P-0006 Inferior Survival in Patients Diagnosed with Venous Thromboembolism Whilst Receiving Neoadjuvant Chemotherapy for Upper GI Malignancy.

Abstract

ABSTRACT Introduction A high risk of venous thromboembolism (VTE) is associated with both active malignancy and chemotherapy. Previous studies in patients undergoing neoadjuvant chemotherapy for upper gastrointestinal (UGI) malignancies have estimated this risk to be around 10-15%. However, to our knowledge, this high rate of VTE has not yet been shown to be adversely associated with patient outcome in this group. Methods We undertook a single-centre descriptive study of all patients undergoing neoadjuvant chemotherapy for UGI malignancies (oesophageal and gastric) between 2007 and 2011, using our prospectively collected database. Frequency of symptomatic and incidental VTE occurring from commencement of chemotherapy and up to three months post-operatively, as well as survival data, was established. These were examined for association with a number of demographic, disease and treatment-related factors. Statistical analysis was performed using SPSS. Download : Download full-size image Results 115 patients were identified, with a mean follow-up period of 626 days. All patients were treated with a platinum-based chemotherapy regimen. The incidence of VTE was 14/115 (12.2%): 50% were deep vein thromboses, and 50% pulmonary emboli. 64% of VTEs were symptomatic and 36% were incidental pulmonary emboli diagnosed from pre-operative imaging. The mean time from commencing chemotherapy to diagnosis of VTE was 42 days (range 6-195 days). 91% were diagnosed pre-operatively, and 9% post-operatively. 45/115 (39%) of patients died during the study period. Neither incidence of VTE nor death was found to be associated with any of the following factors on multivariate analysis: age, gender, disease site, histology, tumour size, and nodal involvement. However, there was a significant difference in survival between those who were and were not diagnosed with VTE (Cox regression analysis, hazard ratio=2.71, 95% CI 1.28-5.75, p=0.009), and this effect was independent of all other variables analysed. Conclusion We have reported a 12% incidence of VTE in patients undergoing neoadjuvant chemotherapy for UGI malignancies, which is consistent with previous studies. However, our data suggest that the majority of VTEs in this patient group are occurring pre-operatively, and that those suffering a VTE have inferior outcomes in terms of survival, at least in the early stages of treatment. Use of prophylactic anticoagulation is not currently recommended in this setting, at least in part because the majority of patients receive neoadjuvant chemotherapy as outpatients. We propose a prospective randomized-controlled study of the use of prophylactic anticoagulation in outpatients receiving neoadjuvant chemotherapy for UGI malignancies. In the era of novel oral anticoagulant therapy, this would represent a welcome opportunity to improve outcomes in this patient group.