title: The survival detriment of venous thromboembolism with epithelial ovarian cancer.
abstract: OBJECTIVE
  The aim of this study is to evaluate the effect of venous thromboembolism (VTE) chronology with respect to surgery on survival with epithelial ovarian cancer (EOC).
  
  
  METHODS
  An IRB approved, retrospective review was performed of patients treated for Stage I-IV EOC from 1996 to 2011. Cox proportional hazards model was used to assess associations between VTE and the primary outcomes of progression free survival (PFS) and overall survival (OS). SAS 9.3 was used for statistical analyses.
  
  
  RESULTS
  586 patients met study criteria. Median age was 63 years (range, 17-94); median BMI was 27.1 kg/m(2) (range, 13.7-67.0). Most tumors were high grade serous (68.3%) and advanced stage (III/IV, 75.4%). 3.7% had a preoperative VTE; 13.2% had a postoperative VTE. Upon multivariate analysis adjusting for age, stage, histology, performance status, and residual disease, preoperative VTE was predictive of OS (HR 3.1, 95% CI: 1.6-6.1, p=0.001) but not PFS (p=0.55). Postoperative VTE was associated with shorter PFS (HR 1.45, 95% CI: 1.04-2.02, p=0.03) and OS (HR 1.8, 95% CI: 1.3-2.6, p=0.001). When VTE timing was modeled, preoperative VTE (HR 3.5, 95% CI: 1.8-6.9, p<0.001) and postoperative VTE after primary therapy (HR 2.3, 95% CI: 1.4-3.6, p=0.001) were predictive of OS.
  
  
  CONCLUSIONS
  Preoperative and postoperative VTE appear to have a detrimental effect on OS with EOC. When modeled as a binary variable, postoperative VTE attenuated PFS; however, when VTE timing was modeled, postoperative VTE was not associated with PFS. It is unclear whether VTE is an inherent poor prognostic marker or if improved VTE prophylaxis and treatment may enable similar survival to patients without these events.
authors.affiliation: University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Oklahoma City, OK, United States. Electronic address: camille-gunderson@ouhsc.edu.
authors.forename: Camille C
authors.initials: CC
authors.lastname: Gunderson
authors.affiliation: University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Oklahoma City, OK, United States.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Thomas
authors.affiliation: University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Oklahoma City, OK, United States.
authors.forename: Katrina N
authors.initials: KN
authors.lastname: Slaughter
authors.affiliation: University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Oklahoma City, OK, United States.
authors.forename: Regina
authors.initials: R
authors.lastname: Farrell
authors.affiliation: The University of Oklahoma Health Sciences Center, College of Public Health, Department of Biostatistics and Epidemiology, Oklahoma City, OK, United States.
authors.forename: Kai
authors.initials: K
authors.lastname: Ding
authors.affiliation: University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Oklahoma City, OK, United States.
authors.forename: Ronni E
authors.initials: RE
authors.lastname: Farris
authors.affiliation: University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Oklahoma City, OK, United States.
authors.forename: Jacob K
authors.initials: JK
authors.lastname: Lauer
authors.affiliation: University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Oklahoma City, OK, United States.
authors.forename: LaToya J
authors.initials: LJ
authors.lastname: Perry
authors.affiliation: University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Oklahoma City, OK, United States.
authors.forename: D Scott
authors.initials: DS
authors.lastname: McMeekin
authors.affiliation: University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Oklahoma City, OK, United States.
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000097:blood* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009825:Oklahoma / Q000453:epidemiology; D010051:Ovarian Neoplasms / Q000097:blood* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D011182:Postoperative Care; D011300:Preoperative Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D054556:Venous Thromboembolism / Q000150:complications* / Q000401:mortality* / Q000473:pathology; D055815:Young Adult
keywords: Ovarian cancer; Survival; Venous thromboembolism