1
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Yang R, Wang H, Liu D, Li W. Incidence and risk factors of VTE in lung cancer: a meta-analysis. Ann Med 2024; 56:2390200. [PMID: 39183726 PMCID: PMC11348814 DOI: 10.1080/07853890.2024.2390200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/07/2024] [Accepted: 06/24/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Lung cancer has maintained a high prevalence and mortality. Besides, venous thromboembolism (VTE) is the third most common disease of cardiovascular disease. Lung cancer with VTE usually influenced the overall survival in the follow-up. In the development of lung cancer, vigilance against and early diagnosis of VTE is of significance. METHODS We searched the databases of PubMed, Web of Science, Embase and Cochrane for related research up to 30 November 2023 and extracted information of incidence, odds ratio (OR), hazard ratio (HR) and their 95% confidence intervals (CIs), for evaluating the incidence of VTE and its risk factors. RESULTS A total of 54 articles and 873,292 records were included in our study. The pooled incidences of VTE and PE were 6% and 3%, respectively. Subgroup analysis revealed that the tumour, node and metastasis (TNM) stage (HR= 5.43, 95% CI: 2.42, 12.22), metastasis (HR= 2.67, 95% CI: 1.35, 5.29) and chemotherapy (HR= 2.27, 95% CI: 1.11, 4.65) had major influence on VTE occurrence. CONCLUSIONS Lung cancer complicated with VTE is unignorable, and its occurrence varies widely by tumour staging, tissue type and treatment. The results may aid in clinical decision-making about lung cancer in higher risk with VTE and weather receiving anticoagulant prophylaxis.
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Affiliation(s)
- Ruiyuan Yang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu, China
| | - Haoyu Wang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu, China
| | - Dan Liu
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu, China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu, China
- Precision Medicine Center, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China, Chinses Academy of Medical Sciences, West China Hospital, Chengdu, China
- Institute of Respiratory Health Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
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2
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Horaguchi T, Tanaka Y, Sato Y, Yamamoto K, Fukada M, Yasufuku I, Asai R, Tajima JY, Kiyama S, Matsuhashi N. Successful direct oral anticoagulant management of asymptomatic superior mesenteric vein thrombosis after adjuvant chemotherapy for colorectal cancer patient: A case report. Exp Ther Med 2024; 28:396. [PMID: 39171143 PMCID: PMC11336804 DOI: 10.3892/etm.2024.12685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 07/18/2024] [Indexed: 08/23/2024] Open
Abstract
Owing to advances in cancer treatment and the diversification of treatment methods, cancer-associated thrombosis is increasing. Cancer can cause blood clots by activating the blood clotting system, increasing clotting factors through inflammation, reducing blood flow due to immobilization and damaging blood vessels through treatments such as chemotherapy. In clinical practice, superior mesenteric vein (SMV) thrombosis is occasionally observed in patients with cancer; however, certain cases of asymptomatic thrombosis can be serious. In the present case, a 71-year-old woman underwent laparoscopic high anterior resection for colorectal cancer. The patient received capecitabine as postoperative adjuvant chemotherapy for 6 months. Contrast-enhanced CT after the completion of chemotherapy revealed a sizable thrombus in the SMV. The thrombus occupied the SMV lumen without evident intestinal ischemia. D-dimer levels were elevated. Since the patient remained asymptomatic, edoxaban (30 mg/day) was administered in an outpatient setting. Six months later, contrast-enhanced CT confirmed thrombus resolution. No hemorrhagic events were observed during edoxaban treatment. In conclusion, cancer and chemotherapy are risk factors for thrombosis, indicating that regular D-dimer measurements may be necessary during cancer treatment. In addition, edoxaban may be an effective therapeutic tool for SMV thrombosis during chemotherapy for cancer.
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Affiliation(s)
- Takeshi Horaguchi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1193, Japan
| | - Yoshihiro Tanaka
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1193, Japan
| | - Yuta Sato
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1193, Japan
| | - Kazuo Yamamoto
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1193, Japan
| | - Masahiro Fukada
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1193, Japan
| | - Itaru Yasufuku
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1193, Japan
| | - Ryuichi Asai
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1193, Japan
| | - Jesse Yu Tajima
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1193, Japan
| | - Shigeru Kiyama
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1193, Japan
| | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1193, Japan
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Shimoyama R, Imamura Y, Uryu K, Mase T, Ohtaki M, Ohtani K, Shiragami M, Fujimura Y, Hayashi M, Shinozaki N, Minami H. Analysis of thromboembolism and prognosis in metastatic pancreatic cancer from the Tokushukai REAl‑world data project. Mol Clin Oncol 2024; 21:73. [PMID: 39170627 PMCID: PMC11337082 DOI: 10.3892/mco.2024.2771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/16/2024] [Indexed: 08/23/2024] Open
Abstract
Cancer-associated thromboembolism (CAT), including venous thromboembolism (VTE) and arterial thromboembolism (ATE), is a frequent complication of advanced pancreatic cancer. However, reports on its incidence and clinical outcomes, especially on ATE, are limited. The present study aimed to investigate the incidence of CAT and its effects on overall survival in patients with metastatic pancreatic cancer. As part of the Tokushukai REAl-world data project in Japan, 846 eligible patients with metastatic pancreatic cancer treated with first-line chemotherapy were identified between April 2010 and March 2020. Using diagnosis procedure combination data from these patients, the present study investigated the incidence of VTE, ATE and cerebral and gastrointestinal bleeding requiring hospitalization. Blood laboratory data were collected within 14 days of the start of first-line treatment, and Khorana scores were calculated. The associations between CAT complications and comorbidities, concomitant medications and prognosis were examined. Among the 846 patients, 21 (2.5) and 70 (8.3%) had VTE and ATE, respectively (including five with overlapping VTE and ATE). CAT-positive patients had a significantly higher rate of gastrointestinal bleeding events compared with CAT-negative patients [13 of 86 (15.2%) vs. 46 of 760 (6.1%); P=0.01]. CAT-positive patients had a poorer prognosis [hazard ratio (HR), 1.28; 95% confidence interval (CI), 1.01-1.62] compared with CAT-negative patients, even after adjusting for background factors (HR, 1.20; 95% CI, 0.95-1.52). Cox regression analyses showed that higher Khorana scores were associated with significantly worse prognosis. This real-world data demonstrated that the incidence rate of CAT in patients with metastatic pancreatic cancer was 10.2%, and no statistically significant differences were observed, although there was a trend toward an adverse prognosis. The Khorana score may also be useful for predicting prognosis, even in the absence of CAT. This study was registered in the UMIN Clinical Trial Registry (http://www.umin.ac.jp/ctr/index.htm; clinical trial no. UMIN000050590).
