@article {Machida924, author = {Hiroko Machida and Marianne S. Hom and Midori Maeda and Jane J. Yeo and Christian S. Ghattas and Brendan H. Grubbs and Koji Matsuo}, title = {Signs and Symptoms of Venous Thromboembolism and Survival Outcome of Endometrial Cancer}, volume = {26}, number = {5}, pages = {924--932}, year = {2016}, doi = {10.1097/IGC.0000000000000684}, publisher = {BMJ Specialist Journals}, abstract = {Objective This study aimed to evaluate if the presence of venous thromboembolism (VTE) diagnosed with subjective and objective measurements correlates with the survival outcome in patients with endometrial cancer.Methods A retrospective study was conducted on patients with endometrial cancer who developed VTE between cancer diagnosis and follow-up from 1999 to 2013. Disease-specific survival after VTE diagnosis was evaluated according to VTE symptoms and vital signs.Results Among 827 endometrial cancer cases during the study period, there were 72 (8.7\%) patients with VTE identified (pulmonary embolism [PE] with or without deep vein thrombosis [DVT], n = 34; and DVT alone n = 38). In the PE group, decreased disease-specific survival after the diagnosis of VTE was associated with fatigue, systolic blood pressure (BP) less than 120 mm Hg, diastolic BP less than 70 mm Hg, and a heart rate 90 beats per minute or greater (all, P \< 0.05) in a univariate analysis. Symptomatic PE was associated with decreased survival as compared to asymptomatic PE (2-year rate; 23.1\% vs 77.8\%, P \< 0.01). In a multivariate analysis controlling for symptoms of VTE, signs, and tumor factors, a diastolic BP less than 70 mm Hg (adjusted-hazard ratio [HR], 10.0; 95\% confidence interval, 2.70{\textendash}37.1; P \< 0.01) and HR greater than 90 beats per minute (adjusted-HR, 8.06; 95\% confidence interval, 2.36{\textendash}27.5; P \< 0.01) remained as independent prognostic factors for decreased disease-specific survival after PE diagnosis. Patients with PE presenting with low diastolic BP and high heart rate resulted in a dismal survival outcome (diastolic BP \< 70 mm Hg/heart rate >= 90 beats per minute vs diastolic BP >= 70 mm Hg/heart rate \< 90 beats per minute; 0\% vs 85.7\%, P \< 0.01). In the group of patients with DVT alone, no signs or symptoms correlated with survival outcome (all, P \> 0.05).Conclusions Our results suggested that both signs and symptoms of PE are important consideration in the management of patients with endometrial cancer with PE.}, issn = {1048-891X}, URL = {https://ijgc.bmj.com/content/26/5/924}, eprint = {https://ijgc.bmj.com/content/26/5/924.full.pdf}, journal = {International Journal of Gynecologic Cancer} }