title: Venous thromboembolism in patients with cholangiocarcinoma:  focus on risk factors and impact on survival.
abstract: BACKGROUND
  A high incidence of venous thromboembolism (VTE) has been observed in patients with cancer. However, few data are available on patients with cholangiocarcinoma.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the clinical characteristics and risk factors of VTE and to investigate whether VTE would affect the survival of patients with cholangiocarcinoma.
  
  
  METHODS
  We retrospectively reviewed 273 patients who were diagnosed with cholangiocarcinoma from January 2004 to December 2008.
  
  
  RESULTS
  We observed 40 cases of VTE, among which 10 patients had VTE at diagnosis. There were 14 cases of pulmonary thromboembolism with or without deep vein thrombosis, 18 cases of portal vein thrombosis, four cases of inferior vena cava thrombosis, and four of hepatic vein thrombosis. We found that progression of stage, C-reactive protein, and chemotherapy were significantly associated with the occurrence of VTE (P=0.022, 0.006, and 0.014, respectively). The median survival in the VTE and non-VTE groups were 13.0 and 25.0 months, respectively (log-rank test, P=0.026). VTE was an unfavorable prognostic factor for cholangiocarcinoma (hazard ratio=1.626, P=0.042).
  
  
  CONCLUSIONS
  In our study, advanced stage, C-reactive protein, and treatment with chemotherapeutic agents were related to the occurrence of VTE in patients with cholangiocarcinoma. VTE was an independent unfavorable prognostic factor for survivors of cholangiocarcinoma.
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
authors.forename: Hye Kyung
authors.initials: HK
authors.lastname: Jeon
authors.forename: Dong Uk
authors.initials: DU
authors.lastname: Kim
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Baek
authors.forename: Dong Woo
authors.initials: DW
authors.lastname: Ha
authors.forename: Bong Eun
authors.initials: BE
authors.lastname: Lee
authors.forename: Dong Yup
authors.initials: DY
authors.lastname: Ryu
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Cheong
authors.forename: Gwang Ha
authors.initials: GH
authors.lastname: Kim
authors.forename: Geun Am
authors.initials: GA
authors.lastname: Song
authors.forename: Ae Lee
authors.initials: AL
authors.lastname: Jang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D001653:Bile Ducts, Intrahepatic; D002097:C-Reactive Protein / Q000378:metabolism; D018281:Cholangiocarcinoma / Q000150:complications* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000097:blood / Q000209:etiology*
chemical_list: D000970:Antineoplastic Agents; D002097:C-Reactive Protein