title: Postoperative venous thromboembolism predicts survival in cancer patients.
abstract: OBJECTIVE
  To determine whether a postoperative venous thromboembolism (VTE) is associated with a worse prognosis and/or a more advanced cancer stage and to evaluate the association between a postoperative VTE and cancer-specific survival when known prognostic factors, such as age, stage, cancer type, and type of surgery, are controlled.
  
  
  BACKGROUND
  It is unknown whether oncology patients who develop a venous thromboembolism after a complete curative resection are at the same survival disadvantage as oncology patients with a spontaneous VTE.
  
  
  METHODS
  A retrospective case control study was conducted at Memorial Sloan-Kettering Cancer Center. Years of study: January 1, 2000, to December 31, 2005. Median follow-up: 24.9 months (Interquartile range 13.0, 43.0). All cancer patients who underwent abdominal, pelvic, thoracic, or soft tissue procedures and those who developed a VTE within 30 days of the procedure were identified from a prospective morbidity and mortality database. Overall survival (OS) was calculated for the entire cohort. In the matched cohort, OS and disease-specific survival (DSS) were calculated for stages 0 to 3 and stages 0 to 2.
  
  
  RESULTS
  A total of 23,541 cancer patients underwent an invasive procedure and 474 (2%) had a postoperative VTE. VTE patients had a significantly worse 5-year OS compared to no-VTE patients (43.8% vs 61.2%; P < 0.0001); 205 VTE patients (stages 0-3) were matched to 2050 controls by age, sex, cancer type, stage, and surgical procedure. In this matched analysis, VTE patients continued to demonstrate a significantly worse prognosis with an inferior 5-year OS (54.7% vs 66.3%; P < 0.0001) and DSS (67.8% vs 79.5%; P = 0.0007) as compared to controls. The survival difference persisted in early stage disease (stage 0-2), with 5-year DSS of 82.9% versus 87.3% (P = 0.01).
  
  
  CONCLUSIONS
  Postoperative VTE in oncology patients with limited disease and a complete surgical resection is associated with an inferior cancer survival. A postoperative VTE remains a poor prognostic factor, even when controlling for age, stage, cancer type, and surgical procedure further supporting an independent link between hypercoagulability and cancer survival.
authors.affiliation: Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada. rauer@ottawahospital.on.ca
authors.forename: Rebecca Ann C
authors.initials: RA
authors.lastname: Auer
authors.forename: Adena Sarah
authors.initials: AS
authors.lastname: Scheer
authors.forename: Jakob I
authors.initials: JI
authors.lastname: McSparron
authors.forename: Allison R
authors.initials: AR
authors.lastname: Schulman
authors.forename: Scott
authors.initials: S
authors.lastname: Tuorto
authors.forename: Steve
authors.initials: S
authors.lastname: Doucette
authors.forename: Jamie
authors.initials: J
authors.lastname: Gonsalves
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology / Q000401:mortality; D016022:Case-Control Studies; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000453:epidemiology / Q000401:mortality; D005833:Genital Neoplasms, Female / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000401:mortality; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012878:Skin Neoplasms / Q000453:epidemiology / Q000401:mortality; D054556:Venous Thromboembolism / Q000453:epidemiology*; D055815:Young Adult