Treatment-related frequency of venous thrombosis in lower esophageal, gastro-esophageal and gastric cancer--a clinical prospective study of outcome and prognostic factors.
BACKGROUND
Prospective studies of chemotherapy-associated VTE in cancer patients undergoing neoadjuvant chemotherapy in combination with curative intended surgery have not been reported for upper gastrointestinal cancer. In this clinical prospective study, we sought to estimate the incidence of VTE in esophagogastric cancer (OEC) patients scheduled for a specific perioperative chemotherapy regime: oxaliplatin, capecitabine, and epirubicin, (EXE) and curative intended surgery.


METHODS
A total of 129 consecutive OEC patients were examined using state-of-the-art bilateral compression ultrasound (biCUS) for deep vein thrombosis (DVT) before undergoing preoperative chemotherapy, surgery, and postoperative chemotherapy. In addition 79 were also consecutively scanned at baseline for pulmonary embolism (PE) using state-of-the-art computer tomography pulmonary angiography (CTPA).


RESULTS
There were 21 VTE cases throughout the course of treatment (16%, 95% confidence interval [95% CI]: 10 - 24%) among the patients examined using both biCUS and CTPA. Fourteen of 21 VTE was incidental (68%, 95% CI: 43 -85) and 7 VTE events was symptomatic (33%, 15 - 57). The median overall survival was 18months (95% CI: 13 - 24) in patients without any VTE and 14months (95% CI: 7 -30, P = 0.820) in patients with VTE. The cancer stage (adjusted odds ratio [OR]: 5.2, 95% CI: 1 - 21, p=0.002) and gastric cancer (OR 6.4, 95% CI: 2 - 21, P = 0.002) was a significant predictor of VTE.


CONCLUSIONS
The incidence of VTE in patients undergoing EXE neoadjuvant chemotherapy was high, particularly among patients with initial stage III and IV cancers. In addition, a substantial number of chemotherapy-related VTE cases were asymptomatic.
Department of Gastrointestinal Surgery, Clinical Cancer Research Center, Aalborg University Hospital, Denmark. Electronic address: anchl@rn.dk.
Anders Christian
AC
Larsen
Department of Radiology, Clinical Cancer Research Center, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Denmark.
Jens Brøndum
JB
Frøkjær
Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Denmark; Department of Radiology, Clinical Cancer Research Center, Aalborg University Hospital, Denmark.
Rune Vincents
RV
Fisker
Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Denmark.
Victor
V
Iyer
Department of Gastrointestinal Surgery, Clinical Cancer Research Center, Aalborg University Hospital, Denmark.
Peter Brøndum
PB
Mortensen
Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, Denmark.
Mette Karen
MK
Yilmaz
Department of Immunology, Skejby Hospital, Aarhus University Hospital, Denmark.
Bjarne
B
Møller
Department of Clinical Biochemistry, Centre of Cardiovascular Research, and Clinical research Center, Aalborg University Hospital, Denmark.
Søren Risom
SR
Kristensen
Department of Gastrointestinal Surgery, Clinical Cancer Research Center, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Denmark.
Ole
O
Thorlacius-Ussing
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D000069287:Capecitabine / Q000008:administration & dosage; D003131:Combined Modality Therapy; D015251:Epirubicin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000150:complications* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010166:Palliative Care; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000150:complications* / Q000503:physiopathology; D012008:Recurrence; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications* / Q000209:etiology / Q000503:physiopathology
D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D015251:Epirubicin; D000069287:Capecitabine
Chemotherapy; Gastric cancer; Gastroesophageal cancer; Overall survivalOutcome; Venous thrombosis