Rate and risk factors of venous thromboembolism during neoadjuvant chemotherapy for advanced ovarian cancer: a retrospective analysis from a referral center.

Authors

Susanna Delfrati, Giuseppe Caruso, Simone Bruni, Diletta Fumagalli, Alberto Agazzi, Fedro Peccatori, Ilaria Betella, Lorenzo Gervaso, Nicola Fazio, Chiara Alessandra Cella, Mariateresa Lapresa, Gabriella Parma, Marina Rosanu, Lucia Ribero, Giovanni Aletti, Nicoletta Colombo, Gabriella Schivardi, Francesco Multinu

Published in

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. Volume 36. Issue 8. Pages 104682. Apr 03, 2026. Epub Apr 03, 2026.

Abstract

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.
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.
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).
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.

PMID:
42546374
Bibliographic data and abstract were imported from PubMed on 04 Aug 2026.

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