Objective: Patients with advanced ovarian cancer receiving neoadjuvant chemotherapy are at increased risk of venous thromboembolism, although the reported incidence, risk factors, and its impact on the timing of interval debulking surgery remain heterogeneous. This study evaluates the rate and predictors of venous thromboembolism during neoadjuvant chemotherapy, its effect on surgical timing, and contextualizes the findings through a targeted narrative review of the literature. Methods: We conducted a retrospective cohort study of patients with International Federation of Gynecology and Obstetrics stage III-IV epithelial ovarian cancer treated with neoadjuvant chemotherapy followed by interval debulking surgery at the European Institute of Oncology between January 2014 and December 2023. Routine thromboprophylaxis was not administered. Clinicopathologic data were collected, and logistic regression analyses were performed to identify predictors of venous thromboembolism and delayed surgery, defined as receiving ≥5 cycles of neoadjuvant chemotherapy prior to surgery. A targeted narrative review of PubMed (2012-2025) summarized venous thromboembolism rates and associated risk factors. Results: Among 694 patients, 32 (4.6%) developed venous thromboembolism during neoadjuvant chemotherapy, including 23 deep vein thromboses (71.9%) and 9 pulmonary embolisms (28.1%). No baseline clinical or pathological factors predicted thromboembolism. However, it was independently associated with surgical delay; affected patients were more than twice as likely to undergo surgery after ≥5 cycles of chemotherapy (adjusted odds ratio 2.15, 95% confidence interval 1.04 to 4.43, p �.04). Conclusions: Venous thromboembolism during neoadjuvant chemotherapy is relatively uncommon but clinically relevant, as it delays surgery. Early detection and preventive strategies may mitigate its impact in this high-risk population.
Rate and risk factors of venous thromboembolism during neoadjuvant chemotherapy for advanced ovarian cancer: a retrospective analysis from a referral center / Delfrati, S., Caruso, G., Bruni, S., Fumagalli, D., Agazzi, A., Peccatori, F., Betella, I., Gervaso, L., Fazio, N., Alessandra Cella, C., Lapresa, M., Parma, G., Rosanu, M., Ribero, L., Aletti, G., Colombo, N., Schivardi, G., Multinu, F.. - In: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER. - ISSN 1048-891X. - (2026). [10.1016/j.ijgc.2026.104682]
Rate and risk factors of venous thromboembolism during neoadjuvant chemotherapy for advanced ovarian cancer: a retrospective analysis from a referral center
Giuseppe Caruso;
2026
Abstract
Objective: Patients with advanced ovarian cancer receiving neoadjuvant chemotherapy are at increased risk of venous thromboembolism, although the reported incidence, risk factors, and its impact on the timing of interval debulking surgery remain heterogeneous. This study evaluates the rate and predictors of venous thromboembolism during neoadjuvant chemotherapy, its effect on surgical timing, and contextualizes the findings through a targeted narrative review of the literature. Methods: We conducted a retrospective cohort study of patients with International Federation of Gynecology and Obstetrics stage III-IV epithelial ovarian cancer treated with neoadjuvant chemotherapy followed by interval debulking surgery at the European Institute of Oncology between January 2014 and December 2023. Routine thromboprophylaxis was not administered. Clinicopathologic data were collected, and logistic regression analyses were performed to identify predictors of venous thromboembolism and delayed surgery, defined as receiving ≥5 cycles of neoadjuvant chemotherapy prior to surgery. A targeted narrative review of PubMed (2012-2025) summarized venous thromboembolism rates and associated risk factors. Results: Among 694 patients, 32 (4.6%) developed venous thromboembolism during neoadjuvant chemotherapy, including 23 deep vein thromboses (71.9%) and 9 pulmonary embolisms (28.1%). No baseline clinical or pathological factors predicted thromboembolism. However, it was independently associated with surgical delay; affected patients were more than twice as likely to undergo surgery after ≥5 cycles of chemotherapy (adjusted odds ratio 2.15, 95% confidence interval 1.04 to 4.43, p �.04). Conclusions: Venous thromboembolism during neoadjuvant chemotherapy is relatively uncommon but clinically relevant, as it delays surgery. Early detection and preventive strategies may mitigate its impact in this high-risk population.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
