The risk of thrombo-embolic events is increased in patients with germ-cell tumours and can be predicted by serum lactate dehydrogenase and body surface area

Abstract

The aim of this study was to evaluate the risk of thrombo-embolic events (TEE) in patients with germ-cell tumours (GCT) who receive cisplatin-based chemotherapy, to compare this risk to that of a matched control group of non-GCT cancer patients, and to identify risk factors of TEE. The rate of TEE during the 6 months following the initiation of chemotherapy was assessed in 100 consecutive patients with GCT and in 100 controls with various neoplasms who were matched on sex and age, and who received first-line cisplatin-based chemotherapy during the same period of time at Institut Gustave Roussy, Villejuif, France. Data were subsequently tested on a validation group of 77 GCT patients treated in Lyon, France. A total of 19 patients (19%) (95% confidence interval (CI): 13 -28) and six patients (6%) (95% CI: 3 -13) had a TEE in the GCT group and the non-GCT control group, respectively (relative risk (RR): 3.4; Po0.01). Three patients from the GCT group died of pulmonary embolism. In multivariate analysis, two factors had independent predictive value for TEE: a high body surface area (41.9 m 2 ) (RR: 5 (1.8 -13.9)) and an elevated serum lactate dehydrogenase (LDH) (RR: 6.4 (2.3 -18.2)). Patients with no risk factor (n ¼ 26) and those with at least one risk factor (n ¼ 71) had a probability of having a TEE of 4% (95% CI: 1 -19) and 26% (95% CI: 17 -37), respectively. In the GCT validation set, 10 (13%) patients had a TEE; patients with no risk factor and those with at least one risk factor had a probability of having a TEE of 0 and 17% (95% CI: 10 -29), respectively. Patients with GCT are at a higher risk for TEE than patients with non-GCT cancer while on cisplatin-based chemotherapy. This risk can be accurately predicted by serum LDH and body surface area. This predictive index may help to study prospectively the impact of thromboprophylaxis in GCT patients.

Venous Thromboembolic Events in Germ Cell Cancer Patients Undergoing Platinum-Based Chemotherapy

“…The incidence of VTEEs of 11% in GCT patients is in line with earlier reports, ranging from 7.7 to 18.0% [12,18,19,21,22]. However, the most important finding is that the majority of the VTEEs occurred even before initiation of chemotherapy and the incidence of just 2% of VTEEs occurring under chemotherapy is much lower than reported in previous analyses, although the rate of patients receiving prophylactic anticoagulation was also low at only 9%.…”

“…A population-based retrospective analysis reported a cumulative incidence of 1% for GCT patients in the first 6 months after diagnosis [1]. However, knowledge on the exact incidence and associated risk factors is limited and is mostly derived from case reports or case series with small patient samples [12,13,18,19,20,21,22]. The reported frequency of VTEEs in these studies varied between 8 and 18% [12,19].…”

“…Several risk factors for VTEEs like the use of a central venous catheter (CVC) and arterial hypertension have been identified in cancer patients [22,23,24,25]. In GCT patients, lactate dehydrogenase (LDH) levels, body surface area, and arterial hypertension have been reported as risk factors [19,21]. …”

Arterial thrombosis after cisplatin-based chemotherapy for metastatic germ cell tumors

“…Another analysis compared TEE in 100 GCT patients with 100 non-GCT patients who received cisplatin therapy. The former were found to be at a higher risk, and it appeared that TEE was predicted by serum lactose dehydrogenase levels and body surface area [12]. In spite of supporting evidence, at least three publications with retrospective analyses have reported no apparent correlation between acute cardiovascular complications, GCTs, and chemotherapy [13Á15].…”

Disappearance of a major thrombus in the brachiocephalic vein without anticoagulant therapy in a patient with seminoma - a case report

“…Several reports have described venous thrombosis in testicular cancer patients during chemotherapy. [1][2][3] We report a case of thrombosis in the right brachiocephalic vein that occurred during cisplatin, etoposide and bleomycin (PEB) therapy for testicular seminoma. The thrombosis in the present case disappeared even though no anticoagulant therapy was undertaken.…”