Attending Instituto Nacional de Cancerología Mexico, Distrito Federal, Mexico
Background: The occurrence of venous thromboembolism (VTE) in women with Locally-advanced cervical cancer (LACC) adds morbidity and may impact prognosis. Tumour and time specific risk scores could help personalize prophylaxis.
Aims: To develop a tumor type-specific thrombotic dynamic risk model.
Methods: We performed a retrospective cohort study of 296 consecutive women with LACC (FIGO stages IB2-IVA) homogenously treated with chemo-radiation and brachytherapy (cohort 1) and 25 women with LACC and known VTE (cohort 2) between 2014 and 2017. A logistic regression model was used to identify factors associated with VTE risk. Time to VTE and survival curves were constructed employing the Kaplan-Meier method, differences were estimated with Log rank test. Structural equation modeling was used to develop a dynamic model.
Results: From cohort 1, median follow-up was 3.3 years with the frequency of VTE was 11.1% (33 patients). Of the 58 women with VTE (both cohorts), 29 (50%) occurred during treatment or within the first 4 months after the end of brachytherapy. Only one woman was in complete response (CR) at the time of VTE and one had VTE associated with surgery. The remaining 56 patients (96.5%) had active pelvic disease at the time of thrombosis. Risk factors (clinical and laboratory) varied dynamically throughout the course of disease evolution and treatment (Figure 1). VTE was associated with poorer prognosis and lack of CR achievement.
Conclusion(s): VTE is a frequent occurrence in women with LACC and negatively affects overall survival. We propose a cervical cancer-specific dynamic thrombotic risk score that could help guide prophylaxis.