Thromboembolism During Neoadjuvant Therapy for Gastrointestinal Cancer

Predictive factors of thromboembolic complications in patients with esophagogatric adenocarcinoma undergoing preoperative chemotherapy

BACKGROUND

Thromboembolic events (TEEs) represent a significant treatment and disease complication for cancer patients. In the present study we assessed the incidence of TEEs in patients receiving preoperative chemotherapy for esophagogastric adenocarcinoma. The risk factors for TEE development and their impact on prognosis were further analyzed.

MATERIAL AND METHODS

Data from 590 patients with esophagogastric adenocarcinoma, who received preoperative epirubicin-cisplatin with capecitabine (ECX) or 5-fluorouracil (ECF) between 2009 and 2016 in three UK hospitals were retrospectively collected.

RESULTS

Twenty-one percent had stomach primary and 98% received ECX chemotherapy. In total, 52 patients (9%) had a venous and 22 (4%) an arterial event. Of those patients with venous TEEs (vTTEs), 39 had pulmonary embolism and 13 deep vein thrombosis, whereas in patients with arterial TEEs (arTTEs), 7 developed a myocardial infarct, 8 developed limb ischemia, 4 developed cerebrovascular accidents and 3 developed superior mesenteric artery thrombosis. ArTEEs were associated with a much higher inoperability rate compared to cases without TEE or with vTEE (77% vs. 20% vs. 31%, respectively, p < .001). Independent risk factors of vTEEs were primary site being the stomach (Odds ratio [OR] 3.24, 95%CI 1.72-6.12, p < .001), being overweight (OR 3.11, 95%CI 1.33-7.26, p = .009) or obese (OR 4.52, 95%CI 1.85-11.09, p = .001) and the presence of central venous access device (OR 3.40, 95%CI 1.00-11.55, p = .050). In contrast, anticoagulant treatment was independently associated with a lower risk of vTEE (OR 0.22, 95%CI 0.06-0.83, p = .026). Khorana score of 4-5 was an independent risk factor of arTEE (OR 6.38, 95%CI 1.85-22.04, p = .003). Finally, arTEEs were an independent poor prognostic factor for OS, when adjusted for baseline patient, tumor and treatment characteristics (Hazard ratio 3.02, 95%CI 1.85-4.95, p < .001).

CONCLUSION

Preoperative ECX/ECF chemotherapy for patients with resectable esophagogastric adenocarcinoma was associated with relatively high incidence of TEEs. However, only arTEEs affected patient survival outcomes.

Neoadjuvant chemoradiation for rectal cancer is not associated with higher rates of thromboembolism

AIM

Thromboembolism (TE) is a leading cause of death amongst cancer patients. The effect of neoadjuvant chemoradiotherapy (nCRT) on the risk of TE in rectal cancer patients is unknown. The aim of this study was to determine whether nCRT was associated with an increased risk of TE in patients with rectal cancer, either during therapy or with subsequent treatment.

METHOD

This was a retrospective study from a prospectively maintained database at a tertiary referral centre. Participants included patients with rectal cancer treated between January 2000 and December 2013. The primary outcome was the rate of TE in patients with rectal cancer who had nCRT compared with those who did not.

RESULTS

One hundred and seventy-one (7.8%) of 2181 rectal cancer patients developed TE. Patients who had nCRT did not have an increased incidence of TE compared with those who had surgery alone (81/946, 8.6% vs 94/1235, 7.6%, P = 0.42) after a median follow-up of 95 months. Ten (1.1%) of 946 patients who received nCRT developed TE during or immediately after nCRT. Most TE events occurred in the 30-day postoperative period (70 patients, 3.2%).

CONCLUSION

The prevalence of TE in patients with rectal cancer was 7.8%, with most events occurring in within 30 days of surgery. Neoadjuvant chemoradiation was not associated with an increased risk of TE.