1
|
Paffenholz P. [Venous thromboembolism: risk factors and prophylaxis]. Aktuelle Urol 2024; 55:44-49. [PMID: 37339669 DOI: 10.1055/a-2099-8233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Venous thromboembolism is an important complication in tumour patients as it occurs frequently in these patients and causes relevant morbidity. The risk of thromboembolic complications in tumour patients is 3-9 times higher than in non-tumour patients and is the second most common cause of death in tumour patients. The risk of thrombosis depends on tumour-induced coagulopathy and on individual factors, type and stage of cancer, time since cancer diagnosis as well as type of systemic cancer therapy. Thromboprophylaxis in tumour patients is effective but can be associated with increased bleeding. Even though there are currently no dedicated recommendations for individual tumour entities, international guidelines recommend prophylactic measures in high-risk patients. A thrombosis risk of >8-10% can be considered an indication for thromboprophylaxis, which is indicated by a Khorana score ≥2, and should be calculated individually using nomograms. In particular, patients with a low risk of bleeding should receive thromboprophylaxis. Risk factors and symptoms of a thromboembolic event should also be intensively discussed with the patient and materials for patient information should be handed out.
Collapse
|
2
|
Michalski W, Poniatowska G, Jońska‐Gmyrek J, Żółciak‐Siwińska A, Zastawna I, Lemiński A, Macios A, Jakubczyk M, Demkow T, Wiechno P. Simple yet (more?) effective. Venous thromboembolism risk assessment model for germ cell tumour patients receiving first-line chemotherapy. Cancer Med 2023; 12:18542-18556. [PMID: 37584231 PMCID: PMC10557845 DOI: 10.1002/cam4.6458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/12/2023] [Accepted: 08/03/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Germ cell tumours (GCT) are highly curable malignancies. Venous thromboembolism (VTE) is a serious complication, needing better risk assessment models (RAM). AIM Identification of VTE incidence and risk factors in metastatic GCT patients starting first-line chemotherapy. Developing a RAM and comparing it to Khorana risk score (KRS) and Padua Prediction Score (PPS). MATERIAL AND METHODS We retrospectively analysed GCT patients staged IS-IIIC. VTE risk factors were identified with logistic regression. Area under curve of receiver operating characteristic (AUC-ROC), Akaike and Bayesian Information Criteria (AIC, BIC) were calculated for the developed RAM, KRS and PPS. RESULTS Among 495 eligible patients, VTE occurred in 69 (13.9%), including 40 prior to chemotherapy. Vein compression (OR: 8.96; 95% CI: 2.85-28.13; p < 0.001), clinical stage IIIB-IIIC (OR: 5.68; 95% CI: 1.82-17.70; p = 0.003) and haemoglobin concentration (OR for 1 g/dL decrease: 1.32; 95% CI: 1.03-1.67; p = 0.026) were significant in our RAM. KRS ≥ 3 (OR: 3.31; 95% CI: 1.77-6.20; p < 0.001), PPS 4-5 (OR: 3.06; 95% CI: 1.49-6.29; p = 0.002) and PPS > 5 (OR 8.05; 95% CI 3.79-17.13; p < 0.001) correlated with VTE risk. Diagnostic criteria (AUC-ROC, AIC, BIC) for the developed RAM, KRS and PPS were (0.885; 0.567; -1641), (0.588; 0.839; -1576) and (0.700; 0.799; -1585), respectively. In the numerical score, the optimal cut-off point for high-risk was ≥9, with sensitivity, specificity, positive and negative predictive value of 0.78, 0.77, 0.35 and 0.96, respectively. CONCLUSIONS Our RAM, based on vein compression, clinical stage and haemoglobin concentration proved superior to both KRS and PPS. VTE is frequent in GCT patients.
