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Splanchnic venous thrombosis a marker of occult cancer
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Splanchnic venous thrombosis served as an indicator for occult cancer, according to study results.
Further, these blood clots were prognostic for poorer survival outcomes in patients with liver and pancreatic cancers, the researchers also found.
Patients who develop deep vein thrombosis or pulmonary embolisms face an increased risk for diagnosis of an occult cancer within 1 year of the event. However, the association between splanchnic venous thrombosis (SVT) — blood clots in abdominal veins — and occult cancer diagnoses remained unstudied, according to study background.
“As we learn more about the association between many types of thromboses and cancer, we also want to better understand these more rare clots and how they can perhaps signal a hidden cancer,” Kirstine K. Søgaard, MD, of the department of clinical epidemiology at the Aarhus University Hospital in Aarhus, Denmark, said in a press release. “In this case, we had access to comprehensive data that we believed could provide insights useful to clinicians caring for patients with this condition.”
Søgaard and colleagues conducted a nationwide cohort study of all Danish patients diagnosed with first-time SVT between 1994 and 2011. Researchers collected information regarding comorbidities — including liver disease, pancreatitis, diabetes, venous thromboembolism, myocardial infarction and congestive heart failure — and surgeries performed within 90 days of SVT diagnosis.
The researchers linked data from the study cohort to the Danish Cancer Registry to obtain information of subsequent cancer diagnoses. The analysis also included a matched comparison cohort of patients with cancer without SVT to ascertain the prognostic impact of SVT on cancer survival rates.
Median follow-up was 1.6 years (interquartile range [IQR], 0-5).
Of the 1,191 patients (median age, 61 years; 52% male) included in the analysis, 78% had portal vein thrombosis. The remaining patients had hepatic vein thrombosis (12%) or mesenteric thrombosis (10%). Eighty-six percent of patients received their diagnosis while hospitalized.
A majority of patients had a moderate (34%) or severe (23%) level of comorbidities. The most commonly observed comorbidities included liver disease (20%), diabetes (15%), heart disease (15%) and pancreatitis (12%).
Further, 33% of patients underwent a surgical procedure within 90 days prior to the SVT event.
The researchers observed 183 occult cancers (standardized incidence ratio [SIR] = 4.2; 95% CI, 3.6-4.9). Patients with portal vein thrombosis accounted for 88% of cancer diagnoses (SIR = 4.7; 95% CI, 4-5.5).
Ninety-five cancer diagnoses occurred within 3 months of the initial SVT event (SIR = 33; 95% CI, 27-40), with 53 diagnoses occurring within 1 month.
The researchers observed that the high incidence of cancer diagnoses within 3 months of SVT stemmed from an excess risk for liver cancer (SIR = 1,805; 95% CI, 1,295-2,448) and pancreatic cancer (SIR = 256; 95% CI, 149-409). Fifty percent of the patients diagnosed with liver cancer had liver disease, whereas only four patients diagnosed with pancreatic cancer had pancreatitis.
Myeloproliferative neoplasms were the most common hematological cancers diagnosed in the cohort (SIR within 3 months = 764; 95% CI, 329-1,505).
Seventy-one percent of the 881 patients diagnosed with SVT since 2002 underwent abdominal ultrasound or CT scan. This subgroup exhibited a higher overall cancer risk compared with the entire cohort (SIR = 7.7; 95% CI, 6.3-9.4).
The survival analysis included 259 patients with liver cancer, 116 patients with pancreatic cancer and 107 patients with myeloproliferative neoplasms. SVT preceded cancer diagnosis in 48 patients with liver cancer, 20 patients with pancreatic cancer and 23 patients with myeloproliferative neoplasms.
Patients with liver cancer and pancreatic cancer experienced poor survival outcomes regardless of SVT.
Among patients with liver cancer, the 3-month survival rates were 44% for patients with SVT and 55% for patients without SVT. SVT remained a prognostic factor for patients with liver cancer after 1 year of follow-up. Seventeen percent of these patients with SVT achieved 1-year survival compared with 30% of patients with liver cancer without SVT.
Patients with pancreatic cancer experienced 3-month survival rates of 35% with SVT and 53% without SVT. However, patients with and without SVT had similar 1-year survival rates (15% vs. 17%).
Patients with myeloproliferative neoplasms experienced more favorable overall outcomes regardless of SVT events.
“This study is the first to demonstrate in a large population that patients who develop SVT are likely to be diagnosed with cancer within a relatively short time period,” Søgaard said. “As we continue to learn more about patients who suffer from these blood clots, it will be important to examine the pros and cons of screening for these hidden cancers.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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