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    Oral Communication

    Venous Thromboembolism

    Molecular Insights in Cancer Associated Thrombosis

    OC 46.4 - Association of growth differentiation factor-15 (GDF-15) with thromboembolism and mortality in patients with cancer: findings from the Vienna CATS study

    Monday, June 26, 2023
    15:30 – 15:45 ET
    Room: 510
    Session Available As: On-Demand

      Presenting Author(s)

    • Stephan Nopp, MD

      PhD Student
      Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
      Vienna, Wien, Austria

      • Co-Author(s)

    • Florian Moik, MD PhD (he/him/his)

      Medical University of Vienna, Department of Medicine I, Clinical Division of Haematology and Haemostaseology
      Vienna, Austria

    • SK

      Simon Kraler

      PhD Student
      Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
      Zurich, Zurich, Switzerland

    • Cornelia Englisch, MD

      PhD Student
      Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Austria
      Vienna, Wien, Austria

    • MP

      Matthias Preusser

      Head of Division
      Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna, Austria
      Vienna, Wien, Austria

    • Av

      Arnold von Eckardstein

      Director
      Institute of Clinical Chemistry, University of Zurich, Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
      Zurich, Zurich, Switzerland

    • Ingrid Pabinger, MD

      Co-Head of the Thrombosis and Haemostasis Research Group
      Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
      Vienna, Wien, Austria

    • TL

      Thomas Lüscher

      Director
      Center for Molecular Cardiology, University of Zurich, Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
      Zurich, Zurich, Switzerland

    • Cihan Ay, MD (he/him/his)

      Professor, Head of the Thrombosis and Haemostasis Research Group
      Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
      Vienna, Wien, Austria

    Background: Preventing thromboembolic events in cancer patients can reduce cancer-associated morbidity and mortality. A novel biomarker, growth differentiation factor-15 (GDF-15), has been shown to improve cardiovascular risk assessment in non-cancer patients.

    Aims: To investigate the association of GDF-15 with risk of venous thromboembolism (VTE), arterial thromboembolism (ATE), and death in patients with cancer and to evaluate its predictive utility on top of established prediction models.

    Methods: The present study was conducted within the framework of the Vienna Cancer and Thrombosis Study (CATS), a prospectively designed observational cohort study. Patients with newly diagnosed or recurrent cancer were included, with regular follow-up visits for up to two years. Serum GDF-15 levels at study inclusion were assessed, and its association with VTE, ATE, and death was explored by harnessing competing risk (VTE and ATE) or Cox regression (death) modelling. The added value of GDF-15 to VTE-risk prediction was assessed using the Khorana- and Vienna-CATScore.

    Results: Among all 1531 cancer patients (median age 62 years, 53% men), median GDF-15 levels were 1004 ng/L (interquartile range, 654-1750). Higher GDF-15 was associated with risk of VTE, ATE, and all-cause death [(subdistribution) HR per double increase: 1.16, 95%CI 1.03-1.32, 1.30, 95%CI 1.11-1.53, and 1.57, 95%CI 1.46-1.69], respectively. Figure 1 shows cumulative incidence curves for VTE, ATE, and death stratified by median GDF-15 value. Figure 2 reports HRs adjusted for various clinical and laboratory characteristics. Despite the above, GDF-15 did not improve the discrimination or calibration of the Khorana- or Vienna-CATScore for the prediction of VTE.

    Conclusion(s): In patients with cancer, serum GDF-15 is strongly associated with all-cause mortality, independent of established risk factors. Further, an association with risk of ATE and VTE was noted, yet GDF-15 does not add predictive value to established prediction models for VTE.

    Learning Objectives:

    • Upon completion, participant will be able to list current prediction models for cancer-associated thrombosis.
    • Upon completion, participant will be able to describe the predictive utility of GDF-15 for predicting cancer-associated thrombosis.
    • Upon completion, participant will be able to understand the relationship between GDF-15 and mortality in cancer patients.