Characterization of risk factors and timing of venous thromboembolism in patients with uterine carcinosarcoma

Objectives: The purpose of this study was to evaluate the timing and risk factors associated with venous thromboembolism in women with uterine carcinosarcoma in a racially and ethnically diverse urban population. Methods: A retrospective cohort study was performed with all women diagnosed with carcinosarcoma from 2005–2018 at Montefiore Medical Center in Bronx, NY. Data regarding patient demographics, medical comorbidities, treatment course, Khorana score and timing of thromboembolic events were abstracted. A Cox proportional hazards model which included time-dependent covariates for treatment course variables was estimated to examine the association between patient-related variables and the incidence and timing of venous thromboembolism. Results: Forty (31%) of 130 included patients developed venous thromboembolism and there were no significant associations between patient demographics, medical comorbidities, or cancer treatment with thromboembolic events. Being within 6 weeks of surgery was associated with a higher hazard of venous thromboembolism (HR 3.8, 95% CI [1.09–13.50], P = 0.04). Thirty-two (80%) patients who developed venous thromboembolism did so outside of the perioperative window. Patients receiving chemotherapy with a Khorana score $\ge$2 had a significantly increased risk of developing venous thromboembolism (HR 3.5, 95% CI [1.30–9.23], P = 0.01). Conclusions: Patients with uterine carcinosarcoma have a high risk of thromboembolic events throughout the entire disease course and were found to be at greatest risk during the 6 weeks following surgery. Although no patient or treatment-related factors were associated with an increased risk of venous thromboembolism, we found that the Khorana score may be helpful in identifying patients who may benefit from thromboprophylaxis while receiving chemotherapy.

Uterine carcinosarcoma; Venous thromboembolism; Khorana score; Thromboprophylaxis

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