Incidence, Timing, and Outcomes of Venous Thromboembolism in Patients Undergoing Surgery for Esophagogastric Cancer: A Population-Based Cohort Study.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
12 Mar 2022
12 Mar 2022
Historique:
received:
27
09
2021
accepted:
24
01
2022
entrez:
13
3
2022
pubmed:
14
3
2022
medline:
14
3
2022
Statut:
aheadofprint
Résumé
Abdominal surgery and chemotherapy are well-established risk factors for venous thromboembolism (VTE) in patients with cancer, but their specific contribution in patients with esophageal and gastric cancer is unclear. We aim to quantify the risk of VTE, identify risk factors associated with VTE, and determine the association between VTE and survival in patients undergoing surgery for esophageal or gastric cancer. A retrospective, population-based cohort study was conducted using linked administrative healthcare databases. We used the Ontario Cancer Registry to identify patients with esophageal or gastric cancer between January 1, 2007 and December 31, 2016 who underwent surgical resection. Incidence of first VTE event was identified using International Classification of Diseases 9 and 10 codes. VTE incidence was calculated at clinically relevant time points 180 days before and after surgery. Logistic regression was used to identify factors associated with VTE with odds ratios (OR) and 95% confidence intervals (CI) reported. Cox proportional hazards regression models were used to estimate associations between covariates and survival. Kaplan-Meier method was used to compare overall (OS) and cancer-specific survival (CSS) by VTE status. A total of 4894 patients had esophagectomy or gastrectomy, of which 8% (n = 383/4894) had VTE. VTE risk was 2.5% (n = 123/4894) 180 days before surgery, 2.8% (n = 138/4894) within 30 days of surgery, and 2.5% (n = 122/4894) from 31 to ≤ 180 days after surgery. Of the patients with VTE within 30 days of surgery, 34% (n = 47/138) were diagnosed after discharge from hospital. Receipt of preoperative chemotherapy was associated with VTE 180 days before surgery (odds ratio [OR] 3.84, 95% confidence interval [CI] 2.41, 6.11). Increased hospital length of stay (LOS) was associated with VTE 30 days after surgery (OR 1.08, 95% CI 1.02, 1.14, per week). Patients with VTE had inferior median OS and CSS (2.2 vs. 3.7 years; 2.3 vs. 4.4 years, respectively). In adjusted models VTE was associated with inferior OS (HR 1.36, 95% CI 1.13, 1.63) and CSS (HR 1.42, 95% CI 1.16, 1.75). The highest risk of VTE is within 30 days of surgery with one third of patients diagnosed after discharge from hospital. Longer hospital LOS and receipt of preoperative chemotherapy are associated with increased risk of VTE. VTE is an independent risk factor for inferior survival in patients with esophageal or gastric cancer.
Sections du résumé
BACKGROUND
BACKGROUND
Abdominal surgery and chemotherapy are well-established risk factors for venous thromboembolism (VTE) in patients with cancer, but their specific contribution in patients with esophageal and gastric cancer is unclear. We aim to quantify the risk of VTE, identify risk factors associated with VTE, and determine the association between VTE and survival in patients undergoing surgery for esophageal or gastric cancer.
METHODS
METHODS
A retrospective, population-based cohort study was conducted using linked administrative healthcare databases. We used the Ontario Cancer Registry to identify patients with esophageal or gastric cancer between January 1, 2007 and December 31, 2016 who underwent surgical resection. Incidence of first VTE event was identified using International Classification of Diseases 9 and 10 codes. VTE incidence was calculated at clinically relevant time points 180 days before and after surgery. Logistic regression was used to identify factors associated with VTE with odds ratios (OR) and 95% confidence intervals (CI) reported. Cox proportional hazards regression models were used to estimate associations between covariates and survival. Kaplan-Meier method was used to compare overall (OS) and cancer-specific survival (CSS) by VTE status.
RESULTS
RESULTS
A total of 4894 patients had esophagectomy or gastrectomy, of which 8% (n = 383/4894) had VTE. VTE risk was 2.5% (n = 123/4894) 180 days before surgery, 2.8% (n = 138/4894) within 30 days of surgery, and 2.5% (n = 122/4894) from 31 to ≤ 180 days after surgery. Of the patients with VTE within 30 days of surgery, 34% (n = 47/138) were diagnosed after discharge from hospital. Receipt of preoperative chemotherapy was associated with VTE 180 days before surgery (odds ratio [OR] 3.84, 95% confidence interval [CI] 2.41, 6.11). Increased hospital length of stay (LOS) was associated with VTE 30 days after surgery (OR 1.08, 95% CI 1.02, 1.14, per week). Patients with VTE had inferior median OS and CSS (2.2 vs. 3.7 years; 2.3 vs. 4.4 years, respectively). In adjusted models VTE was associated with inferior OS (HR 1.36, 95% CI 1.13, 1.63) and CSS (HR 1.42, 95% CI 1.16, 1.75).
