title: Analysis of incidence and clinical outcomes in patients with thromboembolic events and invasive exocrine pancreatic cancer.
abstract: BACKGROUND
  Pancreatic adenocarcinoma is among the most common malignancies associated with thromboembolic events (TEs); however, reported incidence figures vary significantly and contain small patient cohorts. Pancreatic cancer-specific thrombosis studies examining the correlation between clinical variables, including thrombosis timing and the impact of thrombosis on survival, have not been reported.
  
  
  METHODS
  Survival analyses were performed relating to the development and timing of a TE in 1915 patients administered chemotherapy at Memorial Sloan-Kettering Cancer Center with invasive exocrine pancreatic cancer from January 1, 2000 to December 31, 2009. TE timing, relative to clinical parameters including laboratory data, erythropoietin-stimulating agent use, and body mass index (BMI), were also analyzed.
  
  
  RESULTS
  A thrombosis was identified in 690 (36%) patients. After adjusting for patients with pancreatic surgery and thrombosis (n = 127), developing a TE significantly increased the risk of death (hazard ratio [HR], 2.6; 95% confidence interval [CI], 2.3-2.8; P < .01). Patients with an early TE (within 1.5 months from pancreatic cancer diagnosis) had a significantly higher risk of death (HR, 2.1; 95% CI, 1.7-2.5; P < .01) compared with patients with late TE or no TE. Erythropoietin-stimulating agent use and an elevated international normalized ratio were associated with significantly shorter time to thrombosis. Low BMI was associated with significantly longer time to thrombosis.
  
  
  CONCLUSIONS
  TEs are common in exocrine pancreatic cancer, with coagulopathy, erythropoietin-stimulating agent use, and underweight BMI influencing thrombosis timing. TEs, particularly early ones, confer a significantly worse prognosis, suggesting a biological significance, underscoring the relevance of ongoing prophylaxis trials, and raising the question of whether early TEs should be considered a stratification factor for clinical trials.
authors: Department of Medicine, Division of Gastrointestinal Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors: Andrew S
authors: AS
authors: Epstein
authors: Gerald A
authors: GA
authors: Soff
authors: Marinela
authors: M
authors: Capanu
authors: Christopher
authors: C
authors: Crosbie
authors: Manish A
authors: MA
authors: Shah
authors: David P
authors: DP
authors: Kelsen
authors: Brian
authors: B
authors: Denton
authors: Stuart
authors: S
authors: Gardos
authors: Eileen M
authors: EM
authors: O'Reilly
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000401:mortality; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006397:Hematinics / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D016019:Survival Analysis; D013923:Thromboembolism / Q000453:epidemiology*
chemical_list: D006397:Hematinics