Predicting VTE and utility of thromboprophylaxis in metastatic and recurrent cervical cancer

• Published in: Gynecologic oncology Vol. 188; pp. 22 - 26
• Main Authors: Walker, Christopher A., Edwards, Carson, McIntire, Don, Makepeace, Lydia, Holloway, Steven Blaine, Kakadiaris, Ev, Spirtos, Alexandra N., Miller, David S., Lea, Jayanthi S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2024
• Subjects: Anticoagulation; Cervical cancer; Deep vein thrombosis; Khorana score; Pulmonary embolism; Venous thromboembolism; Khorana score; Pulmonary embolism; Deep vein thrombosis; Anticoagulation; Cervical cancer; Venous thromboembolism
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2024.05.028

Patients with cervical cancer who are diagnosed with venous thromboembolism (VTE) have worse outcomes compared to those not affected. There has yet to be a reliable method to predict or prevent VTE in cervical cancer patients. Our objective is to describe the incidence of VTE in patients with recurrent and metastatic (r/mCC) and determine risk factors that may predict VTE in this setting. We performed an observational cohort study of 386 patients with r/mCC who received at least one line of systemic chemotherapy. We collected demographic, clinical, histologic data and Khorana scores for all patients. Inclusion and exclusion criteria were applied before analysis. Statistical analysis was performed using Pearson chi-square, Student's t-test, and Wilcoxon rank-sum. 232 patients were included for evaluation. Mean age was 49 years (range 20–83). The majority (167, 72%) of patients had squamous cell histology. 169 (72.8%) patients received treatment for recurrent disease and 63 (27.2%) for metastatic, stage IVB disease. 180 (78%) patients received prior radiation and 134 (58%) received bevacizumab. VTE was diagnosed in 89 (38%) patients. There were no statistically significant differences amongst clinical and pathologic characteristics between patients who developed VTE and those who did not. There was no significant association between BMI, Khorana score, radiation, bevacizumab, or immunotherapy and the development of VTE. Approximately 40% of patients with r/mCC experienced a new VTE. There were no independent risk factors that could predict VTE in this population. Due to the overwhelmingly high incidence of VTE, prophylactic anticoagulation could be strongly considered in patients with r/mCC. •Venous thromboembolisms (VTEs) are associated with increased morbidity and mortality in cervical cancer patients.•Almost 40% of patients with metastatic and recurrent cervical cancer were diagnosed with a VTE.•Current risk-stratification tools, alone and in combination with other known risk factors, could not predict VTE.•Thromboprophylaxis should be considered for patients with metastatic and recurrent cervical cancer.