A single-institution (MSKCC) analysis of incidence and clinical outcomes in patients with thromboembolic events and exocrine pancreas cancer.

Abstract

4062 Background: Pancreas adenocarcinoma (PC) is one of the most common malignancies associated with venous thromboembolism (VTE), but reported incidence ranges vary and contain relatively small patient subsets. Little has been described about arterial thrombotic events (ATE) in PC, as well as the correlation between VTE timing and patient outcomes. Methods: We identified a total of 6,870 patients with PC seen at our institution from 1/1/00 to 12/31/09. Using ICD codes, we analyzed subsets of this patient group with VTE or ATE. Demographic data included vital status, age at diagnosis of PC, timing of thrombotic event (TE), and thrombosis treatment. Results: Any thrombosis was identified in 1,322 (19%), of which 1,179 (17%) had VTE, 143 (2%) had ATE, and 64 (0.9%) of patients had both an ATE and VTE. 290 (25%) of the VTE patients had pulmonary embolism (PE). For patients in whom treatment information was available, low molecular weight heparin (LMWH) was prescribed in 95% and fondaparinux in 6%. 0.4% received warfarin and 23% received aspirin. 19% of VTE patients received an IVC filter. Of patients with deep vein thromboses (DVTs), the mean overall survival (OS) from PC diagnosis to death was 12.9 months, compared with 13.4 months for PC patients without thrombosis. 96% of TEs were diagnosed after the diagnosis of PC. Of note, of the 4% of TEs diagnosed at or before the diagnosis of PC, the OS was 6.2 months, compared with 13.7 months for patients with later TEs. Conclusions: This is the largest single-institution cohort to describe the incidence of and clinical outcomes associated with TE in PC. VTE predominated, but arterial events were also observed. This analysis confirms the relatively high incidence of TEs in PC. While study limitations include lack of stage and treatment details as well as possible sampling error, the observation that a VTE is associated with a markedly worse prognosis if the event precedes or coincides with PC diagnosis, but not necessarily if the VTE occurs later (typically during treatment), suggests a difference in biological significance and prognosis of these events. No significant financial relationships to disclose.