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Original research
Incidence of venous thromboembolism in patients with ovarian cancer receiving neoadjuvant chemotherapy: systematic review and meta-analysis
  1. Kristin Ashley Black1,
  2. Sylvie Bowden2,
  3. Pamela Chu1,
  4. Caitlin McClurg3,
  5. Sophia Pin4 and
  6. Amy Metcalfe2,5
    1. 1Division of Gynecologic Oncology, University of Calgary, Calgary, Alberta, Canada
    2. 2Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
    3. 3Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
    4. 4Division of Gynecologic Oncology, University of Alberta, Edmonton, Alberta, Canada
    5. 5Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
    1. Correspondence to Dr Kristin Ashley Black, Division of Gynecologic Oncology, University of Calgary, Calgary T2N 4N2, Alberta, Canada; kristin.black{at}albertahealthservices.ca

    Abstract

    Objective Venous thromboembolism is associated with significant patient morbidity, mortality, and can lead to delays in treatment for patients with cancer. The objectives of this study were to identify the incidence of venous thromboembolism in patients with advanced ovarian cancer receiving neoadjuvant chemotherapy, and identify risk factors for venous thromboembolism.

    Methods A systematic literature search of biomedical databases, including Ovid Medline, Web of Science, Scopus, CINAHL, and Embase was performed on December 6, 2022 and updated on December 21, 2023 for peer reviewed articles. Studies were included if they were cohort studies or randomized controlled trials that evaluated the incidence of venous thromboembolism for patients with ovarian cancer receiving neoadjuvant chemotherapy. Risk of bias assessment was performed using the Newcastle Ottawa Scale for cohort studies and the Cochrane risk of bias tool for randomized controlled trials. Random effects meta-analysis was used to pool results across studies.

    Results A total of 2636 studies were screened, and 11 were included in the review. Ten were retrospective cohort studies, and one was a randomized controlled trial. The incidence of venous thromboembolism in the included studies ranged from 0% to 18.9%. The pooled incidence rate of venous thromboembolism was 10% (95% confidence interval (CI) 7% to 13%). This remained significant when restricted to only studies with a low risk of bias (pooled incidence of 11%, 95% CI 9% to 14%). Body mass index of ≥30 kg/m2 was a significant risk factor for venous thromboembolism with a pooled odds ratio of 1.76 (95% CI 1.13 to 2.76)

    Conclusions The results from this study demonstrated a 10% incidence of venous thromboembolism for patients with advanced ovarian cancer receiving neoadjuvant chemotherapy. This suggests that there may be a role for universal thromboprophylaxis in this population.

    Trial registration PROSPERO CRD42022339602.

    • Venous Thromboembolism
    • Carcinoma, Ovarian Epithelial
    • Gynecology
    • Ovarian Cancer
    • Preoperative Care

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

    https://doi.org/10.1136/ijgc-2023-005166

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      Data availability statement

      All data relevant to the study are included in the article or uploaded as supplementary information.

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      Footnotes

      • Twitter @kristinblackmd

      • Contributors KAB and SB performed the data collection. CM developed the review search strategy. KAB and SB performed the descriptive analysis and AM performed the statistical analysis. All authors (KAB, SB, AM, CM, SP, and PC) contributed to study conceptualization, writing and editing of the manuscript, and approved the final manuscript. KAB is the guarantor and responsible for the overall content and conduct of the study.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

      • Competing interests SP has received consultancy fees from GSK.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.