THROMPAN: Portal Vein Thrombosis Associated With Unresectable Pancreatic Cancers : a Prospective Multicentric Cohort Study
Study Details
Study Description
Brief Summary
Little is known concerning the management of portal vein thrombosis (PVT) in digestive cancers other than hepato-cellular carcinoma (HCC). The use of anticoagulant treatment (ACT), screening of oesophageal varices (OV) and oesogatric varices (OGV), and primary prophylaxis of OV (treatment with beta-blocker (BB) and / or OV ligation) if necessary are not clearly defined. The autopsy series by Ogren et al. (World J Gastroenterol. 2006) found an incidence of PVT in cancer patients of 1%, with 44% of digestive cancers other than HCC as a common etiology, mostly pancreatic adenocarcinoma (42%).
We reported a retrospective French study that included 118 patients with digestive cancers other than HCC, including 50% locally advanced or metastatic pancreatic adenocarcinoma, with PVT complications. A total of 38% of patients had radiological signs of portal hypertension (PHT) and 51% had ACT. Only 1% of patients were screened for VO (n = 7). In addition, 19% (n = 22) presented gastrointestinal bleeding. Among the causes of death, 17% (n = 12) were due to gastrointestinal bleeding. Overall survival (OS) was statistically associated with a metastatic disease (HR = 2.83 [95% CI 1.47-5.43], p <0.01) and gastrointestinal bleeding (HR = 1.68 [95% CI 1.01-2.78], p = 0.04).
Bleeding complications from PHT are not uncommon in patients with digestive cancer, especially in patients with pancreatic cancer with PVT; but above all they can be responsible for death. No data existed before our first study (Regnault et al. Dig Liv Dis 2018). However, these data must be validated in a prospective multicentric study with standardized follow-up. In order to obtain precise and homogeneous data, we have chosen to target pancreatic cancers as these tumors are the most common causes of PVT.
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Study Design
Outcome Measures
Primary Outcome Measures
- Rate of digestive and non-digestive bleeding [18 months]
Hematemesis, melena and / or rectal bleeding Hematuria, intra-abdominal, intracranial bleeding and / or other bleeding considered clinically relevant by the investigators
Secondary Outcome Measures
- Screening rate of oesophageal varices by upper gastriintestinal endoscopy, [18 months]
- Detection rate of oesophageal varices [18 months]
- Rate of primary prophylaxis of oesophageal varices [18 months]
- Rate of secondary prophylaxis of oesophageal varices [18 months]
- Rate of anticoagulant treatment use [18 months]
- Portal hypertension related death, predictive factors of gastrointestinal bleeding and overall survival. [18 months]
Eligibility Criteria
Criteria
Inclusion Criteria:
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Pancreatic adenocarcinoma proven histologically or cytologically in favor of pancreatic adenocarcinoma
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Mesurable disease according to RECIST 1.1 criteria or non measurable disease
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Metastatic disease (synchronous or metachronous) or locally advanced / borderline deemed unresectable and / or patient inoperable due to his co-morbidities and / or local recurrence after surgery
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Thrombosis of the main portal vein and/or of one of its branches (endo-luminal defect on the injected CTscan) of cruoric or tumoral origin or circumferential stenosis of the portal vein trunk, the spleno-mesaraic confluence or one of its venous branches with or without signs of portal hypertension on CTscan and / or upper GIendoscopy
Exclusion Criteria:
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- Post-surgical portal vein thrombosis and / or in patients considered in remission
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Non-adenocarcinomatous pancreatic tumor (endocrine, etc.)
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Poitiers University Hospital
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- THROMPAN