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 journalArticle

4 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 ≥ 5 cm (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 - 2018 Feb

Keywords

  • Deep vein thrombosis
  • Pulmonary embolism
  • Risk factors
  • Survival
  • Uterine carcinosarcoma
  • Venous thromboembolism

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

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  • Cite this

    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