Journal Article Ahead of print
PubMed: 42442219 DOI: 10.1016/j.ijgc.2026.104818
Post-operative venous thromboembolism in advanced epithelial ovarian cancer: risk factors, tumor gene expression, and survival.
Int J Gynecol Cancer 36(9):104818
Authors: Matilda Salko, Lasse Myllylahti, Sara Palomino-Echeverria, Johanna Tapper, Riitta Koivisto-Korander, Anna Kanerva, Kaisa Nelskylä, Mikko Loukovaara, Anniina Färkkilä, Ulla-Maija Haltia, Riitta Lassila
Affiliations
- University of Helsinki, Faculty of Medicine, Research Program in Systems Oncology, Helsinki, Finland.
- Helsinki University Hospital, Comprehensive Cancer Center, Department of Hematology, Helsinki, Finland; University of Helsinki, Faculty of Medicine, Research Program in Systems Oncology, Coagulation Disorders, Helsinki, Finland.
- University of Helsinki, Faculty of Medicine, Research Program in Systems Oncology, Helsinki, Finland; University of Helsinki, Helsinki Institute of Life Sciences, Institute for Molecular Medicine Finland, Helsinki, Finland.
- Helsinki University Hospital, Department of Obstetrics and Gynecology, Helsinki, Finland.
- Helsinki University Hospital, Women's Hospital, Department of Anesthesiology, Perioperative and Intensive Care, Helsinki, Finland.
- University of Helsinki, Faculty of Medicine, Research Program in Systems Oncology, Helsinki, Finland; University of Helsinki, Helsinki Institute of Life Sciences, Institute for Molecular Medicine Finland, Helsinki, Finland; Helsinki University Hospital, Department of Obstetrics and Gynecology, Helsinki, Finland.
- University of Helsinki, Faculty of Medicine, Research Program in Systems Oncology, Helsinki, Finland; Helsinki University Hospital, Department of Obstetrics and Gynecology, Helsinki, Finland.
Abstract
OBJECTIVE
Epithelial ovarian cancer is associated with an increased incidence of venous thromboembolism. In this single-center cohort study, we investigated risk factors for post-operative venous thromboembolism, prognostic factors, and the association between venous thromboembolism and the tumor-tissue transcriptome.
METHODS
This cohort consisted of 200 patients with stage III or IV ovarian cancer referred to Helsinki University Hospital for primary or interval de-bulking surgery between 2021 and 2024. We collected data on patient characteristics, coagulation biomarkers, surgical details, post-operative venous thromboembolism and survival, and tumor-tissue RNA sequencing from patients with venous thromboembolism and matched controls.
RESULTS
Of the 200 patients, 125 underwent primary surgery and 75 underwent interval surgery. High-grade serous carcinoma was the dominant histologic type. Pre-operative fibrinogen, coagulation factor VIII, and D-dimer levels were above the normal range and correlated with inflammation. The incidence of venous thromboembolism was 13.6% in the primary surgery group and 2.7% in the interval surgery group (p = .012), despite 31% of patients receiving pre-operative anti-coagulation. Duration of operation and liver mobilization were also risk factors for venous thromboembolism, whereas perioperative red blood cell transfusions to manage bleeding events seemed protective. Low albumin was negatively associated with overall survival. Tumor RNA sequencing identified increased expression of genes related to oxidative stress and reduced expression of genes linked to anti-inflammatory regulation, which may contribute to venous thromboembolism risk.
CONCLUSIONS
A thromboinflammatory phenotype in blood is common in ovarian cancer. Primary surgery and extent of surgery are associated with post-operative venous thromboembolism, whereas perioperative red blood cell transfusions have a protective association. Albumin serves as a prognostic biomarker.
MeSH
Cells, Genes, Thromboembolism, Factor Viii, Erythrocytes, Blood, Incidence, Erythrocyte Transfusion, Ovary, Neoplasms, Biomarkers, Ovarian Neoplasms, Risk Factors, Blood Cells, Venous Thromboembolism, Tissues, Carcinoma, Ovarian Epithelial, Gene Expression