Endometrial Cancer Patients at Increased Risk for Blood Clots

Allison Gandey

July 20, 2007

July 20, 2007 (Chicago) –- Patients presenting with venous thromboembolism and postmenopausal bleeding might be signaling clear-cell carcinoma of the endometrium, researchers warn. And in those with known endometrial cancer, a venous thromboembolism may be an indication of recurrence. Reporting at the recent American Society of Clinical Oncology 43rd Annual Meeting, investigators recommended extended prophylaxis in such patients to prevent clotting.

"When considering the timing of venous thromboembolism," lead author and presenter Leslie Garrett, MD, from Massachusetts General Hospital, in Boston, said, "the events observed in those with clear-cell carcinoma of the endometrium occurred at presentation or with disease recurrence (8 vs 1) while nearly all thromboembolism in the control group occurred in the postoperative period (7 vs 2). This was statistically significant with a P value of .01."

In this retrospective record review, complete clinical data were available for 29 patients with clear-cell carcinoma of the endometrium. Investigators matched 58 controls with patients with high-grade endometrial cancers for stage, age, and date of diagnosis. Researchers collected data on patient age, tumor stage, body-mass index, surgical procedure, adjuvant therapy, survival, and presence of venous thromboembolism.

All patients underwent surgical staging with gynecologic oncology staff surgeons, and all patients received venous thromboembolism prophylaxis perioperatively. Patients ranged in age from 38 to 85 years, with a mean of 64.6 years.

Patients with Advanced-Stage Disease at Greatest Risk

In all, 35% of patients had stage 1 tumors, 10% had stage 2, 27.5% stage 3, and 27.5% had stage 4 tumors. Most were grade 3 endometrioid cancers (50%), with the remainder being serous (35%), of mixed histology (7%), carcinosarcoma (5%), and undifferentiated carcinoma (3%).

The researchers observed that most of the control patients had a higher body-mass index than the cancer patients. And overall, there were 18 venous thrombotic events, with 10 in the endometrial cancer patients and 8 in the controls. A higher proportion of venous thromboembolism occurred in those with stage 3 and 4 disease (n = 16) compared with those with early-stage disease (n = 2) ( P = .01).

The research team concluded that clear-cell endometrial cancer patients are at increased risk for venous thrombotic events. They found this was particularly true for those with advanced-stage disease. "Presentation with a venous thromboembolism and postmenopausal bleeding should raise the suspicion for clear-cell carcinoma of the endometrium," Dr. Garrett said. "Likewise, in those with known endometrial cancer, development of a venous thromboembolism may be a harbinger of recurrence."

American Society of Clinical Oncology 43rd Annual Meeting: Abstract 5597. Presented June 2, 2007.

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