ArticleAmerican journal of cancer research2026
Multidimensional impact of venous thromboembolism on survival outcomes in ovarian cancer patients: deconstructing competing risks between thrombosis-related and tumor-related mortality.
Article in American journal of cancer research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Ovarian cancer carries one of the highest risks of venous thromboembolism (VTE) among gynecological malignancies, yet the independent contribution of VTE to cause-specific mortality remains insufficiently characterized. This retrospective study included 550 primary epithelial ovarian cancer patients who underwent surgery between January 2015 and December 2022 (VTE group, n=68; non-VTE group, n=482), with a median follow-up of 50 months. Fine-Gray competing-risk models and Cox proportional hazards regression were applied to evaluate mortality outcomes. VTE incidence was 12.4%. Elevated D-dimer (odds ratio [OR]=5.398, P<0.001), elevated platelet count (OR=1.007, P=0.005), and operative time ≥240 min (OR=2.255, P=0.033) were identified as independent risk factors for VTE occurrence, while elevated hemoglobin (OR=0.962, P=0.002) and CA125>500 U/mL (OR=0.335, P=0.008) were associated with reduced risk. VTE independently worsened overall survival (HR=2.533, P<0.001). Competing-risk analysis revealed that VTE significantly increased both tumor-related death (SHR=1.624, P=0.014) and VTE-related death (SHR=4.086, P<0.001). At 60 months, cumulative tumor-related mortality was 54.9% versus 34.5%, and VTE-related mortality was 14.7% versus 3.5% in VTE versus non-VTE groups, respectively. Subgroup analyses demonstrated consistent adverse effects of VTE across most clinical subgroups, with a trend toward stronger VTE-related mortality impact in patients with lower tumor burden (CA125≤500 U/mL, P interaction=0.070). Among VTE patients, guideline-adherent anticoagulation significantly reduced VTE-related mortality (P<0.001) but did not significantly affect tumor-related death (P=0.681). These findings demonstrate that VTE imposes a dual mortality burden in ovarian cancer, and the competing-risk framework more accurately delineates this impact than conventional survival analysis. Early VTE recognition and guideline-adherent anticoagulation should be prioritized within the comprehensive management of ovarian cancer.
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