Abstract
BackgroundPatients with testicular germ cell tumors (TGCT) have an increased risk for venous thromboembolism (VTE). We identified risk factors for VTE in this patient cohort and developed a clinical risk model.MethodsIn this retrospective cohort study at the Medical University of Graz we included 657 consecutive TGCT patients across all clinical stages. A predictive model for VTE was developed and externally validated in 349 TGCT patients treated at the University Hospital Zurich.ResultsVenous thromboembolic events occurred in 34 (5.2%) patients in the Graz cohort. In univariable competing risk analysis, higher clinical stage (cS) and a retroperitoneal lymphadenopathy (RPLN) were the strongest predictors of VTE (p<0.0001). As the presence of a RPLN with more than 5cm in greatest dimension without coexisting visceral metastases is classified as cS IIC, we constructed an empirical VTE risk model with the following four categories (12-month-cumulative incidence): cS IA-B 8/463 patients (1.7%), cS IS-IIB 5/86 patients (5.9%), cS IIC 3/21 patients (14.3%) and cS IIIA-C 15/70 patients (21.4%). This risk model was externally validated in the Zurich cohort (12-month-cumulative incidence): cS IA-B (0.5%), cS IS-IIB (6.0%), cS IIC (11.1%) and cS IIIA-C (19.1%). Our model had a significantly higher discriminatory performance than a previously published classifier (RPLN-VTE-risk-classifier) which is based on the size of RPLN alone (AUC-ROC: 0.75 vs. 0.63, p = 0.007).ConclusionsAccording to our risk stratification, TGCT patients with cS IIC and cS III disease have a very high risk of VTE and may benefit from primary thromboprophylaxis for the duration of chemotherapy.
Highlights
Testicular germ cell tumors (TGCT) represent one of the most curable solid malignancies as cisplatin-based chemotherapy is highly efficacious in achieving durable remissions even in widely metastatic disease [1,2,3]
As the presence of a retroperitoneal lymphadenopathy (RPLN) with more than 5cm in greatest dimension without coexisting visceral metastases is classified as clinical stage (cS) IIC, we constructed an empirical venous thromboembolism (VTE) risk model with the following four categories (12month-cumulative incidence): cS IA-B 8/463 patients (1.7%), cS IS-IIB 5/86 patients (5.9%), cS IIC 3/21 patients (14.3%) and cS IIIA-C 15/70 patients (21.4%)
Our model had a significantly higher discriminatory performance than a previously published classifier (RPLN-VTE-risk-classifier) which is based on the size of RPLN alone (AUC-ROC: 0.75 vs. 0.63, p = 0.007)
Summary
Testicular germ cell tumors (TGCT) represent one of the most curable solid malignancies as cisplatin-based chemotherapy is highly efficacious in achieving durable remissions even in widely metastatic disease [1,2,3]. Moore et al have demonstrated a very high incidence of thromboembolic events in patients receiving cisplatin-based chemotherapy [7]. Thromboembolic events have a high impact on morbidity of cancer patients and are negative predictors of survival [8,9,10,11,12]. Khorana et al recently developed a predictive model for chemotherapy-associated VTE [6]. Srikanthan et al have shown that a large (more than 5cm in maximal axial diameter) retroperitoneal lymphadenopathy (RPLN) is a strong risk factor for VTE in TGCT, and that this predictor provides a higher discriminatory accuracy for the prediction of VTE than the Khorana score. Patients with testicular germ cell tumors (TGCT) have an increased risk for venous thromboembolism (VTE). We identified risk factors for VTE in this patient cohort and developed a clinical risk model
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