{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T22:02:37Z","timestamp":1790028157130,"version":"4.0.1"},"reference-count":47,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"8","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["J Clin Oncol"],"published-print":{"date-parts":[[2026,3,10]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Pancreatic ductal adenocarcinoma (PDAC) is associated with a high risk of venous thromboembolism (VTE), which is burdensome and associated with decreased survival. Although neoadjuvant treatment is increasingly used in patients with PDAC, data on VTE in this setting remain scarce. This study evaluated VTE incidence during (neo)adjuvant therapy for resectable and borderline resectable PDAC and its relation to survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This study included patients from the investigator-initiated, multicenter, randomized controlled phase III PREOPANC-2 trial. Patients were randomly assigned to neoadjuvant 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin followed by surgery (FFX arm) or neoadjuvant gemcitabine-based chemoradiotherapy (CRT), followed by surgery and adjuvant gemcitabine (CRT arm). VTE was defined as both incidental and symptomatic lower- or upper-extremity deep vein thrombosis, pulmonary embolism (PE), splanchnic vein thrombosis, and catheter-related thrombosis. VTE occurrence was retrospectively evaluated from random assignment to 12 months after random assignment. The association with overall survival (OS) was analyzed using Cox regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      VTE was diagnosed in 28 of 325 patients (9%): nine (3%) preoperatively and 19 (8%) postoperatively. Most VTEs were symptomatic (54%). Although a higher proportion of patients developed postoperative VTE in the CRT arm (FFX 3%\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      CRT 12%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .02), the 12-month cumulative incidence did not differ between arms (6%\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      11%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .06). Two patients died from PE-related causes in the CRT arm. VTE was independently associated with reduced OS (adjusted time-varying hazard ratio, 2.13,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>VTE occurred in 9% of patients with (borderline) resectable PDAC undergoing (neo)adjuvant treatment in the year after random assignment and was associated with decreased OS. These results underscore the need for standardized reporting of thromboembolic events in clinical trials and future studies assessing the potential benefits of thromboprophylaxis during neoadjuvant therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/jco-25-01935","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T21:00:07Z","timestamp":1769720407000},"page":"662-675","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":2,"title":["Thromboembolic Events During Perioperative Therapy for Resectable and Borderline Resectable Pancreatic Cancer in the PREOPANC-2 Trial"],"prefix":"10.1200","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5157-0191","authenticated-orcid":true,"given":"Ruth A.L.","family":"Willems","sequence":"first","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands"},{"name":"GROW\u2014Research Institute for Oncology &amp; Reproduction, Maastricht University, Maastricht, the Netherlands"},{"name":"Department of Functional Coagulation, Synapse Research Institute, Maastricht, the Netherlands"},{"name":"Maastricht University Medical Center, Thrombosis Expert Center Maastricht, Maastricht, the Netherlands"},{"name":"School for Cardiovascular Diseases, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0192-5354","authenticated-orcid":true,"given":"Aniek E.","family":"van Diepen","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands"},{"name":"GROW\u2014Research Institute for Oncology &amp; Reproduction, Maastricht University, Maastricht, the Netherlands"},{"name":"Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3040-6736","authenticated-orcid":true,"given":"Esther N.","family":"Dekker","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus MC Cancer Institute Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quisette P.","family":"Janssen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus MC Cancer Institute Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6947-9035","authenticated-orcid":true,"given":"Jacob L.","family":"van Dam","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus MC Cancer Institute Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nynke","family":"Michiels","sequence":"additional","affiliation":[{"name":"Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1461-6725","authenticated-orcid":true,"given":"Casper W.F.","family":"van Eijck","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Erasmus University Medical Centre, Solid Tumour Immunology Research Rotterdam (STIRR), Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7629-0820","authenticated-orcid":true,"given":"Karlijn E.P.E.","family":"Hermans","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands"},{"name":"GROW\u2014Research Institute for Oncology &amp; 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