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Affiliation(s)
- Rai Shimoyama
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa 247-8533, Japan
| | - Yoshinori Imamura
- Cancer Care Promotion Center, University of Fukui Hospital, Eiheiji, Fukui 910-1193, Japan
- Department of Hematology and Oncology, University of Fukui Hospital, Eiheiji, Fukui 910-1193, Japan
- Department of Medical Oncology and Hematology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Kiyoaki Uryu
- Department of Medical Oncology, Yao Tokushukai General Hospital, Yao, Osaka 581-0011, Japan
| | - Takahiro Mase
- Department of Breast Surgery, Ogaki Tokushukai Hospital, Ogaki, Gifu 503-0015, Japan
| | - Megu Ohtaki
- deCult Co., Ltd., Hatsukaichi, Hiroshima 739-0413, Japan
| | - Keiko Ohtani
- deCult Co., Ltd., Hatsukaichi, Hiroshima 739-0413, Japan
| | | | | | - Maki Hayashi
- Mirai Iryo Research Center Inc., Tokyo 102-0074, Japan
| | - Nobuaki Shinozaki
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa 247-8533, Japan
| | - Hironobu Minami
- Department of Medical Oncology and Hematology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
- Cancer Center, Kobe University Hospital, Kobe, Hyogo 650-0017, Japan
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4
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Kawachi R, Okano T, Awano N, Matsumoto M, Hosokawa J, Takita A, Oba MS, Kunitoh H. Venous thromboembolism in patients undergoing surgery for lung cancer: a post hoc analysis of the Cancer-VTE Registry. Jpn J Clin Oncol 2024:hyae090. [PMID: 39037954 DOI: 10.1093/jjco/hyae090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 07/16/2024] [Indexed: 07/24/2024] Open
Abstract
The relationship between lung cancer surgery and venous thromboembolism (VTE) in Japan has not been elucidated. This was a post hoc analysis of the Cancer-VTE Registry. The 1057 patients who underwent surgery for lung cancer were divided into the surgery alone (SA) group (n = 598) and the surgery plus chemotherapy (SC) group (n = 459), and the 1-year incidences of VTE and cerebral ischemia were analyzed. In the SA and SC groups, composite VTE was observed in one (0.2%) and 15 (3.3%) patients, respectively, and cerebral ischemia was observed in eight (1.3%) and four (0.9%) patients, respectively. Lymph node metastasis was more common in patients with D-dimer >1.2 μg/ml (odds ratio: 1.781, P = .004). SA had a low risk of VTE but a high risk of cerebral ischemia. Chemotherapy increases the risk of VTE. The D-dimer level was related to VTE and advanced cancer.
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Affiliation(s)
- Riken Kawachi
- Department of Respiratory Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Tetsuya Okano
- Department of Respiratory Medicine, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai-shi, Chiba 270-1694, Japan
| | - Nobuyasu Awano
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Masaru Matsumoto
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Jun Hosokawa
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd., 3-5-1 Nihonbashi-honcho, Chuo-ku, Tokyo 103-8246, Japan
| | - Atsushi Takita
- Data Intelligence Department, Daiichi Sankyo Co., Ltd., 1-2-58 Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan
| | - Mari S Oba
- Department of Medical Statistics, Toho University, 5-21-16 Omorinishi, Ota-ku,Tokyo 143-8540, Japan
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-higashi-cho, Kodaira-shi, Tokyo 187-8551, Japan
| | - Hideo Kunitoh
- Department of Medical Oncology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
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5
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Takahashi Y, Fujiwara H, Yamamoto K, Takano M, Miyamoto M, Hasegawa K, Miwa M, Satoh T, Itagaki H, Hirakawa T, Mori-Uchino M, Nagai T, Hamada Y, Yamashita S, Yano H, Kato T, Fujiwara K, Suzuki M. Prevention of symptomatic pulmonary embolism for gynecologic malignancies with preoperative asymptomatic venous thromboembolism: GOTIC-VTE trial. J Gynecol Oncol 2024; 35:e37. [PMID: 38178702 PMCID: PMC11262890 DOI: 10.3802/jgo.2024.35.e37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 10/07/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE In Japan, perioperative prophylaxis of pulmonary embolism (PE) in gynecologic cancer patients with preoperative asymptomatic venous thromboembolism (VTE) has not been well established yet. The GOTIC-VTE trial was a prospective, multi-center, single-arm clinical trial to investigate the prevention of postoperative symptomatic PE onset by seamless anticoagulant therapy from the preoperative period to 4 weeks after surgery instead of using intermittent pneumatic compression. METHODS Anticoagulant therapy was started immediately after asymptomatic VTE diagnosis and stopped preoperatively according to the rules of each institution. Unfractionated heparin administration was resumed within 12 hours postoperatively, and this was followed by the switch to low-molecular-weight heparin and subsequently, edoxaban; this cycle was continued for 28 days. Primary outcome was the occurrence of symptomatic PE in 28 days postoperatively. Secondary outcomes were the incidence of VTE-related events in 28 days and 6 months postoperatively and protocol-related adverse events. RESULTS Between February 2018 and September 2020, 99 patients were enrolled; of these, 82 patients were assessed as the full analysis set, including 58 for ovarian cancer, fallopian tube, or peritoneal cancer; 21 for endometrial cancer; and 3 for cervical cancer. No symptomatic PE was observed within 28 days postoperatively; two patients had bleeding events (major bleeding and clinically relevant nonmajor bleeding) and three had grade 3 adverse events (increased alanine transaminase, aspartate aminotransferase, or gamma-glutamyl transferase). CONCLUSION The multifaceted perioperative management for gynecologic malignancies with asymptomatic VTE effectively prevented postoperative symptomatic PE. TRIAL REGISTRATION JRCT Identifier: jRCTs031180124.
