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Predictors of thrombosis in testicular cancer during platinum-based chemotherapy

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Abstract

Purpose

To identify potential risk factors for the development of venous thromboembolic events in testicular cancer patients receiving platinum-based chemotherapy.

Methods

We performed a retrospective analysis including 255 patients with testicular germ cell tumors who received platinum-based chemotherapy from 2003 to 2018 as a multi-center observational cohort study. Patient and tumor characteristics of patients with and without a thromboembolic event were analyzed.

Results

49 (19%) patients experienced a venous thromboembolic event, with the majority representing pulmonary embolism and deep venous thrombosis (47%). There were no significant differences regarding the development of a venous thromboembolic event between first- and second-line regimes. Multivariate analysis showed an increased risk for a venous thromboembolic event in patients with clinical stage ≥ IIC disease (OR 2.259 [95% CI 1.105–4.618], p = 0.026), elevated serum LDH (OR 2.162 [95% CI 1.018–4.593], p = 0.045), febrile neutropenia (OR 2.973 [95% CI 1.363–6.487], p = 0.006) and central venous access (OR 3.465 [95% CI 1.068–11.243], p = 0.039). Patients suffering from a venous thromboembolic event revealed a significantly reduced overall survival (p = 0.033) during a median follow-up of 8 months [IQR 2–18].

Conclusions

19% of all patients treated by platinum-based chemotherapy due to testicular cancer suffered from a venous thromboembolic event, associated with reduced overall survival. As a result, monitoring of cancer patients at risk as well as the improvement of patients’ awareness of a thromboembolic event should thus be the main goal of their treating physicians.

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Abbreviations

AFP:

Alpha-Fetoprotein

BEP:

Bleomycin, etoposide, cisplatin

GCT:

Germ cell tumors

β-hCG:

Human chorionic gonadotropin

IGCCCG:

International germ cell cancer collaborative group

IQR:

Interquartile range

LDH:

Lactate dehydrogenase

PEI:

Cisplatin, etopside, ifosfamide

PC-RPLND:

Post-chemotherapy retroperitoneal lymph node dissection

TIP:

Cisplatin, ifosfamide, paclitaxel

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    Pia Paffenholz, Katharina Grein, Tim Nestler, Markus Grabbert, Johannes Salem, David Pfister & Axel Heidenreich

  2. Department of Urology, Medical University Innsbruck, Innsbruck, Austria

    Isabel Heidegger

  3. Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany

    Martin Hellmich

Authors
  1. Pia Paffenholz
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  2. Katharina Grein
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  3. Isabel Heidegger
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  4. Tim Nestler
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  5. Markus Grabbert
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  6. Johannes Salem
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  7. Martin Hellmich
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  8. David Pfister
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  9. Axel Heidenreich
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Contributions

MG: manuscript editing. KG: data collection or management, data analysis. IH: manuscript editing. AH: project development, manuscript editing, supervision. MH: data analysis, manuscript editing. TN: manuscript editing. PP: project development, data collection or management, data analysis, manuscript writing/editing. DP: project development, manuscript editing, supervision. JS: manuscript editing.

Corresponding author

Correspondence to Axel Heidenreich.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Paffenholz, P., Grein, K., Heidegger, I. et al. Predictors of thrombosis in testicular cancer during platinum-based chemotherapy. World J Urol 37, 1907–1916 (2019). https://doi.org/10.1007/s00345-018-2598-7

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  • DOI: https://doi.org/10.1007/s00345-018-2598-7

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