Significance of venous thromboembolism in women with uterine carcinosarcoma

Koji Matsuo; Malcolm S Ross; Dwight D Im; Merieme M Klobocista; Stephen H Bush; Marian S Johnson; Tadao Takano; Erin A Blake; Yuji Ikeda; Masato Nishimura; Yutaka Ueda; Masako Shida; Kosei Hasegawa; Tsukasa Baba; Sosuke Adachi; Takuhei Yokoyama; Shinya Satoh; Hiroko Machida; Shiori Yanai; Keita Iwasaki; Takahito M Miyake; Satoshi Takeuchi; Munetaka Takekuma; Tadayoshi Nagano; Mayu Yunokawa; Tanja Pejovic; Kohei Omatsu; Mian M K Shahzad; Joseph L Kelley; Frederick R Ueland; Lynda D Roman

doi:10.1016/j.ygyno.2017.11.036

Significance of venous thromboembolism in women with uterine carcinosarcoma

Koji Matsuo, Malcolm S Ross, Dwight D Im, Merieme M Klobocista, Stephen H Bush, Marian S Johnson, Tadao Takano, Erin A Blake, Yuji Ikeda, Masato Nishimura, Yutaka Ueda, Masako Shida, Kosei Hasegawa, Tsukasa Baba, Sosuke Adachi, Takuhei Yokoyama, Shinya Satoh, Hiroko Machida, Shiori Yanai, Keita IwasakiTakahito M Miyake, Satoshi Takeuchi, Munetaka Takekuma, Tadayoshi Nagano, Mayu Yunokawa, Tanja Pejovic, Kohei Omatsu, Mian M K Shahzad, Joseph L Kelley, Frederick R Ueland, Lynda D Roman

Research output: Contribution to journal › Article › peer-review

13 Citations (Scopus)

Abstract

OBJECTIVE: To identify risk factors for venous thromboembolism (VTE) and to examine the association of VTE and survival in women with uterine carcinosarcoma.

METHODS: This multicenter retrospective study examined 906 women who underwent primary surgical treatment for stage I-IV uterine carcinosarcoma. Time-dependent analyses were performed for cumulative incidence of VTE after surgery on multivariate models.

RESULTS: There were 72 (7.9%) women who developed VTE after surgery with 1-, 2-, and 5-year cumulative incidences being 5.1%, 7.3%, and 10.2%, respectively. On multivariate analysis, older age (hazard ratio [HR] per year 1.03, P=0.012), non-Asian race (HR 6.28, P<0.001), large body habitus (HR per kg/m2 1.04, P=0.014), residual disease at surgery (HR 3.04, P=0.003), tumor size ≥5cm (HR 2.73, P=0.003), and stage IV disease (HR 2.12, P=0.025) were independently associated with increased risk of developing VTE. A risk pattern analysis identified that obese Non-Asian women with large tumors (13.7% of population) had the highest incidence of VTE (2-year cumulative rate, 26.1%) whereas Asian women with no residual disease (47.1% of population) had the lowest (2-year cumulative rate, 1.6%) (P<0.001). Presence of carcinoma/sarcoma in metastatic sites was significantly associated with increased risk of VTE compared to carcinoma alone (2-year rates, 31.2% versus 8.4%, P=0.049). VTE was independently associated with decreased progression-free survival on multivariate models (5-year rates, 24.9% versus 47.2%, HR 1.46, 95%CI 1.05-2.04, P=0.026).

CONCLUSION: Our study suggests that VTE represents a surrogate marker of aggressive tumor behavior and diminished patient condition in uterine carcinosarcoma; obese Non-Asian women with large tumors carry a disproportionally high risk of VTE, suggesting that long-term prophylaxis may benefit this population.

Original language	English
Pages (from-to)	267-274
Number of pages	8
Journal	Gynecologic Oncology
Volume	148
Issue number	2
DOIs	https://doi.org/10.1016/j.ygyno.2017.11.036
Publication status	Published - Feb 2018
Externally published	Yes

Keywords

Aged
Carcinosarcoma/mortality
Female
Humans
Kaplan-Meier Estimate
Middle Aged
Neoplasm Metastasis
Neoplasm, Residual
Postoperative Complications/etiology
Retrospective Studies
Risk Factors
Tumor Burden
Uterine Neoplasms/mortality
Venous Thromboembolism/etiology

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10.1016/j.ygyno.2017.11.036

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Matsuo, K., Ross, M. S., Im, D. D., Klobocista, M. M., Bush, S. H., Johnson, M. S., Takano, T., Blake, E. A., Ikeda, Y., Nishimura, M., Ueda, Y., Shida, M., Hasegawa, K., Baba, T., Adachi, S., Yokoyama, T., Satoh, S., Machida, H., Yanai, S., ... Roman, L. D. (2018). Significance of venous thromboembolism in women with uterine carcinosarcoma. Gynecologic Oncology, 148(2), 267-274. https://doi.org/10.1016/j.ygyno.2017.11.036

