The impact of venous thromboembolism on the outcomes of patients with cervical carcinoma: a retrospective audit from January 2015 to December 2016

Abstract

Background Venous thromboembolism (VTE) is a frequent cause of morbidity in patients with cervical cancer. The aim of this study was to investigate the outcomes of patients with cervical cancer and a deep vein thrombosis (DVT) in a South African population. Methods The records of 47 cervical cancer patients with a concomitant diagnosis of a deep vein thrombosis (DVT) /VTE who were admitted to the radiation oncology ward at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in 2015 and 2016 were identified and analysed retrospectively. Data collected included the age, stage, Human Immunodeficiency Virus (HIV) status and details of diagnosis of VTE and the treatment received. The survival of patients from diagnosis of VTE and the 2 year overall survival (OS) rate was calculated using the Kaplan and Meier method. Univariate and multivariate analyses of factors influencing survival were performed on selected clinical variables.Results Forty seven patients had a concomitant diagnosis of cervical cancer and VTE. The majority of patients (60%) had stage IIIB cervical cancer. Sixty percent of patients were HIV positive and 40% of patients were HIV negative. The median survival of patients from the time of diagnosis of VTE was 2.7 months, (interquartile range (IQR): 0.97 – 6.93 months) and the 12 month survival from diagnosis of VTE for this cohort was 17%. Once a deep venous thrombosis was diagnosed the survival becomes poor irrespective of age, stage, HIV status. The 2 year overall survival of this cohort was 29.8%. The 2 year overall survival of patients who were diagnosed with a DVT before or during radiotherapy was significantly lower than that of patients who were diagnosed with DVT after radiotherapy, (12.5% versus 38.7%), p = 0.004. The diagnosis of DVT / VTE is a poor prognostic factor in patients with locally advanced cervical cancer.