The burden and predictors of venous thromboembolic diseases in patients with multiple primary malignancies

Abstract

Background: Venous thromboembolism (VTE) represents a considerable burden on cancer patients' survival and quality of life, but this burden varies based on the patient's baseline characteristics and cancer-related factors. Although solid evidence on the predictors and effect of VTE in cancer patients exists.

Aim: To evaluate VTE rate, morbidity, and mortality to develop parameters that could predict VTEs and their associated mortality in patients with multiple primary malignancies (MPMs).

Method and results: This was a retrospective cohort study that took place at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Two hundred and forty-two patients with at least two biopsy-proven malignancies and had at least 3 months of follow-up after MPMs diagnosis were included. VTE was diagnosed in 14.5% of the cases, two-thirds of which were deep vein thrombosis. VTE was significantly associated with a higher mortality and worse survival. Predictors of VTE after MPMs diagnosis were a high ECOG performance status at MPMs diagnosis, a metastatic first primary malignancy, and ICU admission after MPMs diagnosis. Having a GI or hematological malignancy as the second primary malignancy, a high D-dimer at ICU admission, and palliative care referral were significantly associated with a higher mortality in patients who had VTE.

Conclusion: VTE was diagnosed in 14.5% of patients with MPMs and it significantly compromises their survival. We believe that these results might be of particular benefit since the phenomenon of MPMs is becoming more frequently encountered.

Keywords: cancer-associated thrombosis; multiple primaries; multiple primary malignancies; thromboprophylaxis; venous thromboembolism.

FIGURE 1

Comorbid conditions in patients with multiple primary malignancies (MPMs) in consecutive order. Diabetes mellitus and hypertension were the most common comorbidities, followed by dyslipidemia, chronic cardiac disease, and chronic pulmonary disease. Only a history of venous thromboembolism prior to MPMs diagnosis, which was observed in only 5.4%, was associated with venous thromboembolism (VTE)

FIGURE 2

An alluvial plot showing the most frequent malignancy combinations. The most frequent malignancy combinations were head and neck—head and neck, breast—GI, genitourinary—GI, gynecological—GI, and breast—head and neck. The aim of this figure is to trace the pattern of the first and second malignancy combinations.

FIGURE 3

An alluvial plot showing the most frequent histopathological combinations. The most frequent histopathological combinations were adenocarcinoma—adenocarcinoma, adenocarcinoma—papillary carcinoma, and HCC/RCC—adenocarcinoma. The aim of this figure is to trace the pattern of histopathological combination of the first and second diagnoses.

FIGURE 4

Survival of multiple primary malignancies (MPMs) patients with venous thromboembolism (VTE) and without VTE. The median survival time was 1.9 ± 0.6 and 7.4 ± 1.5 years for patients with VTE and without, respectively, and the difference was highly statistically significant (p < .001).

FIGURE 5

Survival of multiple primary malignancies (MPMs) patients who received long‐term prophylactic anticoagulant vs. patients who received long‐term prophylactic anticoagulant after therapeutic anticoagulant for venous thromboembolism (VTE). The median survival time was 6.4 ± 1.3 and 5.1 ± 2.8 months for patients who received and did not receive long‐term prophylactic anticoagulants, but the difference was not statistically significant (p = .472).