Matsuo, K, Ross, MS, Im, DD, Klobocista, MM, Bush, SH, Johnson, MS, Takano, T, Blake, EA, Ikeda, Y, Nishimura, M, Ueda, Y, Shida, M, Hasegawa, K, Baba, T, Adachi, S, Yokoyama, T, Satoh, S, Machida, H, Yanai, S, Iwasaki, K, Miyake, TM, Takeuchi, S, Takekuma, M, Nagano, T, Yunokawa, M, Pejovic, T, Omatsu, K, Shahzad, MMK, Kelley, JL, Ueland, FR & Roman, LD 2018, 'Significance of venous thromboembolism in women with uterine carcinosarcoma', Gynecologic Oncology, vol. 148, no. 2, pp. 267-274. https://doi.org/10.1016/j.ygyno.2017.11.036

@article{97c7f296b7824f91a0f0cada1fa9c114,

title = "Significance of venous thromboembolism in women with uterine carcinosarcoma",

abstract = "OBJECTIVE: To identify risk factors for venous thromboembolism (VTE) and to examine the association of VTE and survival in women with uterine carcinosarcoma.METHODS: This multicenter retrospective study examined 906 women who underwent primary surgical treatment for stage I-IV uterine carcinosarcoma. Time-dependent analyses were performed for cumulative incidence of VTE after surgery on multivariate models.RESULTS: There were 72 (7.9%) women who developed VTE after surgery with 1-, 2-, and 5-year cumulative incidences being 5.1%, 7.3%, and 10.2%, respectively. On multivariate analysis, older age (hazard ratio [HR] per year 1.03, P=0.012), non-Asian race (HR 6.28, P<0.001), large body habitus (HR per kg/m2 1.04, P=0.014), residual disease at surgery (HR 3.04, P=0.003), tumor size ≥5cm (HR 2.73, P=0.003), and stage IV disease (HR 2.12, P=0.025) were independently associated with increased risk of developing VTE. A risk pattern analysis identified that obese Non-Asian women with large tumors (13.7% of population) had the highest incidence of VTE (2-year cumulative rate, 26.1%) whereas Asian women with no residual disease (47.1% of population) had the lowest (2-year cumulative rate, 1.6%) (P<0.001). Presence of carcinoma/sarcoma in metastatic sites was significantly associated with increased risk of VTE compared to carcinoma alone (2-year rates, 31.2% versus 8.4%, P=0.049). VTE was independently associated with decreased progression-free survival on multivariate models (5-year rates, 24.9% versus 47.2%, HR 1.46, 95%CI 1.05-2.04, P=0.026).CONCLUSION: Our study suggests that VTE represents a surrogate marker of aggressive tumor behavior and diminished patient condition in uterine carcinosarcoma; obese Non-Asian women with large tumors carry a disproportionally high risk of VTE, suggesting that long-term prophylaxis may benefit this population.",

keywords = "Aged, Carcinosarcoma/mortality, Female, Humans, Kaplan-Meier Estimate, Middle Aged, Neoplasm Metastasis, Neoplasm, Residual, Postoperative Complications/etiology, Retrospective Studies, Risk Factors, Tumor Burden, Uterine Neoplasms/mortality, Venous Thromboembolism/etiology",

author = "Koji Matsuo and Ross, {Malcolm S} and Im, {Dwight D} and Klobocista, {Merieme M} and Bush, {Stephen H} and Johnson, {Marian S} and Tadao Takano and Blake, {Erin A} and Yuji Ikeda and Masato Nishimura and Yutaka Ueda and Masako Shida and Kosei Hasegawa and Tsukasa Baba and Sosuke Adachi and Takuhei Yokoyama and Shinya Satoh and Hiroko Machida and Shiori Yanai and Keita Iwasaki and Miyake, {Takahito M} and Satoshi Takeuchi and Munetaka Takekuma and Tadayoshi Nagano and Mayu Yunokawa and Tanja Pejovic and Kohei Omatsu and Shahzad, {Mian M K} and Kelley, {Joseph L} and Ueland, {Frederick R} and Roman, {Lynda D}",