Collapse
Affiliation(s)
- Wojciech Michalski
- Department of Urological CancerMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Grażyna Poniatowska
- Department of Urological CancerMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Joanna Jońska‐Gmyrek
- Department of Gynaecological OncologyMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Agnieszka Żółciak‐Siwińska
- Department of Gynaecological OncologyMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Inga Zastawna
- Clinical Centre of Cardiology and Rare Diseases of the Cardiovascular SystemNational Institute of Medicine of the Ministry of the Interior and AdministrationWarsawPoland
| | - Artur Lemiński
- Department of Urology and Urological OncologyPomeranian Medical UniversitySzczecinPoland
| | - Anna Macios
- Department of Cancer PreventionMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Michał Jakubczyk
- SGH Warsaw School of Economics, Institute of Econometrics, Collegium of Economic AnalysisWarsawPoland
| | - Tomasz Demkow
- Department of Urological CancerMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Paweł Wiechno
- Department of Urological CancerMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| |
Collapse
|
3
|
Terbuch A, Walser G, Stotz M, Gerger A, Posch F, Bauernhofer T. Primary Thromboprophylaxis and the Risk of Venous Thromboembolic Events in Patients With Testicular Germ Cell Tumors Treated With Cisplatinum-Based Chemotherapy. Clin Genitourin Cancer 2023; 21:24-31. [PMID: 36400695 DOI: 10.1016/j.clgc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cisplatinum-based chemotherapy is associated with an increased risk of venous thromboembolism (VTE). We hypothesized that primary thromboprophylaxis in patients with testicular germ cell tumors (GCT) undergoing cisplatinum-based chemotherapy can reduce the risk of VTE. PATIENTS AND METHODS In this single-center retrospective cohort study, we investigated the increased use of primary thromboprophylaxis between January 2000 and December 2021 at our institution and its effect on the risk of VTE. Patients with GCT undergoing adjuvant or curative cisplatinum-based chemotherapy were included. RESULTS Three hundred forty-six patients with GCT initiating a cisplatinum-based therapy were included in the study, of whom 122 (35%) were treated in the adjuvant and 224 (65%) in the curative setting, respectively. VTE events occurred in 49 (14.2%) patients. In univariable competing risk analysis, a higher clinical tumor stage and large retroperitoneal lymphadenopathy (RPLND >5 cm) were the strongest predictors of an elevated VTE risk (SHR for stage IIC - IIIC: 2.6 (95%CI: 5.0-24.7, P < .001), SHR for RPLN: 2.36 (95%CI: 1.27-4.4, P < .007)). The proportion of patients receiving primary thromboprophylaxis strongly increased over time and reached 100% in CS IIC-III patients from 2019 onwards. After adjusting for tumor stage, primary thromboprophylaxis was associated with a 52% relatively lower risk of VTE (SHR = 0.48, 95% CI: 0.24-0.97; P = .032). CONCLUSION In this retrospective cohort study, we showed that TGCT patients undergoing cisplatinum-based chemotherapy have a lower VTE risk when receiving primary thromboprophylaxis. For the duration of chemotherapy, primary thromboprophylaxis should be considered on a risk-benefit ratio.
Collapse
Affiliation(s)
- Angelika Terbuch
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gudrun Walser
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Michael Stotz
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Armin Gerger
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florian Posch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | - Thomas Bauernhofer
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| |
Collapse
|
4
|
Testicular cancer with extensive gonadal and renal vein tumor thrombus. Clin Imaging 2021; 79:348-352. [PMID: 34419852 DOI: 10.1016/j.clinimag.2021.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 11/20/2022]
Abstract
Tumor thrombus has been demonstrated to occur with hepatocellular and renal cell carcinoma, however, rarely occurs in testicular germ cell malignancies. Tumor thrombus results from the intravascular invasion of malignant cells, different from the hypercoagulable state induced by malignancy, and has significant implications with regards to prognosis and therapeutic options. We describe a case of an otherwise healthy 30-year-old patient with extensive gonadal and renal vein tumor thrombus from testicular germ cell cancer, as well as discuss the diagnosis and treatment options for this type of metastatic disease.
Collapse
|
5
|
Abdel-Razeq H, Tamimi F, Abdel-Razeq R, Salah S, Omari Z, Salama O, Abufara A, Al-Tell A, Qahoush H, Nasman A, Taqash A, Alhalaseh Y, Bater R. Predictors of Venous Thromboembolism in Patients With Testicular Germ Cell Tumors: A Retrospective Study. Clin Appl Thromb Hemost 2021; 27:10760296211024756. [PMID: 34121471 PMCID: PMC8207283 DOI: 10.1177/10760296211024756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Malignancy, including testicular tumors, significantly increases the risk of venous thromboembolism (VTE). In this study, we search for predictors that may help identify subgroups of patients at higher risk of VTE. Patients with confirmed diagnosis of testicular germ cell tumor and proven VTE were identified. Clinical and pathological features possibly associated with VTE were reviewed. A total of 322 patients, median age (range) 31 (18-76) years were identified. Tumors were mostly non-seminoma (n = 194, 60.2%), node-positive (n = 130, 40.4%) and 58 (18.0%) had metastatic disease at diagnosis. Venous thromboembolism were confirmed in 27 (8.4%) patients; however, rates were significantly higher (P < 0.001) in patients with node-positive (18.5%), metastatic disease (22.4%), and those with high lactate dehydrogenase (LDH) (21.3%). Rates were also significantly higher among those who received multiple lines of chemotherapy (27.5%) compared to those who received one line (13.8%) or none (<1.0%), P < 0.001. Patients with testicular tumors and high tumor burden, including nodal involvement, high LDH or metastatic disease, and those treated with multiple lines of chemotherapy have significantly higher rates of VTE.