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Affiliation(s)
- Yoshifumi Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
| | - Hiroyuki Fujiwara
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Kouji Yamamoto
- Department of Biostatistics, School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Masashi Takano
- Department of Obstetrics and Gynecology, National Defense Medical College, Saitama, Japan
| | - Morikazu Miyamoto
- Department of Obstetrics and Gynecology, National Defense Medical College, Saitama, Japan
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Maiko Miwa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toyomi Satoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroya Itagaki
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Takashi Hirakawa
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Mayuyo Mori-Uchino
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomonori Nagai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yoshinobu Hamada
- Department of Obstetrics and Gynecology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Soichi Yamashita
- Department of Gynecology, Gunma Prefectural Cancer Center, Gunma, Japan
| | - Hiroko Yano
- Department of Gynecologic Oncology, Hyogo Cancer Center, Hyogo, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Keiichi Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Mitsuaki Suzuki
- Department of Obstetrics and Gynecology, Shin-Yurigaoka General Hospital, Kanagawa, Japan
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6
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Kayser A, Wolff A, Berlin P, Duehring L, Henze L, Mundkowski R, Bergmann W, Müller-Hilke B, Wagner C, Huehns M, Oehmcke-Hecht S, Maletzki C. Selective but not pan-CDK inhibition abrogates 5-FU-driven tissue factor upregulation in colon cancer. Sci Rep 2024; 14:10582. [PMID: 38719932 PMCID: PMC11078971 DOI: 10.1038/s41598-024-61076-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
Thromboembolic events are complications in cancer patients and hypercoagulability has been linked to the tissue factor (TF) pathway, making this an attractive target. Here, we investigated the effects of chemotherapeutics and CDK inhibitors (CDKI) abemaciclib/palbociclib (CDK4/6), THZ-1 (CDK7/12/13), and dinaciclib (CDK1/2/5/9) alone and in combination regimens on TF abundance and coagulation. The human colorectal cancer (CRC) cell line HROC173 was treated with 5-FU or gemcitabine to stimulate TF expression. TF+ cells were sorted, recultured, and re-analyzed. The effect of treatment alone or in combination was assessed by functional assays. Low-dose chemotherapy induced a hypercoagulable state and significantly upregulated TF, even after reculture without treatment. Cells exhibited characteristics of epithelial-mesenchymal transition, including high expression of vimentin and mucin. Dinaciclib and THZ-1 also upregulated TF, while abemaciclib and palbociclib downregulated it. Similar results were observed in coagulation assays. The same anticoagulant activity of abemaciclib was seen after incubation with peripheral immune cells from healthy donors and CRC patients. Abemaciclib reversed 5-FU-induced TF upregulation and prolonged clotting times in second-line treatment. Effects were independent of cytotoxicity, senescence, and p27kip1 induction. TF-antibody blocking experiments confirmed the importance of TF in plasma coagulation, with Factor XII playing a minor role. Short-term abemaciclib counteracts 5-FU-induced hypercoagulation and eventually even prevents thromboembolic events.
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Affiliation(s)
- Annika Kayser
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Annabell Wolff
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
- Institute of Medical Microbiology, Virology and Hygiene, Rostock University Medical Center, 18057, Rostock, Germany
| | - Peggy Berlin
- Department of Medicine II, Division of Gastroenterology, Rostock University Medical Center, 18057, Rostock, Germany
| | - Lara Duehring
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
- Institute of Medical Microbiology, Virology and Hygiene, Rostock University Medical Center, 18057, Rostock, Germany
| | - Larissa Henze
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
- Department of Internal Medicine II, Asklepios Hospital Harz, Goslar, Germany
| | - Ralf Mundkowski
- Center of Pharmacology and Toxicology, Institute of Clinical Pharmacology, Rostock University Medical Center, 18057, Rostock, Germany
| | - Wendy Bergmann
- Laboratory for Clinical Immunology, Core Facility for Cell Sorting and Cell Analysis, Rostock University Medical Center, 18057, Rostock, Germany
| | - Brigitte Müller-Hilke
- Laboratory for Clinical Immunology, Core Facility for Cell Sorting and Cell Analysis, Rostock University Medical Center, 18057, Rostock, Germany
| | - Charlotte Wagner
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Maja Huehns
- Institute of Pathology, Rostock University Medical Center, 18057, Rostock, Germany
| | - Sonja Oehmcke-Hecht
- Institute of Medical Microbiology, Virology and Hygiene, Rostock University Medical Center, 18057, Rostock, Germany.
