Pooled Prevalence, Risk Factors of Chemotherapy-Related VTE in Ovarian Cancer Are Revealed

Data examined the prevalence, risk factors, and prognostic value of chemotherapy-associated venous thromboembolism in patients with ovarian cancer.

A study published in the World Journal of Surgical Oncology examining the prevalence, risk factors, and prognostic value of chemotherapy-associated venous thromboembolism (VTE) in patients with ovarian cancer found a pooled prevalence of 9% (95% CI, 0.06–0.12) for this group of patients.

The data also found substantial risk factors for chemotherapy-related VTE, potentially assisting future efforts to target preventative measures in patients with this disease.

“Our findings revealed that the pooled prevalence of chemotherapy-related VTE in OC was approximately 9% in [ovarian cancer] with substantial heterogeneity (88.9%),” wrote the investigators. “Considering that significant heterogeneity may impair the evidence quality of the pooled estimate, the meta-regressions based on publication time, sample size, and [Newcastle-Ottawa Scale] score were performed to explore the potential sources of statistical heterogeneity.”

The investigators determined that a number of risk factors were associated with patients developing VTE, including advanced age, D-dimer levels greater than 0.5 mg/mL, and tumor diameter of 10 cm or more. While risk factors and prevalence were evident, only 2 of the 11 studies examined included data on the prognostic value of VTE in patients with ovarian cancer receiving chemotherapy, but the results were inconsistent.

The potential of publication bias was found via a funnel plot, verified by statistical test. Regardless, the results determined by the trim-and-fill test concluded the pool estimate remained stable even after the addition of 2 “missing” studies.

The results for both the subgroup and sensitivity analysis were relatively consistent with that of the overall pooled estimate.

Eleven observational studies including 4759 patients with ovarian cancer were collected from 3 databases (PubMed, Embase, and the Cochrane Library). The databases were searched for relevant patients from the databases’ inception to October 14, 2020.

“The current meta-analysis based on 11 observational studies indicated that VTE was a relatively common complication in [patients with ovarian cancer] receiving chemotherapy,” wrote the investigators. “The systematic review for risk factors found that some risk factors were potential predictors for VTE including advanced age, D-dimer [levels] > 0.5 mg/mL, and tumor diameter > 10 cm.”

The primary outcome of the research was the prevalence of VTE in patients with ovarian cancer receiving chemotherapy, while secondary end points included the risk factors and prognostic value of VTE.

The investigators admitted the research has some limitations, including that the studies examined were only from Asia, Europe, and the United States. While the parameters were not limited to these regions, the results cannot be generalized to other regions of the world. Moreover, statistical heterogeneity existed across the studies examined in the meta-analysis. This analysis determined that sample size was the determining factor in this heterogeneity.

The team suggests future research focus on the benefits of preventative strategies for chemotherapy-related VTE in patients with ovarian cancer.

“Moreover, there are other factors like anesthesia condition, clinic care, and other related health conditions which were not identified in the current meta-analysis, but may also be potential risk factors for chemotherapy-related VTE,” wrote the investigators. “Accordingly, these results may put cautious interpretation and further studies focused on these important risk factors should be warranted, which contributes to improving or controlling critical risk factors for chemotherapy-related VTE in [ovarian cancer].”


Ye L, Cai L, Zhuang D, et al. The prevalence, risk factors, and prognostic value of venous thromboembolism in ovarian cancer patients receiving chemotherapy: a systematic review and meta-analysis. World J Surg Oncol. 2021;19(1):12. doi: 10.1186/s12957-020-02101-5