Abstract Number: PB1095
Meeting: ISTH 2021 Congress
Theme: Venous Thromboembolism » Cancer Associated Thrombosis
Background: Patients with osteosarcoma and Ewing sarcoma are considered to have a high risk of venous thromboembolism (VTE), although the exact incidence is understudied.
Aims: To study the incidence of VTE and major bleeding (MB) in these patients.
Methods: We performed a chart review in patients treated for osteosarcoma (OS) or Ewing sarcoma (ES) in our hospital between 1980 and 2018. The study was approved by the Institutional Review Board. Patient charts were scrutinized for patient and tumor characteristics, and outcome events, the latter adjudicated by an independent expert. Cumulative incidences were estimated using Kaplan-Meier and cumulative incidence competing risk (CICR) method. Multivariable time-dependent Cox models were used to determine the association between outcome events and mortality.
Results: Baseline characteristics of 520 osteosarcoma and 165 Ewing sarcoma patients are shown in Table 1. VTE occurred in 65 OS patients (13%) and 11 ES patients (6.7%), MB in 31 OS patients (6.0%) and 9 ES patients (5.5%). Adjusted cumulative incidences for VTE and MB at 3, 6, 9, 12 and 24 months are presented in Table 2. The most frequent VTE presentation was arm vein thrombosis (32% and 45% in OS and ES, respectively), mostly related to central venous catheters (CVC; in 18/21 OS patients and 5/5 ES patients). From the 31 MB complications in osteosarcoma patients, 13 patients were known to use prophylactic or therapeutic anticoagulants (42%). The majority of MBs (84% in OS, 78% in ES) were bleedings within metastases or rebleeds after surgery. In osteosarcoma, VTE and MB were both associated with all-cause mortality (adjusted HRs 1.9 (95%CI 1.3-2.7) and 3.3 (95%CI 2.1-5.1) respectively), whereas this association was only present for MB in Ewing sarcoma (adjusted HR 2.9 (95%CI 1.0-8.1)).
| Table 1. Baseline characteristics of osteosarcoma and Ewing sarcoma patients | ||
|---|---|---|
| Baseline characteristics | Osteosarcoma | Ewing sarcoma |
| Number of patients | 520 | 165 |
| Age at diagnosis – years Mean (+/- SD) Range |
32 (19) 3.5-84 |
23 (13) 1.2-67 |
| Gender – no (%) Male Female |
288 (55) 232 (45) |
113 (69) 52 (32) |
| Presence of distant metastases at time of diagnosis – no (%) | 107 (21) | 50 (30) |
| Tumor grade – no (%) High grade sarcoma Low grade sarcoma Intermediate grade Undefined |
453 (87) 40 (7.7) 10 (1.9) 17 (3.3) |
NA NA NA NA |
| Presence of CVC – no (%) Yes No Unknown |
394 (76) 91 (18) 35 (6.7) |
152 (92) 3 (2) 10 (6.1) |
| Patients died – no (%) | 257 (49) | 88 (53) |
| Median follow-up time in months – IQR | 60 (22-142) | 42 (19-124) |
| Note: SD: standard deviation; no: number; CVC: central venous catheter; IQR: interquartile range; NA: not available | ||
Baseline characteristics of osteosarcoma patients and Ewing sarcoma patients
| Table 2. Adjusted cumulative incidences of venous thrombotic complications and major bleeding events in osteosarcoma patients and Ewing sarcoma patients | ||||
|---|---|---|---|---|
| Index date: date of histological diagnosis of OS or ES |
Osteosarcoma VTE % (95% CI) |
Ewing sarcoma VTE % (95% CI) |
Osteosarcoma MB % (95% CI) |
Ewing sarcoma MB % (95% CI) |
| 3 months |
5.2 (3.5-7.3) |
1.8 (0.50-4.8) |
1.2 (0.48-2.4) |
0 |
| 6 months |
6.7 (4.8-9.1) |
1.8 (0.50-4.8) |
2.3 (1.3-3.9) |
0.61 (0.06-3.1) |
| 9 months |
7.5 (5.4-10) |
4.2 (1.9-8.1 |
2.5 (1.4-4.1) |
0.61 (0.06-3.1) |
| 12 months |
8.3 (6.1-11) |
6.1 (3.1-10) |
3.3 (2.0-5.1) |
1.2 (0.24-4.0) |
| 24 months |
8.8 (6.6-11) |
6.7 (3.5-11) |
4.0 (2.6-6.0) |
2.5 (0.81-5.8) |
| Note: OS: osteosarcoma; ES: Ewing sarcoma; VTE: venous thromboembolism; MB: major bleeding; CI: confidence interval Adjusted cumulative incidence: cumulative incidence adjusted for competing risk of death (following the CICR method) |
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Adjusted cumulative incidences of venous thrombotic complications and major bleeding events in osteosarcoma patients and Ewing sarcoma patients
Conclusions: Our findings provide accurate estimations of the incidence and prognostic relevance of VTE and MB in patients with osteosarcoma and Ewing sarcoma.
To cite this abstract in AMA style:
Stals MAM, HJ Kaptein F, E Evenhuis R, AJ Gelderblom , V Huisman M, DSA Karis , RWD Noten , SC Cannegieter , HH Versteeg , MAJ van de Sande , FA Klok . Risk of Venous Thromboembolism and Major Bleeding in the Clinical Course of Osteosarcoma and Ewing Sarcoma Patients [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/risk-of-venous-thromboembolism-and-major-bleeding-in-the-clinical-course-of-osteosarcoma-and-ewing-sarcoma-patients/. Accessed November 28, 2022.« Back to ISTH 2021 Congress
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