Collapse
Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan.,School of Medicine, University of Jordan, Amman, Jordan
| | - Faris Tamimi
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
| | | | - Samer Salah
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Zaid Omari
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Osama Salama
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Alaa Abufara
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Abdalla Al-Tell
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Hanna Qahoush
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Ahmad Nasman
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Ayat Taqash
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Yazan Alhalaseh
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Rayan Bater
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
| |
Collapse
|
6
|
Ellis ML, Okano S, McCann A, McDowall A, Van Kuilenburg R, McCarthy AL, Joubert W, Harper J, Jones M, Mollee P. Catheter-related thrombosis incidence and risk factors in adult cancer patients with central venous access devices. Intern Med J 2021; 50:1475-1482. [PMID: 32043739 DOI: 10.1111/imj.14780] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/08/2019] [Accepted: 02/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Central venous access devices (CVAD) are commonly employed in the management of cancer patients. While having several benefits they are associated with significant risks. AIM To review the incidence and risk factors for catheter-related thrombosis (CRT) in cancer patients with a CVAD. METHODS We performed a prospective observational cohort study of adult patients with cancer requiring a CVAD between 1 January 2004 and 29 June 2016. The rate of, and risk factors for the development of, symptomatic CRT were evaluated. RESULTS A total of 4920 central lines was inserted into 3130 patients. The incidence of CRT was 3.6%. CRT developed a median of 12 days following line insertion. Peripherally inserted central catheters (PICC) were associated with the highest rates of CRT (hazards ratio (HR) 22.2, 95% confidence interval (CI) 2.9-170.6). Older age groups developed CRT at lower rates (HR 0.57; 95% CI 0.39-0.84 for age 50-61 years, and HR 0.63; 95% CI 0.45-0.89 for age >61 years) compared to age <50 years. Increased CRT was seen in patients with prior CRT (HR 1.81; 95% CI 1.19-2.77). There was a trend to more CRT events with a Khorana tumour score of 1 compared to those with a score of 0 (HR 1.37, 95% CI 1.00-1.88). Hodgkin lymphoma, germ cell and oesophagus cancers had the highest CRT rates. Side of insertion was not associated with thrombosis risk (HR 0.77; 95% CI 0.57-1.05; P = 0.10). CONCLUSIONS Age <50 years, PICC lines and prior CRT were associated with highest CRT rate. Cancer subtype and insertion side were not predictive of thrombosis.
Collapse
Affiliation(s)
- Marc L Ellis
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Satomi Okano
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Andrew McCann
- Department of Vascular Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Angela McDowall
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Rosita Van Kuilenburg
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Alexandra L McCarthy
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Warren Joubert
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - John Harper
- Department of Interventional Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mark Jones
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Peter Mollee
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
7
|
Chovanec M, Lauritsen J, Bandak M, Oing C, Kier GG, Kreiberg M, Rosenvilde J, Wagner T, Bokemeyer C, Daugaard G. Late adverse effects and quality of life in survivors of testicular germ cell tumour. Nat Rev Urol 2021; 18:227-245. [PMID: 33686290 DOI: 10.1038/s41585-021-00440-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 02/06/2023]
Abstract
Currently, ~95% of patients with testicular germ cell tumour (TGCT) are cured, resulting in an increasing number of TGCT survivors. Although cured, these men face potential late adverse effects and reduced quality of life. Survivors face a twofold increased risk of second malignant neoplasms after chemotherapy and radiotherapy, with evidence of dose-dependent associations. For survivors managed with surveillance or treated with radiotherapy, the risk of cardiovascular disease (CVD) is comparable to the risk in the general population, whereas treatment with chemotherapy increases the risk of life-threatening CVD, especially during treatment and after 10 years of follow-up. Other adverse effects are organ-related toxicities such as neuropathy and ototoxicity. Pulmonary and renal impairment in patients with TGCT treated with chemotherapy is limited. Survivors of TGCT might experience psychosocial distress including anxiety disorders, fear of cancer recurrence and TGCT-specific issues, such as sexual dysfunction. Late adverse effects can be avoided in most patients with stage I disease if followed on a surveillance programme. However, patients with disseminated disease can experience toxicities associated with radiotherapy and chemotherapy, and/or adverse effects related to surgery for residual disease. The severity of adverse effects increases with dose of both chemotherapy and radiotherapy. This Review discusses the most recent data concerning the late adverse effects of today's standard treatments for TGCT.
