Abstract
<title>Abstract</title> <p>Background Risk stratification in patients with venous thromboembolism (VTE) and cancer is predominantly tumor-centered, although outcomes are also influenced by patient clinical characteristics. Whether non-oncologic clinical profiles identify prognostic subgroups independent of tumor-related thrombotic risk remains insufficiently explored. Methods We conducted a retrospective cohort study of patients with venous thromboembolism (VTE) and current or prior malignancy treated at a tertiary referral center in Colombia between January 2011 and January 2025. Clinical phenotypes were identified using multiple correspondence analysis followed by hierarchical clustering (Ward’s method), excluding tumor site and oncologic treatments from the clustering process. Overall survival (OS) was estimated using Kaplan–Meier analysis. Cox proportional hazards models were used to evaluate the association between clinical phenotypes and mortality, adjusting for tumor-related thrombotic risk categories. Results A total of 654 patients were included (median age 66.6 years; 68.8% female; 72.9% with active cancer at VTE diagnosis). Median OS for the entire cohort was 3.7 years (95% CI 2.8–5.4). Three clinical phenotypes were identified: (1) younger patients with active cancer (n = 367), (2) older patients with recent surgical exposure (n = 211), and (3) older patients with multimorbidity (n = 76). Median OS differed across phenotypes (2.4, 6.2, and 3.8 years, respectively). Low-molecular-weight heparin was the predominant anticoagulant (76.5%). In multivariable analysis, both clinical phenotype and tumor-related thrombotic risk were independently associated with OS. Conclusions Among patients with VTE and malignancy, clinical phenotypes defined by non-oncologic characteristics identify prognostic groups beyond tumor-related thrombotic risk. These findings highlight the relevance of patient clinical profile in outcome heterogeneity within this population.</p>