Selected Publication:

Schwarzenbacher, E.
Incidences, prediction and outcome of venous and arterial thromboembolism in patients with advanced pancreatic cancer treated with palliative first line chemotherapy of Gemcitabine/nab-Paclitaxel or FOLFIRINOX
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2021. pp. 75 [OPEN ACCESS]
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Authors Med Uni Graz:

Advisor:

Pichler Martin

Riedl Jakob

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Abstract:

Introduction: Cancer-type specific characterisation of venous- and arterial thromboembolism (VTE/ATE) risk in pancreatic cancer patients might improve personalized prevention strategies. This multicenter retrospective cohort study provides a comprehensive and contemporary investigation of incidence, risk factors and outcomes of VTE/ATE in homogenously treated patients with advanced pancreatic cancer (aPC). Material and Methods: Patients with aPC undergoing palliative 1st-line chemotherapy (Gemcitabine/nab-Paclitaxel (GN) or FOLIRINOX) at three Austrian academic centers were included (n=455). Primary outcomes were objectively confirmed VTE (deep-vein thrombosis, pulmonary embolism, splanchnic vein thrombosis) and/or ATE (myocardial infarction, ischemic stroke, or peripheral embolism). Cumulative incidences and between-group comparisons of VTE/ATE risk were obtained in a competing-risk framework. The impact of VTE/ATE on overall- and progression free survival was studied by multi-state modelling. Results: Over a median follow-up of 26 months (interquartile range: 14-44), 86 VTE (cumulative incidence: 20.0% [95% confidence interval (CI): 16.3-24.0]) and 11 ATE events (cumulative incidence: 2.8% [95%CI: 1.5-4.9]) were observed. VTE diagnosis was associated with increased mortality (transition hazard ratio (THR): 1.59 [95%CI 1.21-2.09]) and increased risk of disease progression (THR: 1.47 [95%CI: 1.08-2.01]), while the impact of ATE on mortality was numerically but not statistically significant (THR: 1.85 [95%CI: 0.87-3.94]). The strongest predictor for VTE risk was history of cancer-associated VTE (SHR 3.29 [95%CI: 2.09-5.18]), while two validated prediction models for cancer-associated VTE, the Khorana-score (SHR 0.78 [0.57-1.06]) and CONKO-score (0.78 [0.60-1.03]) failed to predict VTE risk. A history of cerebrovascular disease was associated with markedly increased ATE risk (SHR: 22.05 [95%CI: 6.83-71.22], p<0.001) especially of ischemic stroke. Risk of VTE/ATE did not significantly differ according to type of 1st line chemotherapy. Conclusion: Patients with aPC undergoing palliative 1st-line chemotherapy with FOLFIRINOX or GN face a high risk for VTE/ATE and its diagnosis is linked with worse clinical outcomes. VTE-risk prediction models have limited ability to sub-stratify thrombotic events in this high-risk scenario.

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