| | - Claudia Maletzki
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
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7
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Nakamura M, Sakon M, Sasako M, Okusaka T, Mukai H, Fujiwara K, Kunitoh H, Oba MS, Wada H, Hosokawa J, Takita A, Ikeda M. Association of D-dimer level with thrombotic events, bleeding, and mortality in Japanese patients with solid tumors: a Cancer-VTE Registry subanalysis. Int J Clin Oncol 2024; 29:407-416. [PMID: 38430303 DOI: 10.1007/s10147-024-02475-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/10/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND The D-dimer test is a simple test frequently used in routine clinical screening for venous thromboembolism (VTE). The Cancer-VTE Registry was a large-scale, multicenter, prospective, observational study in Japanese patients with cancer. This study aimed to clarify the relationship between D-dimer level at cancer diagnosis (baseline) and the incidence of events during cancer treatment (1-year follow-up period). METHODS This was a post hoc sub-analysis of patients from the Cancer-VTE Registry whose D-dimer levels were measured at baseline. The incidence of events during the 1-year follow-up period was evaluated stratified by baseline D-dimer level. Adjusted hazard ratios for D-dimer level and events during the follow-up period were evaluated. RESULTS Among the total enrolled patients, baseline D-dimer level was measured in 9020 patients. The mean ± standard deviation baseline D-dimer level was 1.57 ± 3.94 µg/mL. During the follow-up period, the incidence of VTE, cerebral infarction/transient ischemic attack (TIA)/systemic embolic events (SEE), bleeding, and all-cause death increased with increasing baseline D-dimer level. The incidence of all-cause death increased with increasing D-dimer level regardless of cancer stage. The adjusted hazard ratio of all-cause death was 1.03 (95% confidence interval: 1.02-1.03) per 1.0-µg/mL increase in baseline D-dimer level. CONCLUSIONS Increases in D-dimer levels were associated with a higher risk of thrombotic events, such as VTE and cerebral infarction/TIA/SEE, during cancer treatment. Furthermore, higher D-dimer levels at cancer diagnosis were associated with a higher mortality rate, regardless of cancer stage.
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Affiliation(s)
- Mashio Nakamura
- Nakamura Medical Clinic, 7-1510, Hidamarinooka, Kuwana, Mie, 511-0867, Japan.
| | - Masato Sakon
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Chuo-Ku, Osaka, Japan
| | - Mitsuru Sasako
- Department of Surgery, Yodogawa Christian Hospital, Higashi Yodogawa-Ku, Osaka, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan
| | - Hirofumi Mukai
- Division of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Keiichi Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hideo Kunitoh
- Department of Medical Oncology, Japanese Red Cross Medical Center, Shibuya-Ku, Tokyo, Japan
| | - Mari S Oba
- Department of Medical Statistics, Toho University, Ota-Ku, Tokyo, Japan
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Hideo Wada
- Department of General and Laboratory Medicine, Mie Prefectural General Medical Center, Yokkaichi, Mie, Japan
| | - Jun Hosokawa
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd, Chuo-Ku, Tokyo, Japan
| | - Atsushi Takita
- Data Intelligence Department, Daiichi Sankyo Co., Ltd, Shinagawa-Ku, Tokyo, Japan
| | - Masataka Ikeda
- Division of Lower Gastrointestinal Surgery, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
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8
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Kawakado K, Tsubata Y, Hotta T, Yamasaki M, Ishikawa N, Fujitaka K, Kubota T, Kobayashi K, Isobe T. Risk Factors for Bleeding Events in Japanese Patients with Advanced Lung Cancer: Data from the Rising-VTE/NEJ037 Study. Cancers (Basel) 2024; 16:301. [PMID: 38254791 PMCID: PMC10814048 DOI: 10.3390/cancers16020301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Despite the occurrence of various hemorrhagic events during advanced lung cancer treatment, few researchers have reported on their risk factors. Moreover, the development of cancer-related thromboembolism indicates anticoagulant use. However, adverse events such as bleeding should be monitored. In this study, we aimed to identify factors that influence the onset of hemorrhagic events in patients with lung cancer. The Rising-VTE/NEJ037 study was a multicenter, prospective, observational study. A total of 1008 patients with lung cancer who were unsuitable for radical resection or radiation were enrolled and followed up for 2 years. Multivariate analysis using a Cox proportional hazard model was performed to compare the outcomes of the time to the onset of hemorrhagic events for 2 years after registration. Hemorrhagic events occurred in 115 patients (11.4%), with 35 (30.4%) experiencing major bleeding. Significant risk factors included venous thromboembolism (VTE) (hazard ratio [HR]: 4.003, p < 0.001) and an Eastern Cooperative Oncology Group Performance Status score of 1 (HR: 2.476, p < 0.001). Factors that significantly reduced hemorrhagic event risk were female sex (HR: 0.454, p = 0.002) and M1a status (HR: 0.542, p = 0.038). VTE is a risk factor for hemorrhagic events in patients with advanced lung cancer, and risks associated with anticoagulant therapy should be considered.
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Affiliation(s)
- Keita Kawakado
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo 693-8501, Japan; (K.K.); (T.H.); (T.I.)
| | - Yukari Tsubata
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo 693-8501, Japan; (K.K.); (T.H.); (T.I.)
| | - Takamasa Hotta
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo 693-8501, Japan; (K.K.); (T.H.); (T.I.)
| | - Masahiro Yamasaki
- Department of Respiratory Disease, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, 1-9-6, Senda-Machi, Naka-ku, Hiroshima 730-8619, Japan;
| | - Nobuhisa Ishikawa
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima 734-8530, Japan;
| | - Kazunori Fujitaka
- Department of Respiratory Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan;
| | - Tetsuya Kubota
- Department of Respiratory Medicine and Allergology, Kochi University Hospital, 185-1 Kohasu, Oko-Cho, Nankoku 783-8505, Japan;
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka 350-1298, Japan;
| | - Takeshi Isobe
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo 693-8501, Japan; (K.K.); (T.H.); (T.I.)
