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PO-98 Venous thromboembolism (VTE) as first sign of occult malignancy is associated with increased risk of recurrent VTE
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4th Int. Conf. on Thrombosis and Hemostasis Issues in Cancer / Thrombosis Research 120 Suppl. 2 (2007) S145–S178
Patients and Methods: Among 56 consecutive ALL children who were studied for CVL-VT by ultrasound and spiral computed tomography (CT) at the end of induction, 49 were re-evaluated for CVL-VT outcome (resolution, persistence, recurrence, new VT, postthrombotic syndrome PTS) after CVL removal. Correlation between CVL-VT and survival was also analyzed (5 7 years from diagnosis). Results: CVL-VT at end of induction occurred in 73% (41/56) of patients (pts), most of them asymptomatic; CVL size/body surface ratio was the most predictive factor (Leukemia 2007; 21: 552). After removal, 3 pts presented a new VT and 10/41 had a persistent VT. The CVL size/body surface ratio was a significant risk factor for new or persistent CVL-VT; the left insertion site was significantly related to the persistence of CVL-VT. 4/10 pts (40%) with persistent VT developed a non-severe PTS. Among the 56 pts no significant correlation was found between CVL-VT and RFS and/or OS. Conclusion: Most (70%) of CVL-VT in ALL children recover spontaneously and do not affect survival, however pts should be followed up because of high risk of PTS. A careful choice of CVL lumen size and insertion site is recommended. PO-98 Venous thromboembolism (VTE) as first sign of occult malignancy is associated with increased risk of recurrent VTE S. Brækkan1 *, E.M. Johansen1 , E.B. Mathiesen2 , I. Njølstad3 , T. Wilsgaard3 , J. Størmer4 , J.-B. Hansen1 . 1 Center for Atherothrombotic Research in Tromsø; 2 Department of Neurology, Institute of Clinical Medicine, 3 Institute of Community Medicine, University of Tromsø; 4 Department of Radiology, University Hospital of Northern Norway, Norway Introduction: A first episode of VTE is often associated with overt malignancy and less frequently accompanied by occult malignancy. Cancer patients with VTE are more likely to develop recurrent thromboembolic complications than those without malignancy. However, little is known about the risk of recurrence and survival of VTE patients with occult malignancy. Aim: The objective of the present study was to investigate the risk of recurrent VTE and mortality in VTE patients without malignancy, with overt malignancy, and patients with subsequent diagnosis of malignancy during the following year. Materials and Methods: During 1994 2005 all first episodes of VTE were registered in the municipality of Tromsø (approximately 58,000 inhabitants). Recurrent VTE, mortality and subsequent diagnosis of malignancy were registered during one year follow-up. Results: There were 583 validated first VTE events in which 21.6% (126 pts) had overt malignancy. Subsequent diagnosis of malignancy appeared in 4.8% of the VTE patients (22 out of 457 pts) during the following year, in which 81.8% was diagnosed within 6 months. The 12-month cumulative incidence of recurrent VTE was 4.4% in patients without malignancy, 8.7% in patients with malignancy (p = 0.003) and 27.3% in patients with occult malignancy (p < 0.001 and p = 0.02, respectively). Cumulative survival was 88.0% in patients without malignancy, 37.3% in patients with malignancy (p < 0.001) and 45.5% in patients with occult malignancy (p < 0.001 and p = 0.39, respectively). Conclusion: VTE patients with occult malignancy had increased risk of recurrent VTE and similar risk of mortality compared to patients with overt malignancy. Our findings suggest that VTE as a first sign of malignancy is associated with malignant diseases of high procoagulant potential.
