Large retroperitoneal lymphadenopathy and increased risk of venous thromboembolism in patients receiving first-line chemotherapy for metastatic germ cell tumors: A study by the global germ cell cancer group (G3).
Adolescent
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols
/ administration & dosage
Catheters, Indwelling
/ adverse effects
Child
Cisplatin
/ administration & dosage
Humans
Lymph Nodes
/ pathology
Lymphatic Metastasis
/ drug therapy
Male
Middle Aged
Neoplasms, Germ Cell and Embryonal
/ drug therapy
Retroperitoneal Neoplasms
/ drug therapy
Retroperitoneal Space
/ pathology
Retrospective Studies
Risk Assessment
Risk Factors
Vascular Access Devices
/ adverse effects
Venous Thromboembolism
/ epidemiology
Young Adult
deep vein thrombosis
germ cell tumor
pulmonary embolism
testicular cancer
vascular access device
venous thromboembolism
Journal
Cancer medicine
ISSN: 2045-7634
Titre abrégé: Cancer Med
Pays: United States
ID NLM: 101595310
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
02
09
2019
revised:
19
10
2019
accepted:
21
10
2019
pubmed:
13
11
2019
medline:
20
1
2021
entrez:
13
11
2019
Statut:
ppublish
Résumé
Metastatic germ cell tumor (mGCT) patients receiving chemotherapy have increased risk of life-threatening venous thromboembolism (VTE). Identifying VTE risk factors may guide thromboprophylaxis in this highly curable population. Data were collected from mGCT patients receiving first-line platinum-based chemotherapy at 22 centers. Predefined variables included International Germ Cell Cancer Collaborative Group (IGCCCG) risk classification, long-axis diameter of largest retroperitoneal lymph node (RPLN), Khorana score, and use of indwelling vascular access device (VAD). VTE occurring at baseline, during chemotherapy and within 90 days, was analyzed. Data from 1135 patients were collected. Median age was 31 years (range 10-74). IGCCCG risk was 64% good, 20% intermediate, and 16% poor. VTE occurred in 150 (13%) patients. RPLN >3.5 cm demonstrated highest discriminatory accuracy for VTE (AUC 0.632, P < .001) and was associated with significantly higher risk of VTE in univariable analysis (22% vs 8%, OR 3.0, P < .001) and multivariable analysis (OR 1.8, P = .02). Other significant risk factors included, Khorana score ≥3 (OR 2.6, P = .008) and VAD use (OR 2.7, P < .001). Large RPLN and VAD use are independent risk factors for VTE in mGCT patients receiving chemotherapy. VAD use should be minimized in this population and thromboprophylaxis might be considered for large RPLN.
Sections du résumé
BACKGROUND
Metastatic germ cell tumor (mGCT) patients receiving chemotherapy have increased risk of life-threatening venous thromboembolism (VTE). Identifying VTE risk factors may guide thromboprophylaxis in this highly curable population.
METHODS
Data were collected from mGCT patients receiving first-line platinum-based chemotherapy at 22 centers. Predefined variables included International Germ Cell Cancer Collaborative Group (IGCCCG) risk classification, long-axis diameter of largest retroperitoneal lymph node (RPLN), Khorana score, and use of indwelling vascular access device (VAD). VTE occurring at baseline, during chemotherapy and within 90 days, was analyzed.
RESULTS
Data from 1135 patients were collected. Median age was 31 years (range 10-74). IGCCCG risk was 64% good, 20% intermediate, and 16% poor. VTE occurred in 150 (13%) patients. RPLN >3.5 cm demonstrated highest discriminatory accuracy for VTE (AUC 0.632, P < .001) and was associated with significantly higher risk of VTE in univariable analysis (22% vs 8%, OR 3.0, P < .001) and multivariable analysis (OR 1.8, P = .02). Other significant risk factors included, Khorana score ≥3 (OR 2.6, P = .008) and VAD use (OR 2.7, P < .001).
CONCLUSIONS
Large RPLN and VAD use are independent risk factors for VTE in mGCT patients receiving chemotherapy. VAD use should be minimized in this population and thromboprophylaxis might be considered for large RPLN.
Identifiants
pubmed: 31715650
doi: 10.1002/cam4.2674
pmc: PMC6943085
doi:
Substances chimiques
Cisplatin
Q20Q21Q62J
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
116-124Informations de copyright
© 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
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