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9
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Okusaka T, Saiura A, Shimada K, Ikeda M, Ioka T, Kimura T, Hosokawa J, Takita A, Oba MS. Incidence and risk factors for venous thromboembolism in the Cancer-VTE Registry pancreatic cancer subcohort. J Gastroenterol 2023; 58:1261-1271. [PMID: 37676492 PMCID: PMC10657787 DOI: 10.1007/s00535-023-02033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND This substudy of the Cancer-VTE Registry estimated venous thromboembolism (VTE) incidence and risk factors in pancreatic cancer patients. METHODS The Cancer-VTE Registry was an observational study that collected VTE data from patients with solid tumors across Japan. We measured baseline VTE prevalence, and at 1-year follow-up, the cumulative incidence of symptomatic and composite VTE (symptomatic VTE and incidental VTE requiring treatment), bleeding, cerebral infarction/transient ischemic attack (TIA)/systemic embolic event (SEE), and all-cause death. RESULTS Of 1006 pancreatic cancer patients, 86 (8.5%) had VTE at baseline, and seven (0.7%) had symptomatic VTE. Significant risk factors of baseline VTE were Eastern Cooperative Oncology Group performance status (ECOG PS) of 1, body mass index (BMI) ≥ 25 kg/m2, history of VTE, D-dimer > 1.2 µg/mL, and hemoglobin < 10 g/dL. At 1-year follow-up, the cumulative incidence of events was higher for pancreatic cancer vs other cancers. Pancreatic cancer patients with VTE vs those without VTE had significantly higher incidences of bleeding, cerebral infarction/TIA/SEE, and all-cause death. No significant risk factors for composite VTE were identified. CONCLUSIONS The cumulative incidence of composite VTE during cancer treatment was higher in pancreatic cancer than in other cancer types. Some risk factors for VTE prevalence at cancer diagnosis were identified. Although VTE prevalence at cancer diagnosis did not predict the subsequent 1-year incidence of composite VTE, it was a significant predictor of other events such as all-cause death in pancreatic cancer patients. TRIAL REGISTRATION UMIN Clinical Trials Registry; UMIN000024942.
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Affiliation(s)
- Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kazuaki Shimada
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tatsuya Ioka
- Oncology Center, Yamaguchi University Hospital, Ube, Japan
| | - Tetsuya Kimura
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd., Chuo-ku, Tokyo, Japan
| | - Jun Hosokawa
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd., Chuo-ku, Tokyo, Japan
| | - Atsushi Takita
- Data Intelligence Department, Daiichi Sankyo Co., Ltd., Shinagawa-ku, Tokyo, Japan
| | - Mari S Oba
- Department of Medical Statistics, Toho University, Ota-ku, Tokyo, Japan
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Kodaira, Japan
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10
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Yamashita Y, Morimoto T, Muraoka N, Oyakawa T, Umetsu M, Akamatsu D, Nishimoto Y, Sato Y, Takada T, Jujo K, Minami Y, Ogihara Y, Dohi K, Fujita M, Nishikawa T, Ikeda N, Hashimoto G, Otsui K, Mori K, Sueta D, Tsubata Y, Shoji M, Shikama A, Hosoi Y, Tanabe Y, Chatani R, Tsukahara K, Nakanishi N, Kim K, Ikeda S, Mo M, Yoshikawa Y, Kimura T. Edoxaban for 12 Months Versus 3 Months in Patients With Cancer With Isolated Distal Deep Vein Thrombosis (ONCO DVT Study): An Open-Label, Multicenter, Randomized Clinical Trial. Circulation 2023; 148:1665-1676. [PMID: 37638968 DOI: 10.1161/circulationaha.123.066360] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/15/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND The optimal duration of anticoagulation therapy for isolated distal deep vein thrombosis in patients with cancer is clinically relevant, but the evidence is lacking. The prolonged anticoagulation therapy could have a potential benefit for prevention of thrombotic events; however, it could also increase the risk of bleeding. METHODS In a multicenter, open-label, adjudicator-blinded, randomized clinical trial at 60 institutions in Japan, we randomly assigned patients with cancer with isolated distal deep vein thrombosis, in a 1-to-1 ratio, to receive either a 12-month or 3-month edoxaban treatment. The primary end point was a composite of a symptomatic recurrent venous thromboembolism (VTE) or VTE-related death at 12 months. The major secondary end point was major bleeding at 12 months, according to the criteria of the International Society on Thrombosis and Haemostasis. The primary hypothesis was that a 12-month edoxaban treatment was superior to a 3-month edoxaban treatment with respect to the primary end point. RESULTS From April 2019 through June 2022, 604 patients were randomized, and after excluding 3 patients who withdrew consent, 601 patients were included in the intention-to-treat population: 296 patients in the 12-month edoxaban group and 305 patients in the 3-month edoxaban group. The mean age was 70.8 years, 28% of the patients were men, and 20% of the patients had symptoms of deep vein thrombosis at baseline. The primary end point of a symptomatic recurrent VTE event or VTE-related death occurred in 3 of the 296 patients (1.0%) in the 12-month edoxaban group and in 22 of the 305 patients (7.2%) in the 3-month edoxaban group (odds ratio, 0.13; 95% CI, 0.03-0.44). The major secondary end point of major bleeding occurred in 28 of the 296 patients (9.5%) in the 12-month edoxaban group and in 22 of the 305 patients (7.2%) in the 3-month edoxaban group (odds ratio, 1.34; 95% CI, 0.75-2.41). The prespecified subgroups did not affect the estimates on the primary end point. CONCLUSIONS In patients with cancer with isolated distal deep vein thrombosis, 12 months was superior to 3 months for an edoxaban treatment with respect to the composite outcome of a symptomatic recurrent VTE or VTE-related death. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03895502.
