Skip to main content
SSO 2024 Annual Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Recorded for On-Demand Viewing
Recorded for On-Demand Viewing
Back

Hepato-pancreato-biliary

E224: Rates of Venous Thromboembolism in Patients with Pancreatic Ductal Adenocarcinoma Undergoing Preoperative Therapy

Introduction: Patients with pancreatic cancer (PC) experience clinically relevant rates of venous thromboembolism (VTE), which is potentiated by systemic chemotherapy. Patients with localized PC are increasingly treated with induction chemotherapy; however, little is known about VTE risk during preoperative therapy. The aim of this study was to determine the prevalence and incidence of VTE in patients with PC treated with induction chemotherapy with intent for surgery.

Methods: We performed a cohort study of a prospectively maintained database of all patients with anatomically resectable (AR) or borderline resectable (BR) PC treated with chemotherapy with intent for surgery from March 1, 2016 to December 31, 2020. Primary outcomes were prevalent VTE at diagnosis or incident VTE during induction therapy. VTE was defined as occurrence of extremity deep vein thrombosis or pulmonary embolism. Occurrence of mesenteric venous thrombosis (MVT) was separately collected. Patients were censored at the date of surgery or when surgical intent was discontinued.

Results: 410 patients were identified; 19 patients (4.6%) treated with anticoagulation for mesenteric vein narrowing or thrombus were excluded, as were 36 patients (8.8%) on anticoagulation for comorbid conditions. Thirteen patients (3.2%) were diagnosed with VTE at diagnosis. A total of 332 patients were assessed for VTE during induction therapy. Median follow-up for the cohort was 29 months. 33 patients (9.9%) developed incident VTE. MVT was identified in 18 patients (5.4%), including 3 with concomitant VTE. The proportion of patients with BR disease was similar among patients with and without VTE (39% vs. 30.8%, p=0.33), as were proportions receiving FOLFIRINOX (73% vs. 59.5%) or gemcitabine/nab-paclitaxel chemotherapy (24% vs. 35%, p=0.24). Receipt of chemoradiation was similar between groups (42% and 48%, p=0.59). Of patients with VTE, 51.5% underwent curative-intent resection compared to 56.9% of patients without VTE (p=0.58). Median overall survival was similar among patients with and without VTE (33 vs. 28 months, p=0.6).

Conclusions: In a cohort of patients with localized PC treated with induction chemotherapy, 13% were found to have prevalent or incident VTE. VTE events were not associated with resection rates or survival in this cohort. These data provide the basis for studying the effectiveness of routine VTE prophylaxis in this high-risk population.

Learning Objectives:

  • Upon completion, participants will be able to define rates of venous thromboembolism in patients with pancreatic cancer undergoing induction chemotherapy.
  • Upon completion, participants will be able to examine differences in chemotherapy regimens, degree of disease, and other patient characteristics and rates of VTE during induction therapy in patients with PC.
  • Upon completion, participants will be able describe potential differences in outcomes of patients with PC who develop VTE during induction therapy compared to patients who do not develop VTE.