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 journalArticlepeer-review

9 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 languageEnglish
Pages (from-to)267-274
Number of pages8
JournalGynecologic Oncology
Volume148
Issue number2
DOIs
Publication statusPublished - Feb 2018
Externally publishedYes

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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