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Affiliation(s)
- Yugo Yamashita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (Y. Yamashita, Y. Yoshikawa)
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan (T.M.)
| | - Nao Muraoka
- Division of Cardiology, Shizuoka Cancer Center, Japan (N.M., T.O.)
| | - Takuya Oyakawa
- Division of Cardiology, Shizuoka Cancer Center, Japan (N.M., T.O.)
| | - Michihisa Umetsu
- Division of Vascular Surgery, Department of Surgery, Tohoku University Hospital, Sendai, Japan (M.U., D.A.)
| | - Daijirou Akamatsu
- Division of Vascular Surgery, Department of Surgery, Tohoku University Hospital, Sendai, Japan (M.U., D.A.)
| | - Yuji Nishimoto
- Division of Cardiology, Osaka General Medical Center, Japan (Y.N.)
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Japan (Y.S.)
| | - Takuma Takada
- Department of Cardiology, Tokyo Women's Medical University, Japan (T.T., K.J., Y.M.)
| | - Kentaro Jujo
- Department of Cardiology, Tokyo Women's Medical University, Japan (T.T., K.J., Y.M.)
| | - Yuichiro Minami
- Department of Cardiology, Tokyo Women's Medical University, Japan (T.T., K.J., Y.M.)
| | - Yoshito Ogihara
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan (Y.O., K.D.)
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan (Y.O., K.D.)
| | - Masashi Fujita
- Department of Onco-Cardiology, Osaka International Cancer Institute, Japan (M.F., T.N.)
| | - Tatsuya Nishikawa
- Department of Onco-Cardiology, Osaka International Cancer Institute, Japan (M.F., T.N.)
| | - Nobutaka Ikeda
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan (N.I., G.H.)
| | - Go Hashimoto
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan (N.I., G.H.)
| | - Kazunori Otsui
- Department of General Internal Medicine, Kobe University Graduate School of Medicine, Japan (K.O., K.M.)
| | - Kenta Mori
- Department of General Internal Medicine, Kobe University Graduate School of Medicine, Japan (K.O., K.M.)
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (D.S.)
| | - Yukari Tsubata
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, Izumo, Japan (Y. Tsubata)
| | - Masaaki Shoji
- Department of Cardiovascular Medicine, National Cancer Center Hospital, Tokyo, Japan (M.S.)
| | - Ayumi Shikama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Japan (A.S.)
| | - Yutaka Hosoi
- Department of Cardiovascular Surgery, Kyorin University Faculty of Medicine, Tokyo, Japan (Y.H.)
| | - Yasuhiro Tanabe
- Department of Cardiology, St Marianna University School of Medicine, Kawasaki, Japan (Y. Tanabe)
| | - Ryuki Chatani
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Japan (R.C.)
| | - Kengo Tsukahara
- Division of Cardiology, Fujisawa City Hospital, Japan (K.T.)
| | - Naohiko Nakanishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan (N.N.)
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (K.K.)
| | - Satoshi Ikeda
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan (S.I.)
| | - Makoto Mo
- Department of Cardiovascular Surgery, Yokohama Minami Kyosai Hospital, Japan (M.M.)
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (Y. Yamashita, Y. Yoshikawa)
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Japan (T.K.)
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11
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Yoshikawa T, Sano T, Terashima M, Yamaguchi K, Bando E, Kawabata R, Yabusaki H, Shinohara H, Oba MS, Kimura T, Takita A, Sasako M. Incidence and risk factors for venous thromboembolism in the Cancer-VTE Registry stomach cancer subcohort. Gastric Cancer 2023; 26:493-503. [PMID: 37004667 PMCID: PMC10284943 DOI: 10.1007/s10120-023-01378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/26/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND The Cancer-VTE Registry was a large-scale, multicenter, prospective registry designed to investigate real-world data on venous thromboembolism (VTE) incidence and risk factors in adult Japanese patients with solid tumors. This pre-specified subgroup analysis aimed to estimate the incidence of VTE, including VTE types other than symptomatic VTE, and identify risk factors of VTE in stomach cancer from the Cancer-VTE Registry. METHODS Stage II-IV stomach cancer patients who planned to initiate cancer therapy and underwent VTE screening within 2 months before registration were enrolled. RESULTS Of 1,896 patients enrolled, 131 (6.9%) had VTE at baseline, but 96.2% were asymptomatic. Female sex, age ≥ 65 years, VTE history, and D-dimer > 1.2 μg/mL were independent risk factors of VTE at baseline. Notably, patients with D-dimer > 1.2 µg/mL at the time of cancer diagnosis had an approximately 20-fold risk of VTE. During follow-up, event incidences were symptomatic VTE, 0.3%; incidental VTE requiring treatment, 1.1%; composite VTE, 1.4%; bleeding, 1.6%; cerebral infarction/transient ischemic attack/systemic embolic events, 0.7%; and all-cause death, 15.0%. The incidence of all-cause death was higher in patients with VTE vs without VTE at baseline (adjusted hazard ratio 1.67; 95% confidence interval 1.21-2.32; p = 0.002). CONCLUSIONS VTE prevalence at the time of cancer diagnosis was not negligible and was extremely high when the patients had high D-dimer. VTE screening by D-dimer before starting cancer treatment is advisable, even for asymptomatic patients, regardless of whether the patient is undergoing surgery or chemotherapy. TRIAL REGISTRATION UMIN000024942.