CONCLUSIONS
CONCLUSIONS
The highest risk of VTE is within 30 days of surgery with one third of patients diagnosed after discharge from hospital. Longer hospital LOS and receipt of preoperative chemotherapy are associated with increased risk of VTE. VTE is an independent risk factor for inferior survival in patients with esophageal or gastric cancer.
Identifiants
pubmed: 35279774
doi: 10.1245/s10434-022-11520-5
pii: 10.1245/s10434-022-11520-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2022. Society of Surgical Oncology.
Références
Donnellan E, Khorana AA. Cancer and venous thromboembolic disease: a review. Oncologist. 2017;22(2):199–207.
doi: 10.1634/theoncologist.2016-0214
Trinh VQ, Karakiewicz PI, Sammon J, Sun M, Sukumar S, Gervais MK, et al. Venous thromboembolism after major cancer surgery: temporal trends and patterns of care. JAMA Surg. 2014;149(1):43–9.
doi: 10.1001/jamasurg.2013.3172
Fleming F, Gaertner W, Ternent CA, Finlayson E, Herzig D, Paquette IM, et al. The American Society of Colon and rectal surgeons clinical practice guideline for the prevention of venous thromboembolic disease in colorectal surgery. Dis Colon Rectum. 2018;61(1):14–20.
doi: 10.1097/DCR.0000000000000982
Violette PD, Cartwright R, Briel M, Tikkinen KA, Guyatt GH. Guideline of guidelines: thromboprophylaxis for urological surgery. BJU Int. 2016;118(3):351–8.
doi: 10.1111/bju.13496
Key NS, Khorana AA, Kuderer NM, Bohlke K, Lee AYY, Arcelus JI, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol. 2020;38(5):496–520.
doi: 10.1200/JCO.19.01461
Hata T, Ikeda M, Miyata H, Nomura M, Gotoh M, Sakon M, et al. Frequency and risk factors for venous thromboembolism after gastroenterological surgery based on the Japanese National Clinical Database (516 217 cases). Ann Gastroenterol Surg. 2019;3(5):534–43.
doi: 10.1002/ags3.12275
De Martino RR, Goodney PP, Spangler EL, Wallaert JB, Corriere MA, Rzucidlo EM, et al. Variation in thromboembolic complications among patients undergoing commonly performed cancer operations. J Vasc Surg. 2012;55(4):1035–40.
doi: 10.1016/j.jvs.2011.10.129
Khanna A, Reece-Smith AM, Cunnell M, Madhusudan S, Thomas A, Bowrey DJ, et al. Venous thromboembolism in patients receiving perioperative chemotherapy for esophagogastric cancer. Dis Esophagus. 2014;27(3):242–7.
doi: 10.1111/dote.12084
Slagter AE, Sikorska K, Grootscholten C, van Laarhoven HWM, Lind P, Nordsmark M, et al. Venous thromboembolism during preoperative chemotherapy in the CRITICS gastric cancer trial. Cancer Med. 2020;9(18):6609–16.
doi: 10.1002/cam4.3118
Kaida S, Miyake T, Murata S, Yamaguchi T, Tatsuta T, Murakami K, et al. A prospective multicenter observational study of venous thromboembolism after gastric cancer surgery (SHISA-1601). Eur Surg Res. 2021;62:1–10.
doi: 10.1159/000514309
Osaki T, Saito H, Fukumoto Y, Kono Y, Murakami Y, Shishido Y, et al. Risk and incidence of perioperative deep vein thrombosis in patients undergoing gastric cancer surgery. Surg Today. 2018;48(5):525–33.
doi: 10.1007/s00595-017-1617-4
Rollins KE, Peters CJ, Safranek PM, Ford H, Baglin TP, Hardwick RH. Venous thromboembolism in oesophago-gastric carcinoma: incidence of symptomatic and asymptomatic events following chemotherapy and surgery. Eur J Surg Oncol. 2011;37(12):1072–7.
