Clinical and prognostic insights into Trousseau's syndrome in gynecologic malignancies: a multicenter study

Trousseau's syndrome lacks standardized diagnostic criteria, and its rarity has hindered large-scale investigations. This study aims to elucidate the diagnostic landscape of Trousseau's syndrome in gynecological malignancies within a multicenter framework and to identify prognostic determinants.

A retrospective multicenter study was conducted, encompassing patients diagnosed with Trousseau's syndrome secondary to gynecologic malignancies across 6 Japanese institutions affiliated with the Tohoku Gynecologic Cancer Unit from 2003 to 2018. Institutional diagnostic criteria were consolidated, and clinical characteristics, treatment approaches, and prognostic factors were systematically analyzed.

A total of 88 patients were included, the majority presenting with multiple infarctions involving cerebral infarction and hypercoagulability. However, some cases were diagnosed based on isolated cerebral infarction, highlighting variability in diagnostic criteria. Prognostic factors significantly associated with survival included D-dimer levels (p=0.030), treatment of the primary malignancy after infarction (p<0.001), International Federation of Gynecology and Obstetrics stage (p<0.001), performance status (p=0.006), and the timing of Trousseau's syndrome onset (p<0.001) in univariate analysis. Multivariate analysis revealed that treatment of the primary malignancy after infarction was a key determinant of improved prognosis.

This study underscores the heterogeneity in diagnostic criteria for Trousseau's syndrome and suggests that hypercoagulability serves not only as a diagnostic adjunct but also as a prognostic indicator. Moreover, intervention targeting the primary malignancy after infarction significantly enhances survival outcomes, emphasizing the necessity of an integrated therapeutic strategy.