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Affiliation(s)
- Takaki Yoshikawa
- Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Kensei Yamaguchi
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Ryohei Kawabata
- Department of Surgery, Osaka Rosai Hospital, Sakai, Japan
- Department of Surgery, Sakai City Medical Center, Sakai, Japan
| | - Hiroshi Yabusaki
- Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hisashi Shinohara
- Department of Gastroenterological Surgery, Division of Upper GI, Hyogo Medical University, Nishinomiya, Japan
| | - Mari S Oba
- Department of Medical Statistics, Toho University, Tokyo, Japan
- Department of Clinical Data Science, Clinical Research and Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tetsuya Kimura
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd, Tokyo, Japan
| | - Atsushi Takita
- Data Intelligence Department, Daiichi Sankyo Co., Ltd, Tokyo, Japan
| | - Mitsuru Sasako
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
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12
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Ohsumi S, Watanabe K, Kondo N, Kosaka Y, Ishikawa T, Kitahara M, Kubo S, Oba MS, Kimura T, Takita A, Mukai H. Venous thromboembolism in Japanese patients with breast cancer: subgroup analysis of the Cancer-VTE Registry. Breast Cancer 2023; 30:607-616. [PMID: 37069366 PMCID: PMC10284999 DOI: 10.1007/s12282-023-01452-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/07/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND This subgroup analysis of the Cancer-VTE Registry, a nationwide, large-scale, multicenter observational study with a 1-year follow-up, assessed real-world data on venous thromboembolism (VTE) among Japanese patients with breast cancer. METHODS Patients with stage II-IV pretreatment breast cancer screened for VTE at enrollment were included. During the 1-year follow-up period, incidences of VTE, bleeding, and all-cause death, and background factors associated with VTE risk were examined. RESULTS Of 9,630 patients in the Cancer-VTE Registry analysis set, 993 (10.3%) had breast cancer (973 [98.0%] did not have and 20 [2.0%] had VTE at baseline). The mean age was 58.4 years, 73.4% of patients had stage II cancer, and 94.8% had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0. Risk factors for VTE at baseline by univariable analysis were age ≥ 65 years, ECOG PS of 2, VTE history, and D-dimer > 1.2 μg/mL. During follow-up, the incidence of symptomatic VTE was 0.4%; incidental VTE requiring treatment, 0.1%; composite VTE (symptomatic VTE and incidental VTE requiring treatment), 0.5%; bleeding, 0.2%; cerebral infarction/transient ischemic attack/systemic embolic event, 0.2%; and all-cause death, 2.1%. One patient with symptomatic VTE developed pulmonary embolism (PE) and died. Incidences of VTE and all-cause death were higher in patients with VTE vs without VTE at baseline. CONCLUSIONS In Japanese patients with breast cancer, VTE screening before initiating cancer treatment revealed a 2.0% prevalence of VTE. During follow-up, one patient had a fatal outcome due to PE, but the incidences of VTE were low. CLINICAL TRIAL REGISTRATION UMIN000024942; UMIN Clinical Trials Registry: https://www.umin.ac.jp/ctr/ .
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Affiliation(s)
- Shozo Ohsumi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umemoto-machi, Matsuyama, Ehime, 791-0280, Japan.
| | - Kenichi Watanabe
- Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
| | - Naoto Kondo
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Yoshimasa Kosaka
- Department of Breast and Endocrine Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
- Department of Breast Surgery, Japanese Red Cross Sagamihara Hospital, Sagamihara, Kanagawa, Japan
| | - Takashi Ishikawa
- Department of Breast Oncology and Surgery, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Miyuki Kitahara
- Department of Breast Surgery, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Kasama, Ibaraki, Japan
| | - Shinichiro Kubo
- Division of Breast and Thyroid Gland Surgery, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Mari S Oba
- Department of Medical Statistics, Toho University, Ota-ku, Tokyo, Japan
- Department of Clinical Data Science, Clinical Research and Education Promotion Division, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Tetsuya Kimura
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd., Chuo-ku, Tokyo, Japan
| | - Atsushi Takita
- Data Intelligence Department, Daiichi Sankyo Co., Ltd., Shinagawa-ku, Tokyo, Japan
| | - Hirofumi Mukai
- Division of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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13
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Kitahama T, Otsuka S, Sugiura T, Ashida R, Ohgi K, Yamada M, Uesaka K. A case of pancreatic head cancer with Trousseau's syndrome treated with radical resection and anticoagulant therapy. Surg Case Rep 2023; 9:6. [PMID: 36633733 PMCID: PMC9837346 DOI: 10.1186/s40792-023-01585-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The primary disease of Trousseau's syndrome is often highly advanced cancer, and treatment of the primary disease after cerebral infarction is often difficult. We herein report a case of pancreatic head cancer with Trousseau's syndrome treated with radical resection and anticoagulant therapy. CASE PRESENTATION A 78-year-old man was admitted with dizziness and diagnosed with cerebral infarction. Abdominal contrast-enhanced computed tomography for a thorough checkup indicated borderline resectable pancreatic head cancer. Radical resection after neoadjuvant chemotherapy (NAC; gemcitabine plus nab-paclitaxel) was scheduled. During the second course of NAC, multiple cerebral infarctions recurred, and the patient was diagnosed with Trousseau's syndrome. Continuous intravenous infusion of heparin was started for cerebral infarction. Since it was impossible to continue NAC and there was no worsening of imaging findings, radical resection was planned. Thereafter, he underwent pancreatoduodenectomy with superior mesenteric vein resection. The patient progressed well and was discharged on the 19th day after surgery. He continued subcutaneous injection of heparin at home and is alive without recurrence of cancer or cerebral infarction at more than 21 months after surgery. CONCLUSION Surgical treatment may be an option for pancreatic cancer with Trousseau's syndrome under favorable conditions.
