Key result
An ONKOTEV score ≥ 2 independently predicted thromboembolism in the first year among patients with cholangiocarcinoma, increasing the risk by 3.1-fold compared to a score < 2.
Why the study?
Because cholangiocarcinoma is rare, the incidence of thromboembolism in this patient population is not well defined.
Cohort (n=133)
No
Cholangiocarcinoma carries a high risk of thromboembolism (29.3%), which can be independently predicted by an ONKOTEV score ≥ 2 and elevated serum CA 19-9.
May support ONKOTEV-based risk stratification in cholangiocarcinoma; leaves open whether score-guided prophylaxis improves outcomes.
BACKGROUND: Patients with cancer are at increased risk of thromboembolic events contributing significantly to cancer-related morbidity and mortality. Because cholangiocarcinoma is a rare type of cancer, the incidence of thromboembolism in this patient population is not well defined. METHODS: Patients with cholangiocarcinoma treated at the University Cancer Center Leipzig between January 2014 and December 2018 were analyzed retrospectively regarding the incidence of arterial and venous thromboembolism. RESULTS: A total of 133 newly and consecutively diagnosed patients were included, of whom 22% had stage IV disease. Thromboembolism was diagnosed in 39 (29.3%), with 48% of the events occurring between 60 days prior and 30 days after the initial diagnosis. Arterial thrombosis accounted for 19% and portal venous thrombosis for 33% of the events, while the rest of events occurred in the non-portal venous system. In multivariable analysis, an ONKOTEV score ≥ 2 was the only independent predictor for thromboembolism. Serum CA 19-9 was available in 87 patients (65.4%). In this subgroup, CA 19-9 above the median of 97.7 U/ml and vascular or lymphatic compression were independent predictors for thromboembolism in the first year and CA 19-9 alone remained a significant predictor over the whole observation period. An ONKOTEV score ≥ 2 and increasing age were predictors of survival. CONCLUSIONS: A very high thromboembolic risk was observed in cholangiocarcinoma, comparable to the risk situation in pancreatic and gastric cancer. The ONKOTEV score and serum CA 19-9 are independent predictors of thromboembolic events. Prospective validation of our observations in this patient population is warranted.
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Pfrepper et al. (2021) conducted a cohort in Cholangiocarcinoma (n=133). ONKOTEV score ≥ 2 vs. ONKOTEV score < 2 was evaluated on Thromboembolism in the first year (HR 3.1, 95% CI 1.4-6.7, p=0.004). An ONKOTEV score ≥ 2 independently predicted thromboembolism in the first year among patients with cholangiocarcinoma, increasing the risk by 3.1-fold compared to a score < 2.
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