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Significance of venous thromboembolism in women with uterine carcinosarcoma
Authors: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  Lynda D. Roman
Affiliation:1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, CA, USA;2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Magee-Womens Hospital, University of Pittsburgh, PA, USA;3. The Gynecologic Oncology Center, Mercy Medical Center, Baltimore, MD, USA;4. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, NY, USA;5. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, FL, USA;6. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, KY, USA;7. Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan;8. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, CO, USA;9. Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan;10. Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan;11. Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan;12. Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan;13. Department of Obstetrics and Gynecology, Saitama Medical University International Medical Center, Saitama, Japan;14. Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan;15. Department of Obstetrics and Gynecology, Niigata University, Niigata, Japan;p. Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Osaka, Japan;q. Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan;r. Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan;s. Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan;t. Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan;u. Department of Obstetrics and Gynecology, Iwate Medical University, Morioka, Japan;v. Department of Gynecology, Shizuoka Cancer Center, Shizuoka, Japan;w. Department of Obstetrics and Gynecology, Kitano Hospital, Osaka, Japan;x. Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan;y. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, OR, USA;z. Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan
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.
Keywords:Uterine carcinosarcoma  Venous thromboembolism  Deep vein thrombosis  Pulmonary embolism  Risk factors  Survival
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