Non-bacterial thrombotic endocarditis in ovarian cancer: A systematic review

IF 1.2 Q3 OBSTETRICS & GYNECOLOGY

Gynecologic Oncology Reports Pub Date : 2025-05-05 DOI:10.1016/j.gore.2025.101751

Mahalia Huba , Fahad Hussain , Saimanoj Guntaka , Awais Paracha , Pranav Sathe , Bhavya Parikh , Margot Noyelle , Umar Durrani , Himanshu Patel , Veena John

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Abstract

Background

Non-Bacterial Thrombotic Endocarditis (NBTE) is characterized by the formation of sterile vegetations on the heart valves, often due to an underlying hypercoagulable state in the setting of malignancy, inflammation, or autoimmune disease. NBTE is a rare condition with a reported incidence rate of between 0.9% and 1.6%. Among gynecologic malignancies, NBTE is predominantly observed in ovarian cancer. A comprehensive review of the literature was conducted to understand the association between NBTE and ovarian cancer.

Methods

A search of PubMed/MEDLINE was conducted from database inception to January 2024 using terms related to “Non-Bacterial Thrombotic Endocarditis” and “Ovarian Cancer.” Studies were included if they involved patients diagnosed with both NBTE and ovarian cancer and excluded if they did not report confirmed NBTE and ovarian cancer. Risk of bias was assessed using Mixed Methods Analysis Testing.

Results

The search identified 15 patients from 14 case reports, all female, with an average age of 50.6. The most common presenting diagnosis was CVA (53%). Ovarian cancer was diagnosed before NBTE 57% of the time. Most patients (67%) had stage III or IV cancer. Metastases predominantly affected lymph nodes (40%), liver (40%), and the other ovary (20%). Malignancy was treated with chemotherapy in 63% of cases. Surgical resection was performed in 40% of cases. One patient underwent radiation therapy. Mortality rate was 40% in patients treated with chemotherapy and 100% in patients not receiving chemotherapy. NBTE predominantly affected the mitral valve (52.4%), followed by the aortic valve at (33.3%), and the tricuspid valve (14.3%). 80% of patients experienced organ infarct. Infarcts predominantly affected the brain (27.0%), spleen (27.0%), lung (8.1%), and heart (8.1%). NBTE was treated with anticoagulation in 54% of cases. All-cause mortality at study publication was 75%.

Conclusions

NBTE is an important, and often overlooked, cause of mortality in ovarian cancer. Clinicians should maintain high clinical suspicion for NBTE in patients with ovarian cancer presenting with thromboembolic phenomena.

REGISTRATION

This review was registered with PROSPERO under the ID number: CRD42024501301.

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卵巢癌的非细菌性血栓性心内膜炎：一项系统综述

背景：非细菌性血栓性心内膜炎（NBTE）的特点是在心脏瓣膜上形成无菌植被，通常是由于恶性肿瘤、炎症或自身免疫性疾病背景下的潜在高凝状态。NBTE是一种罕见的疾病，据报道发病率在0.9%至1.6%之间。在妇科恶性肿瘤中，NBTE主要见于卵巢癌。我们对相关文献进行了全面的回顾，以了解NBTE与卵巢癌之间的关系。方法检索PubMed/MEDLINE数据库，从数据库建立到2024年1月，检索与“非细菌性血栓性心内膜炎”和“卵巢癌”相关的术语。同时诊断为NBTE和卵巢癌的患者纳入研究，未报告证实NBTE和卵巢癌的排除研究。偏倚风险采用混合方法分析检验进行评估。结果从14例报告中确定了15例患者，均为女性，平均年龄为50.6岁。最常见的诊断是CVA（53%）。在NBTE之前卵巢癌的诊断率为57%。大多数患者（67%）为III期或IV期癌症。转移主要发生在淋巴结（40%）、肝脏（40%）和另一侧卵巢（20%）。63%的恶性肿瘤接受化疗。40%的病例行手术切除。一名患者接受了放射治疗。接受化疗的患者死亡率为40%，未接受化疗的患者死亡率为100%。NBTE主要影响二尖瓣（52.4%），其次是主动脉瓣（33.3%）和三尖瓣（14.3%）。80%的患者出现器官梗死。梗死主要累及脑（27.0%）、脾（27.0%）、肺（8.1%）和心脏（8.1%）。54%的NBTE患者接受抗凝治疗。研究发表时的全因死亡率为75%。结论snbte是卵巢癌重要的死亡原因，但常被忽视。临床医生应该对伴有血栓栓塞现象的卵巢癌患者的NBTE保持高度的临床怀疑。本综述已在普洛斯彼罗注册，ID号：CRD42024501301。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gynecologic Oncology Reports OBSTETRICS & GYNECOLOGY-

CiteScore

2.00

自引率

0.00%

发文量

183

审稿时长

41 days

期刊介绍： Gynecologic Oncology Reports is an online-only, open access journal devoted to the rapid publication of narrative review articles, survey articles, case reports, case series, letters to the editor regarding previously published manuscripts and other short communications in the field of gynecologic oncology. The journal will consider papers that concern tumors of the female reproductive tract, with originality, quality, and clarity the chief criteria of acceptance.