fifty-nine consecutive patients presenting to the Thrombosis Unit Registry at Auckland City Hospital between January 1997 and October 2006 were observed. Events were confirmed by standard imaging procedures. The diagnosis date and site of VTE as well as the type of malignancy were recorded.


RESULTS
Mean follow up was 21.4 months. Overall median survival from VTE was 13.5 months. Six-month, one-, two- and five-year survivals were 64%, 53%, 43% and 33% respectively. Survival was longest for haematological malignancy at 44.4 months, followed by prostate, bowel, breast (metastatic breast), lung and pancreatic malignancy at 29.4, 27.4, 15.5 (6.2), 2.4 and 1.9 months respectively. Median survival varied with thrombotic location from 31.1 months for upper limb/jugular deep vein thrombosis reducing to only 10.1 months for iliocaval/abdominal deep vein thrombosis, but this did not reach statistical significance. Survival from cancer diagnosis was also determined.


CONCLUSIONS
The 1-year 53% survival in cancer patients with VTE treated using extended low molecular weight heparin is longer than that reported from large registry and population studies in which specific patient information and therapeutic regimens are unknown. Survival is critically determined by tumour type and correlates with tumour stage in women with breast cancer. There is also a trend towards differing survival by thrombus location.
Thrombosis Unit, Department of Haematology, Auckland City Hospital, Auckland, New Zealand. timothypresto@yahoo.com
T
T
Prestidge
S
S
Lee
P
P
Harper
L
L
Young
P
P
Ockelford
D001943:Breast Neoplasms / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000401:mortality; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007414:Intestinal Neoplasms / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality; D008297:Male; D009369:Neoplasms / Q000097:blood / Q000145:classification / Q000150:complications / Q000401:mortality*; D009520:New Zealand / Q000453:epidemiology; D009928:Organ Specificity; D010190:Pancreatic Neoplasms / Q000401:mortality; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000517:prevention & control
D006495:Heparin, Low-Molecular-Weight