PO-99 Outcomes in cancer patients with unsuspected pulmonary emboli found on staging CT scans C. O’Connell, L. Mark, W. Boswell, S. Boyle, S. Vasan, M. Ghalichi *, H.A. Liebman. University of Southern California Keck School of Medicine, Los Angeles, CA, USA Background: The significance of unsuspected pulmonary emboli (PE) found on routine cancer staging multi-detector row CT (MDCT) scans is unknown. Aim: To evaluate treatment, radiologic outcome, and survival data among cancer patients with unsuspected PE and to compare them to age-matched control subjects with the same cancer types and stages. Material and Methods: We performed a case-controlled retrospective study of cancer patients with unsuspected PE found on routine cancer staging MDCT scans between May, 2003 and December, 2004. Study design and patient characteristics have previously been published (J Clin Oncol 2006; 24: 4928). We recorded use of anticoagulation, IVC filters, appearance of PE on subsequent staging scans, time to death, and cause of death for cases and controls. Results: Of 53 patients with unsuspected PE, 46 had age and stage matched controls. Survival data were available for 45 patients. Thirty-nine patients were treated; 24 with warfarin, 14 with treatment-dose LMW heparin (LMWH) and 1 with prophylactic LMWH. 32 treated patients had follow-up MDCT, with either a decrease in size or resolution of PE in 31. No anticoagulation was administered to 7 patients. Follow-up MDCT in 4 untreated patients showed resolution of the initial PE. Three of the 7 untreated patients died within 5 weeks of PE diagnosis, 3 between 7 and 12 months and 1 alive at follow-up. Of 92 control subjects, 88 had available death data. There was a trend toward reduced survival in the unsuspected PE group as compared to the control group (median 39.7 weeks vs. 66.6 weeks, p = 0.08). Conclusion: Whether or not they are treated, most unsuspected PE resolve on subsequent staging CT scans; however, unsuspected PE may predict poorer overall survival in cancer patients. PO-100 Factor V Leiden (FVL), prothrombin, MTHFR and PAI-1 polymorphisms and cancer risk in women; the Jerusalem Perinatal Study (JPS) E. Tiram1 *, Y. Friedlander1 , L. Kadouri2 , O. Manor1 , R. Isacson3 , R. Yanetz1 , L. Deutsch1 , S. Harlap4 , O. Paltiel1 . 1 Hadassah-Hebrew University Braun School of Public Health; 2 Sharett Institute of Oncology, Hadassah University Hospital; 3 Department of Oncology, Shaare-Zedek Medical Center, Jerusalem, Israel, 4 Mailman School of Public Health, Columbia University, New York, NY, USA Introduction: Despite inconsistent reports of associations between MTHFR polymorphisms and stomach, breast and ovarian cancer as well as between PAI-1 genotype and breast or stomach cancer, an association between genetic thrombophilia and a tendency toward cancer development has not been established. To date no relation between FVL or prothrombin mutations and cancer have been described. Aim: To evaluate the association between genetic thrombophilia and cancer in a nested case-control study. Methods: The JPS cohort includes all West Jerusalem women who delivered from 1964 1976. From 2003 2006 we performed a nested case-control study within this cohort, which included 188 cancer cases (with breast, ovary, uterus, colorectal, lung and stomach) and 360 controls (without cancer) matched for age and ethnic origin. After obtaining signed informed consent, cases and controls were interviewed regarding medical history, thrombotic events, family history and lifestyle characteristics. A blood sample was taken and PCR tests performed for the determination of FVL1691, Prothrombin20210, MTHFR677 and PAI-1 (4G/5G) polymorphisms. Results: Comparing cases and controls, odds ratios (95% confidence intervals) of 0.89 (0.38 2.11), 2.0 (0.60 6.64), 1.01 (0.57 1.58) and
4th Int. Conf. on Thrombosis and Hemostasis Issues in Cancer / Thrombosis Research 120 Suppl. 2 (2007) S145–S178
Patients and Methods: Among 56 consecutive ALL children who were studied for CVL-VT by ultrasound and spiral computed tomography (CT) at the end of induction, 49 were re-evaluated for CVL-VT outcome (resolution, persistence, recurrence, new VT, postthrombotic syndrome PTS) after CVL removal. Correlation between CVL-VT and survival was also analyzed (5 7 years from diagnosis). Results: CVL-VT at end of induction occurred in 73% (41/56) of patients (pts), most of them asymptomatic; CVL size/body surface ratio was the most predictive factor (Leukemia 2007; 21: 552). After removal, 3 pts presented a new VT and 10/41 had a persistent VT. The CVL size/body surface ratio was a significant risk factor for new or persistent CVL-VT; the left insertion site was significantly related to the persistence of CVL-VT. 4/10 pts (40%) with persistent VT developed a non-severe PTS. Among the 56 pts no significant correlation was found between CVL-VT and RFS and/or OS. Conclusion: Most (70%) of CVL-VT in ALL children recover spontaneously and do not affect survival, however pts should be followed up because of high risk of PTS. A careful choice of CVL lumen size and insertion site is recommended. PO-98 Venous thromboembolism (VTE) as first sign of occult malignancy is associated with increased risk of recurrent VTE S. Brækkan1 *, E.M. Johansen1 , E.B. Mathiesen2 , I. Njølstad3 , T. Wilsgaard3 , J. Størmer4 , J.-B. Hansen1 . 1 Center for Atherothrombotic Research in Tromsø; 2 Department of Neurology, Institute of Clinical Medicine, 3 Institute of Community Medicine, University of Tromsø; 4 Department of Radiology, University Hospital of Northern Norway, Norway Introduction: A first episode of VTE is often associated with overt malignancy and less frequently accompanied by occult malignancy. Cancer patients with VTE are more likely to develop recurrent thromboembolic complications than those without malignancy. However, little is known about the risk of recurrence and survival of VTE patients with occult malignancy. Aim: The objective of the present study was to investigate the risk of recurrent VTE and mortality in VTE patients without malignancy, with overt malignancy, and patients with subsequent diagnosis of malignancy during the following year. Materials and Methods: During 1994 2005 all first episodes of VTE were registered in the municipality of Tromsø (approximately 58,000 inhabitants). Recurrent VTE, mortality and subsequent diagnosis of malignancy were registered during one year follow-up. Results: There were 583 validated first VTE events in which 21.6% (126 pts) had overt malignancy. Subsequent diagnosis of malignancy appeared in 4.8% of the VTE patients (22 out of 457 pts) during the following year, in which 81.8% was diagnosed within 6 months. The 12-month cumulative incidence of recurrent VTE was 4.4% in patients without malignancy, 8.7% in patients with malignancy (p = 0.003) and 27.3% in patients with occult malignancy (p < 0.001 and p = 0.02, respectively). Cumulative survival was 88.0% in patients without malignancy, 37.3% in patients with malignancy (p < 0.001) and 45.5% in patients with occult malignancy (p < 0.001 and p = 0.39, respectively). Conclusion: VTE patients with occult malignancy had increased risk of recurrent VTE and similar risk of mortality compared to patients with overt malignancy. Our findings suggest that VTE as a first sign of malignancy is associated with malignant diseases of high procoagulant potential.
