Concomitant venous thromboembolism at the time of primary EOC diagnosis: Perioperative outcomes and survival analyses

Objective To compare outcomes among women with epithelial ovarian cancer (EOC) undergoing primary surgery who present without venous thromboembolism (VTE) versus with VTE and placement of inferior vena cava (IVC) filter. Methods Women who underwent primary surgery for EOC between 1/2/2003 and 12/30/2011 were identified. Patient characteristics were retrospectively abstracted, including diagnosis of VTE within 30 days prior to surgery and placement of IVC filter. Associations with overall survival (OS) were evaluated using Cox proportional hazards models. Results A total of 843 patients met inclusion criteria; 817 patients (Group 1) did not have VTE at the time of EOC diagnosis and 26 patients (Group 2) had a VTE and IVC placement within 30 days prior to surgery. Group 2 had worse performance status, lower albumin, and more likely to have clear cell histology. Groups 1 and 2 were similar in terms of perioperative outcomes. Mortality within 90 days of surgery was 6.4% in Group 1 versus 11.5% in Group 2 (p = 0.24). Although median OS for group 1 was much higher than group 2, 56.6 m versus 25.7 m, in this cohort this difference did not reach statistical significance (adjusted HR 1.39, 95% CI 0.85–2.29, p = 0.19). Conclusions Patients with VTE diagnosed at the time of EOC diagnosis have poor outcomes. This may reflect more aggressive tumor biology, worse overall health of the patient following VTE, or may reflect worse survival secondary to the VTE. Patients must be carefully selected for surgery in the setting of VTE.