title: Signs and Symptoms of Venous Thromboembolism and Survival Outcome of Endometrial Cancer.
abstract: This study aimed to evaluate if the presence of venous thromboembolism (VTE) diagnosed with subjective and objective measurements correlates with the survival outcome in patients with endometrial cancer.
  
  
  
  A retrospective study was conducted on patients with endometrial cancer who developed VTE between cancer diagnosis and follow-up from 1999 to 2013. Disease-specific survival after VTE diagnosis was evaluated according to VTE symptoms and vital signs.
  
  
  
  Among 827 endometrial cancer cases during the study period, there were 72 (8.7%) patients with VTE identified (pulmonary embolism [PE] with or without deep vein thrombosis [DVT], n = 34; and DVT alone n = 38). In the PE group, decreased disease-specific survival after the diagnosis of VTE was associated with fatigue, systolic blood pressure (BP) less than 120 mm Hg, diastolic BP less than 70 mm Hg, and a heart rate 90 beats per minute or greater (all, P < 0.05) in a univariate analysis. Symptomatic PE was associated with decreased survival as compared to asymptomatic PE (2-year rate; 23.1% vs 77.8%, P < 0.01). In a multivariate analysis controlling for symptoms of VTE, signs, and tumor factors, a diastolic BP less than 70 mm Hg (adjusted-hazard ratio [HR], 10.0; 95% confidence interval, 2.70-37.1; P < 0.01) and HR greater than 90 beats per minute (adjusted-HR, 8.06; 95% confidence interval, 2.36-27.5; P < 0.01) remained as independent prognostic factors for decreased disease-specific survival after PE diagnosis. Patients with PE presenting with low diastolic BP and high heart rate resulted in a dismal survival outcome (diastolic BP < 70 mm Hg/heart rate ≥ 90 beats per minute vs diastolic BP ≥ 70 mm Hg/heart rate < 90 beats per minute; 0% vs 85.7%, P < 0.01). In the group of patients with DVT alone, no signs or symptoms correlated with survival outcome (all, P > 0.05).
  
  
  
  Our results suggested that both signs and symptoms of PE are important consideration in the management of patients with endometrial cancer with PE.
authors.affiliation: *Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA; †School of Medicine, Niigata University, Niigata, Japan; ‡Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Los Angeles County Medical Center; and §Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Machida
authors.forename: Marianne S
authors.initials: MS
authors.lastname: Hom
authors.forename: Midori
authors.initials: M
authors.lastname: Maeda
authors.forename: Jane J
authors.initials: JJ
authors.lastname: Yeo
authors.forename: Christian S
authors.initials: CS
authors.lastname: Ghattas
authors.forename: Brendan H
authors.initials: BH
authors.lastname: Grubbs
authors.forename: Koji
authors.initials: K
authors.lastname: Matsuo
mesh_terms: D002140:California / Q000453:epidemiology; D016889:Endometrial Neoplasms / Q000097:blood* / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011655:Pulmonary Embolism / Q000097:blood / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D015996:Survival Rate; D054556:Venous Thromboembolism / Q000097:blood / Q000401:mortality* / Q000473:pathology*