doi: 10.1016/j.ejso.2011.08.140
Bellini G, Teng A, Kotecha N, Sutton E, Yang CK, Passeri M, et al. The identification of risk factors for venous thromboembolism in gastrointestinal oncologic surgery. J Surg Res. 2016;205(2):279–85.
doi: 10.1016/j.jss.2016.06.089
McAlpine K, Breau RH, Knee C, Carrier M, Violette PD, van Walraven C, et al. Venous thromboembolism and transfusion after major abdominopelvic surgery. Surgery. 2019;166(6):1084–91.
doi: 10.1016/j.surg.2019.05.050
Sorensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Engl J Med. 2000;343(25):1846–50.
doi: 10.1056/NEJM200012213432504
Robles SC, Marrett LD, Clarke EA, Risch HA. An application of capture-recapture methods to the estimation of completeness of cancer registration. J Clin Epidemiol. 1988;41(5):495–501.
doi: 10.1016/0895-4356(88)90052-2
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613–9.
doi: 10.1016/0895-4356(92)90133-8
Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, et al. The reporting of studies conducted using observational routinely-collected health data (RECORD) statement. PLoS Med. 2015;12(10):e1001885.
doi: 10.1371/journal.pmed.1001885
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–9.
doi: 10.1016/j.ijsu.2014.07.013
Lyman GH, Culakova E, Poniewierski MS, Kuderer NM. Morbidity, mortality and costs associated with venous thromboembolism in hospitalized patients with cancer. Thromb Res. 2018;164(Suppl 1):S112–8.
doi: 10.1016/j.thromres.2018.01.028
Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th edn: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e227S – e277.
doi: 10.1378/chest.11-2297
National Comprehensive Cancer Network. Cancer-Associated Venous Throboembolic Disease. 2021.
Patel SV, Zhang L, Wei XS, Merchant SJ, Nanji S, James PD, et al. A population-based cohort study of venous thromboembolism rates following surgery and during adjuvant chemotherapy in patients with colon cancer. Dis Colon Rectum. 2020;63(3):336–45.
doi: 10.1097/DCR.0000000000001557
Merkow RP, Bilimoria KY, McCarter MD, Cohen ME, Barnett CC, Raval MV, et al. Post-discharge venous thromboembolism after cancer surgery: extending the case for extended prophylaxis. Ann Surg. 2011;254(1):131–7.
doi: 10.1097/SLA.0b013e31821b98da
Adiamah A, Ban L, West J, Humes DJ. The risk of venous thromboembolism after surgery for esophagogastric malignancy and the impact of chemotherapy: a population-based cohort study. Dis Esophagus. 2020;33(6):doz079.
doi: 10.1093/dote/doz079
Marshall-Webb M, Bright T, Price T, Thompson SK, Watson DI. Venous thromboembolism in patients with esophageal or gastric cancer undergoing neoadjuvant chemotherapy. Dise Esophagus. 2017;30(2):1–7.
Starling N, Rao S, Cunningham D, Iveson T, Nicolson M, Coxon F, et al. Thromboembolism in patients with advanced gastroesophageal cancer treated with anthracycline, platinum, and fluoropyrimidine combination chemotherapy: a report from the UK National Cancer Research Institute Upper Gastrointestinal Clinical Studies Group. J Clin Oncol. 2009;27(23):3786–93.
doi: 10.1200/JCO.2008.19.4274
Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008;111(10):4902–7.
doi: 10.1182/blood-2007-10-116327
Carrier M, Abou-Nassar K, Mallick R, Tagalakis V, Shivakumar S, Schattner A, et al. Apixaban to prevent venous thromboembolism in patients with cancer. N Engl J Med. 2019;380(8):711–9.
doi: 10.1056/NEJMoa1814468
Brennan K, Karim S, Doiron RC, Siemens DR, Booth CM. Venous thromboembolism and peri-operative chemotherapy for muscle-invasive bladder cancer: a population-based study. Bladder Cancer. 2018;4(4):419–28.
doi: 10.3233/BLC-180184
Doiron RC, Booth CM, Wei X, Siemens DR. Risk factors and timing of venous thromboembolism after radical cystectomy in routine clinical practice: a population-based study. BJU Int. 2016;118(5):714–22.
doi: 10.1111/bju.13443
Harron K, Dibben C, Boyd J, Hjern A, Azimaee M, Barreto ML, et al. Challenges in administrative data linkage for research. Big Data Soc. 2017;4(2):2053951717745678.
doi: 10.1177/2053951717745678