Biliary tract cancers and the associated risk of venous thromboembolism.
304 Background: Venous thromboembolism (VTE) is a common cause of morbidity and mortality in cancer patients. Because biliary tract cancers (BTC) cholangiocarcinoma and gallbladder (GB) cancer are uncommon, the incidence of VTE in this population are not well-described. Methods: We conducted a retrospective study of patients with BTC identified by the cancer registry at the Los Angeles County-University of Southern California (USC) Medical Center, USC Norris Cancer Center, and USC Keck Hospital between January 2011 to December 2016 to describe the incidence of VTE. 330 BTC patients’ medical records were reviewed for demographics, tumor characteristics, treatment history, and VTE events. 41 patients were excluded due to incomplete records/follow-up. Overall survival (OS) was calculated from date of diagnosis to date of death or last follow-up. Logrank test was used to evaluate the association of VTE with OS. Results: 289 patients with BTC were identified (177 cholangiocarcinoma, 112 GB) with a median follow-up period of 16.7 (0.3-89.0) months (mo). 169 (58%) were women. The median age at diagnosis of 66 years (range 22-89). 144 (59%) underwent cancer surgery and 274 (95%) received chemotherapy. 65 (22%) patients had VTE events: 22 pulmonary embolism [PE] with or without lower extremity (LE) deep vein thrombosis [DVT], 15 with LE DVT alone, three with upper extremity DVT, and 30 with visceral thrombosis (27 portal vein thrombosis [PVT] with or without inferior vena cava thrombosis [IVC], 2 IVC thrombosis, two hepatic vein thrombosis). Five patients had both DVT/PE and visceral thrombosis. The median time from cancer diagnosis to VTE event was not met. Patients with a PVT or any visceral thrombosis had an inferior OS compared to those without (PVT: median OS 16.2 mo [95% CI 12.2-25.8] versus 7.5 [3.4-14.2], p = 0.10, visceral thrombosis: 17.0 mo [95% CI 11.8-25.9] versus 8.4 [95% CI 3.7-14.3], p = 0.30). There was a non-significant trend towards inferior OS in patients with any VTE event type (median OS 17.0 mo [95% CI 11.8-39.0] versus 11.4 [95% CI 7.2-18.4], p = 0.10). There was no difference in OS for patients with PE/DVT compared to those without. Conclusions: VTE is commonly observed in patients with BTC. Visceral thrombosis is associated with inferior survival in patients with BTC.