year = "2018",

month = feb,

doi = "10.1016/j.ygyno.2017.11.036",

language = "English",

volume = "148",

pages = "267--274",

journal = "Gynecologic Oncology",

issn = "0090-8258",

publisher = "Academic Press Inc.",

number = "2",

}

TY - JOUR

T1 - Significance of venous thromboembolism in women with uterine carcinosarcoma

AU - Matsuo, Koji

AU - Ross, Malcolm S

AU - Im, Dwight D

AU - Klobocista, Merieme M

AU - Bush, Stephen H

AU - Johnson, Marian S

AU - Takano, Tadao

AU - Blake, Erin A

AU - Ikeda, Yuji

AU - Nishimura, Masato

AU - Ueda, Yutaka

AU - Shida, Masako

AU - Hasegawa, Kosei

AU - Baba, Tsukasa

AU - Adachi, Sosuke

AU - Yokoyama, Takuhei

AU - Satoh, Shinya

AU - Machida, Hiroko

AU - Yanai, Shiori

AU - Iwasaki, Keita

AU - Miyake, Takahito M

AU - Takeuchi, Satoshi

AU - Takekuma, Munetaka

AU - Nagano, Tadayoshi

AU - Yunokawa, Mayu

AU - Pejovic, Tanja

AU - Omatsu, Kohei

AU - Shahzad, Mian M K

AU - Kelley, Joseph L

AU - Ueland, Frederick R

AU - Roman, Lynda D

PY - 2018/2

Y1 - 2018/2

N2 - OBJECTIVE: To identify risk factors for venous thromboembolism (VTE) and to examine the association of VTE and survival in women with uterine carcinosarcoma.METHODS: This multicenter retrospective study examined 906 women who underwent primary surgical treatment for stage I-IV uterine carcinosarcoma. Time-dependent analyses were performed for cumulative incidence of VTE after surgery on multivariate models.RESULTS: There were 72 (7.9%) women who developed VTE after surgery with 1-, 2-, and 5-year cumulative incidences being 5.1%, 7.3%, and 10.2%, respectively. On multivariate analysis, older age (hazard ratio [HR] per year 1.03, P=0.012), non-Asian race (HR 6.28, P<0.001), large body habitus (HR per kg/m2 1.04, P=0.014), residual disease at surgery (HR 3.04, P=0.003), tumor size ≥5cm (HR 2.73, P=0.003), and stage IV disease (HR 2.12, P=0.025) were independently associated with increased risk of developing VTE. A risk pattern analysis identified that obese Non-Asian women with large tumors (13.7% of population) had the highest incidence of VTE (2-year cumulative rate, 26.1%) whereas Asian women with no residual disease (47.1% of population) had the lowest (2-year cumulative rate, 1.6%) (P<0.001). Presence of carcinoma/sarcoma in metastatic sites was significantly associated with increased risk of VTE compared to carcinoma alone (2-year rates, 31.2% versus 8.4%, P=0.049). VTE was independently associated with decreased progression-free survival on multivariate models (5-year rates, 24.9% versus 47.2%, HR 1.46, 95%CI 1.05-2.04, P=0.026).CONCLUSION: Our study suggests that VTE represents a surrogate marker of aggressive tumor behavior and diminished patient condition in uterine carcinosarcoma; obese Non-Asian women with large tumors carry a disproportionally high risk of VTE, suggesting that long-term prophylaxis may benefit this population.

AB - OBJECTIVE: To identify risk factors for venous thromboembolism (VTE) and to examine the association of VTE and survival in women with uterine carcinosarcoma.METHODS: This multicenter retrospective study examined 906 women who underwent primary surgical treatment for stage I-IV uterine carcinosarcoma. Time-dependent analyses were performed for cumulative incidence of VTE after surgery on multivariate models.RESULTS: There were 72 (7.9%) women who developed VTE after surgery with 1-, 2-, and 5-year cumulative incidences being 5.1%, 7.3%, and 10.2%, respectively. On multivariate analysis, older age (hazard ratio [HR] per year 1.03, P=0.012), non-Asian race (HR 6.28, P<0.001), large body habitus (HR per kg/m2 1.04, P=0.014), residual disease at surgery (HR 3.04, P=0.003), tumor size ≥5cm (HR 2.73, P=0.003), and stage IV disease (HR 2.12, P=0.025) were independently associated with increased risk of developing VTE. A risk pattern analysis identified that obese Non-Asian women with large tumors (13.7% of population) had the highest incidence of VTE (2-year cumulative rate, 26.1%) whereas Asian women with no residual disease (47.1% of population) had the lowest (2-year cumulative rate, 1.6%) (P<0.001). Presence of carcinoma/sarcoma in metastatic sites was significantly associated with increased risk of VTE compared to carcinoma alone (2-year rates, 31.2% versus 8.4%, P=0.049). VTE was independently associated with decreased progression-free survival on multivariate models (5-year rates, 24.9% versus 47.2%, HR 1.46, 95%CI 1.05-2.04, P=0.026).CONCLUSION: Our study suggests that VTE represents a surrogate marker of aggressive tumor behavior and diminished patient condition in uterine carcinosarcoma; obese Non-Asian women with large tumors carry a disproportionally high risk of VTE, suggesting that long-term prophylaxis may benefit this population.

KW - Aged

KW - Carcinosarcoma/mortality

KW - Female

KW - Humans

KW - Kaplan-Meier Estimate

KW - Middle Aged

KW - Neoplasm Metastasis

KW - Neoplasm, Residual

KW - Postoperative Complications/etiology

KW - Retrospective Studies

KW - Risk Factors

KW - Tumor Burden

KW - Uterine Neoplasms/mortality

KW - Venous Thromboembolism/etiology

U2 - 10.1016/j.ygyno.2017.11.036

DO - 10.1016/j.ygyno.2017.11.036

M3 - Article

C2 - 29248197

SN - 0090-8258

VL - 148

SP - 267

EP - 274

JO - Gynecologic Oncology

JF - Gynecologic Oncology

IS - 2

ER -

Significance of venous thromboembolism in women with uterine carcinosarcoma

Abstract

Keywords

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