Abstract
PurposeTo investigate if patients receiving neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) had an increased risk of thromboembolic events (TEE) and to evaluate when these events occur on a timeline starting from 6 months pre-cystectomy, during NAC-administration and 60 months post-cystectomy.MethodsTwo hundred and fifty five patients undergoing radical cystectomy during 2009–2014 at three Swedish cystectomy centers (Umeå, Linköping and Sundsvall) were in-detail reviewed retrospectively, using individual medical records. One hundred and twenty nine patients were ineligible for analysis. NAC patients (n = 67) were compared to NAC-naïve NAC-eligible patients (n = 59). The occurrence of TEE was divided into different periods pre-cystectomy and post-cystectomy. Statistical analyses included Chi-squared and logistical regression tests.ResultsSignificant associations were found between receiving NAC and acquiring a TEE during NAC therapy pre-cystectomy. All but one pre-cystectomy event was venous and all but one of the patients received NAC. 31% (14/45) of TEEs occurred pre-cystectomy. The incidence of TEEs pre-cystectomy in NAC-naive NAC-eligible patients was only 10% (2/20), whereas the incidence of TEEs in NAC patients occurred pre-cystectomy in 48% (12/25) and 11/12 incidents were detected during NAC therapy—this including 7/11 (64%) incidents affecting veins in anatomical conjunction with the placement of central venous access for chemotherapy administration.ConclusionsThere is a significantly increased risk for TEE pre-cystectomy during chemotherapy administration in MIBC patients receiving NAC, compared to the risk in NAC-naïve NAC-eligible MIBC patients. In 64% of the pre-RC TEEs in NAC patients, there was a clinical connection to placement of central venous access.
Highlights
Kristoffer Ottosson and Sofia Pelander have contributed to this work.Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 901 85 Umeå, SwedenDivision of Urology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, SwedenDepartment of Urology, Sundsvall Hospital, Sundsvall, SwedenUrinary bladder cancer (UBC) is the fourth most common malignancy in men and eighth most common in women, in the western world [1]
The incidence of thromboembolic events (TEE) pre-cystectomy in neoadjuvant combination chemotherapy (NAC)-naive NAC-eligible patients was only 10% (2/20), whereas the incidence of TEEs in NAC patients occurred pre-cystectomy in 48% (12/25) and 11/12 incidents were detected during NAC therapy—this including 7/11 (64%) incidents affecting veins in anatomical conjunction with the placement of central venous access for chemotherapy administration
In 64% of the pre-RC TEEs in NAC patients, there was a clinical connection to placement of central venous access
Summary
Kristoffer Ottosson and Sofia Pelander have contributed to this work. Division of Urology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. While most newly diagnosed patients have non-muscle-invasive bladder cancer, urothelial muscle-invasive bladder cancer (MIBC) accounts for approximately 25% of new cases, with a 5-year overall survival (OS) of approximately 50% in stages cT2-T4 after radical cystectomy [2]. Cisplatin-based neoadjuvant combination chemotherapy (NAC) for MIBC is a treatment, first introduced internationally and nationally (Sweden) in the mid-2000s with the intention to eradicate micrometastatic disease at the best point of time. NAC had been preceded by reliable randomized prospective studies showing that the treatment had conveyed survival benefits equivalent to a 5–8% absolute improvement in 5 years median time, compared to local treatment (RC). NAC has been shown to significantly increase
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