PO-99 Outcomes in cancer patients with unsuspected pulmonary emboli found on staging CT scans C. O’Connell, L. Mark, W. Boswell, S. Boyle, S. Vasan, M. Ghalichi *, H.A. Liebman. University of Southern California Keck School of Medicine, Los Angeles, CA, USA Background: The significance of unsuspected pulmonary emboli (PE) found on routine cancer staging multi-detector row CT (MDCT) scans is unknown. Aim: To evaluate treatment, radiologic outcome, and survival data among cancer patients with unsuspected PE and to compare them to age-matched control subjects with the same cancer types and stages. Material and Methods: We performed a case-controlled retrospective study of cancer patients with unsuspected PE found on routine cancer staging MDCT scans between May, 2003 and December, 2004. Study design and patient characteristics have previously been published (J Clin Oncol 2006; 24: 4928). We recorded use of anticoagulation, IVC filters, appearance of PE on subsequent staging scans, time to death, and cause of death for cases and controls. Results: Of 53 patients with unsuspected PE, 46 had age and stage matched controls. Survival data were available for 45 patients. Thirty-nine patients were treated; 24 with warfarin, 14 with treatment-dose LMW heparin (LMWH) and 1 with prophylactic LMWH. 32 treated patients had follow-up MDCT, with either a decrease in size or resolution of PE in 31. No anticoagulation was administered to 7 patients. Follow-up MDCT in 4 untreated patients showed resolution of the initial PE. Three of the 7 untreated patients died within 5 weeks of PE diagnosis, 3 between 7 and 12 months and 1 alive at follow-up. Of 92 control subjects, 88 had available death data. There was a trend toward reduced survival in the unsuspected PE group as compared to the control group (median 39.7 weeks vs. 66.6 weeks, p = 0.08). Conclusion: Whether or not they are treated, most unsuspected PE resolve on subsequent staging CT scans; however, unsuspected PE may predict poorer overall survival in cancer patients. PO-100 Factor V Leiden (FVL), prothrombin, MTHFR and PAI-1 polymorphisms and cancer risk in women; the Jerusalem Perinatal Study (JPS) E. Tiram1 *, Y. Friedlander1 , L. Kadouri2 , O. Manor1 , R. Isacson3 , R. Yanetz1 , L. Deutsch1 , S. Harlap4 , O. Paltiel1 . 1 Hadassah-Hebrew University Braun School of Public Health; 2 Sharett Institute of Oncology, Hadassah University Hospital; 3 Department of Oncology, Shaare-Zedek Medical Center, Jerusalem, Israel, 4 Mailman School of Public Health, Columbia University, New York, NY, USA Introduction: Despite inconsistent reports of associations between MTHFR polymorphisms and stomach, breast and ovarian cancer as well as between PAI-1 genotype and breast or stomach cancer, an association between genetic thrombophilia and a tendency toward cancer development has not been established. To date no relation between FVL or prothrombin mutations and cancer have been described. Aim: To evaluate the association between genetic thrombophilia and cancer in a nested case-control study. Methods: The JPS cohort includes all West Jerusalem women who delivered from 1964 1976. From 2003 2006 we performed a nested case-control study within this cohort, which included 188 cancer cases (with breast, ovary, uterus, colorectal, lung and stomach) and 360 controls (without cancer) matched for age and ethnic origin. After obtaining signed informed consent, cases and controls were interviewed regarding medical history, thrombotic events, family history and lifestyle characteristics. A blood sample was taken and PCR tests performed for the determination of FVL1691, Prothrombin20210, MTHFR677 and PAI-1 (4G/5G) polymorphisms. Results: Comparing cases and controls, odds ratios (95% confidence intervals) of 0.89 (0.38 2.11), 2.0 (0.60 6.64), 1.01 (0.57 1.58) and