Incidence of Venous Thromboembolism in Patients with Pancreatic Ductal Adenocarcinoma Undergoing Neoadjuvant Chemotherapy.

[BACKGROUND] Patients with pancreatic ductal adenocarcinoma (PDAC) experience an increased risk of venous thromboembolism (VTE), which is further potentiated by systemic chemotherapy. However, risk of VTE during preoperative therapy has not been well characterized to date. This study aimed to determine the prevalence and incidence of VTE in patients with PDAC treated with preoperative therapy with intent for surgery.

[PATIENTS AND METHODS] We performed a cohort study of all patients in a prospectively maintained database who had anatomically resectable or borderline resectable PDAC treated with chemotherapy with intent for surgery from 1 March 2016 to 31 December 2020. Primary outcomes were prevalent VTE at diagnosis or incident VTE during neoadjuvant therapy (NAT). Patients were censored at the date of surgery or when surgical intent was discontinued.

[RESULTS] Of 400 patients who met the inclusion criteria, 13 (3.3%) had prevalent VTE at diagnosis. After exclusions, the final study cohort included 332 patients. During NAT, 33 (9.9%) patients were diagnosed with incident VTE. Mesenteric venous thrombosis (MVT) was identified in 16 patients (4.8%), including 3 patients who experienced both MVT and VTE. Increased body mass index was the only factor analyzed that was associated with an increased risk of VTE in both unadjusted and adjusted analyses. Mean Khorana score between groups was not statistically different. Clinical characteristics, resection rates, and overall survival (OS) of patients with and without VTE were similar.

[CONCLUSIONS] In a cohort of patients with locoregional PC treated with NAT, 3.3% had prevalent VTE at diagnosis and 9.9% had incident VTE. These data provide the basis for studying the effectiveness of VTE prophylaxis in this high-risk population.