High rates of venous thromboembolism in endometrial cancer patients requiring systemic therapy: an opportunity for risk assessment and intervention.

OBJECTIVES: We aim to describe the venous thromboembolism (VTE) rate among patients who received chemotherapy for initial endometrial cancer treatment, and identify factors associated with VTE diagnosis in this population. METHODS: This is a retrospective cohort study of patients who received chemotherapy during initial treatment for endometrial cancer from January 2015 to December 2023 within a single academic medical system. The primary outcome is overall VTE incidence. Sociodemographic and biomedical factors were collected. Descriptive statistics were used for analysis. RESULTS: Two hundred ninety-two patients were identified who received chemotherapy during initial treatment for endometrial cancer; 78 (26.7%) developed a VTE after cancer diagnosis. Cancer stage was associated with VTE development (p < 0.001); 50.0% of patients who developed VTE had Stage IV at diagnosis compared to 20.4% of those who did not. Twenty-four patients (30.8%) had carcinomatosis at the time of VTE diagnosis and 14 (17.9%) had ascites. A high-risk Khorana score (≥3) at initiation of initial chemotherapy, histology, grade, age, ECOG functional status, tobacco use, body mass index, and receipt of external beam pelvic radiation, immunotherapy, or bevacizumab during initial treatment were not associated with VTE development. DISCUSSION: More than 1 in 4 patients who received chemotherapy for initial endometrial cancer developed a VTE during their treatment course. Stage at cancer diagnosis was the only factor associated with subsequent VTE; factors including histology, grade, BMI and Khorana score were not associated. As endometrial cancer incidence rises, continued efforts to improve the accuracy of risk assessment tools and evaluate prophylactic anticoagulation in this high-risk population are warranted.