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Affiliation(s)
- Takumi Kitahama
- grid.415797.90000 0004 1774 9501Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimongakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777 Japan
| | - Shimpei Otsuka
- grid.415797.90000 0004 1774 9501Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimongakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777 Japan
| | - Teiichi Sugiura
- grid.415797.90000 0004 1774 9501Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimongakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777 Japan
| | - Ryo Ashida
- grid.415797.90000 0004 1774 9501Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimongakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777 Japan
| | - Katsuhisa Ohgi
- grid.415797.90000 0004 1774 9501Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimongakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777 Japan
| | - Mihoko Yamada
- grid.415797.90000 0004 1774 9501Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimongakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777 Japan
| | - Katsuhiko Uesaka
- grid.415797.90000 0004 1774 9501Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimongakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777 Japan
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14
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One-Year Incidences of Venous Thromboembolism, Bleeding, and Death in Patients With Lung Cancer (Cancer-VTE Subanalysis). JTO Clin Res Rep 2022; 3:100392. [PMID: 36089919 PMCID: PMC9460508 DOI: 10.1016/j.jtocrr.2022.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/20/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction This subanalysis aimed to provide real-world data on venous thromboembolism (VTE) from patients with lung cancer in the Cancer-VTE Registry. Methods The primary outcome was the number of baseline VTE events in patients with lung cancer. The 1-year cumulative incidences of symptomatic VTE; composite VTE (symptomatic and incidental VTE requiring treatment); bleeding; cerebral infarction, transient ischemic attack, and systemic embolic events; and all-cause death were calculated. Clinical trial registration: UMIN000024942. Results The study enrolled a total of 2377 patients with lung cancer; of these, 119 (5.0%) had VTE (six [0.3%], symptomatic, and 113 [4.8%], asymptomatic) and 14 (0.6%) had pulmonary embolism at baseline. During the follow-up period (mean, 337.7 d), the incidence was 0.6% for symptomatic VTE, 1.8% for composite VTE, 1.5% for bleeding events, 1.3% for cerebral infarction, transient ischemic attack, and systemic embolism, and 19.1% for all-cause death. Composite VTE frequency did not vary by anticancer drug type. Patients with (versus without) VTE at baseline had higher hazard ratios (HRs) for composite VTE (unadjusted HR: 5.29; Gray test p < 0.001) and symptomatic VTE (unadjusted HR: 4.89; Gray test p = 0.007). Patients with VTE at baseline had higher HRs for bleeding events (unadjusted HR: 3.27; Gray test p = 0.010) and all-cause death (unadjusted HR: 2.73; log-rank test p < 0.001) than patients without. In multivariable analysis, patients with baseline VTE prevalence and Eastern Cooperative Oncology Group Performance Status of 2 had increased composite VTE risk during cancer therapy. There were no other risk factors for composite VTE. Conclusions Our findings emphasize the importance of VTE screening at cancer diagnosis.
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15
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Ikeda M, Uetake H, Yoshino T, Hata T, Oba MS, Takita A, Kimura T. Incidence and risk factors for venous thromboembolism, bleeding, and death in colorectal cancer (Cancer-VTE Registry). Cancer Sci 2022; 113:3901-3911. [PMID: 35947508 PMCID: PMC9633296 DOI: 10.1111/cas.15527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/08/2022] [Accepted: 08/03/2022] [Indexed: 12/01/2022] Open
Abstract
The impact of venous thromboembolism in Japanese colorectal cancer patients has not been elucidated. This prespecified subanalysis of the Cancer‐VTE Registry aimed to report venous thromboembolism and event data after 1 year of follow‐up in 2477 patients with colorectal cancer and investigate risk factors of venous thromboembolism. Of 2477 patients, 158 (6.4%) had venous thromboembolism in venous thromboembolism screening at enrollment. Asymptomatic distal deep‐vein thrombosis accounted for 123/158 (77.8%) of venous thromboembolism cases. During the follow‐up period, symptomatic, incidental events requiring treatment and composite venous thromboembolism incidences were 0.3%, 0.8%, and 1.0%, respectively. The incidence of bleeding events, cerebral infarction/transient ischemic attack/systemic embolic event, and all‐cause death were 1.0%, 0.3%, and 4.8%, respectively. These results were consistent with the main study results. In multivariable analysis, venous thromboembolism at baseline was a risk factor of composite venous thromboembolism during the follow‐up period. Japanese patients with colorectal cancer and advancing cancer stage before treatment had more frequent venous thromboembolism complications at baseline, higher incidence of venous thromboembolism events during cancer treatment, and higher mortality.
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Affiliation(s)
- Masataka Ikeda
- Division of Lower Gastrointestinal Surgery, Department of Gastroenterological Surgery, Hyogo Medical University, Hyogo, Japan
| | - Hiroyuki Uetake
- Department of Clinical Research, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Taishi Hata
- Department of Surgery, Kansai Rosai Hospital Japan Organization of Occupational Health and Safety, Hyogo, Japan
| | - Mari S Oba
- Department of Medical Statistics, Toho University, Tokyo, Japan.,Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Atsushi Takita
- Data Intelligence Department, Daiichi Sankyo Co., Ltd, Tokyo, Japan
| | - Tetsuya Kimura
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd, Tokyo, Japan
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