Collapse
Affiliation(s)
- Michal Chovanec
- 2nd Department of Oncology, Comenius University, National Cancer Institute, Bratislava, Slovakia
| | - Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christoph Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gry Gundgaard Kier
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Kreiberg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Josephine Rosenvilde
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Wagner
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| |
Collapse
|
8
|
Shields LBE, Daniels MW, Mar N, Rezazadeh Kalebasty A. Thromboembolic events in metastatic testicular cancer treated with cisplatin-based chemotherapy. World J Clin Oncol 2021; 12:183-194. [PMID: 33767973 PMCID: PMC7968108 DOI: 10.5306/wjco.v12.i3.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/18/2020] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Testicular germ cell tumor (TGCT) is the most curable solid tumor and most common cancer among men 18-39 years. While cisplatin-based chemotherapy has significantly lengthened the survival of patients with TGCT, it is associated with a high rate of thromboembolic events (TEE).
AIM To summarize our single-center experience highlighting patients who were diagnosed with TGCT and received platinum-based chemotherapy, with special attention to those patients who suffered a TEE.
METHODS A retrospective analysis of the medical records and imaging studies of 68 consecutive individuals who were diagnosed with TGCT and received platinum-based chemotherapy at our Institution in a metropolitan community between January 1, 2014 and December 31, 2019.
RESULTS A total of 19 (28%) patients experienced a TEE following orchiectomy which occurred during chemotherapy in 13 (68%) of these patients. Patients with a higher pathologic stage (stage III) were significantly (P = 0.023) more likely to experience a TEE compared to patients who had a lower stage. Additionally, patients who were treated with 3 cycles of bleomycine, etoposide, and cisplatin and 1 cycle of etoposide and cisplatin or 4 cycles of etoposide and cisplatin were significantly 5 (P = 0.02) times more likely to experience a TEE compared to patients who were treated with only 3 cycles of bleomycine, etoposide, and cisplatin.
CONCLUSION Due to numerous factors that predispose to a TEE such as large retroperitoneal disease, higher clinical stage, greater number of chemotherapy cycle, central venous catheter, cigarette smoking, and possible cannabis use, high-risk ambulatory patients with TGCT treated with cisplatin-based chemotherapy may benefit from prophylactic anticoagulation. Randomized studies to evaluate the safety and efficacy of prophylactic anticoagulants are warranted in this young patient population generally devoid of medical co-morbidities.
Collapse
Affiliation(s)
- Lisa B E Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, United States
| | - Michael W Daniels
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY 40292, United States
| | - Nataliya Mar
- Division of Hematology/Oncology, Department of Medicine, UCI Medical Center, Orange, CA 92868, United States
| | - Arash Rezazadeh Kalebasty
- Division of Hematology/Oncology, Department of Medicine, UCI Medical Center, Orange, CA 92868, United States
| |
Collapse
|
9
|
Dieckmann KP, Marghawal D, Pichlmeier U, Wülfing C. Thromboembolic Events in Patients with Testicular Germ Cell Tumours Are Predominantly Triggered by Advanced Disease and by Central Venous Access Systems. Urol Int 2020; 105:257-263. [PMID: 33333524 DOI: 10.1159/000512055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thromboembolic events (TEEs) may significantly complicate the clinical management of patients with testicular germ cell tumours (GCTs). We analysed a cohort of GCT patients for the occurrence of TEEs and looked to possible pathogenetic factors. PATIENTS, METHODS TEEs occurring within 6 months after diagnosis were retrospectively analysed in 317 consecutive patients with testicular GCT (median age 37 years, 198 seminoma, 119 nonseminoma). The following factors were analysed for association with TEE: histology, age, clinical stage (CS), chemotherapy, use of a central venous access device (CVA). Data analysis involved descriptive statistical methods with multivariable analysis to identify independent risk factors. RESULTS Twenty-three TEEs (7.3%) were observed, 18 deep vein thromboses, 4 pulmonary embolisms, and 1 myocardial infarction. Univariable risk calculation yielded the following odds ratios (ORs) : >CS1 OR = 43.7 (95% confidence intervals [CIs] 9.9-191.6); chemotherapy OR = 7.8 (95% CI 2.3-26.6); CVA OR = 30.5 (95% CI 11.0-84.3). Multivariable analysis identified only CS > 1 (OR = 16.9; 95% CI 3.5-82.4) and CVA (OR = 9.0; 95% CI 2.9-27.5) as independent risk factors. CONCLUSIONS Patients with CSs >CS1 are at significantly increased risk of TEEs even without chemotherapy. Particular high risk is associated with the use of CVA devices for chemotherapy. Caregivers of GCT patients must be aware of the particular risk of TEEs.
Collapse
Affiliation(s)
| | - David Marghawal
- Asklepios Klinik Altona, Urologische Abteilung, Hamburg, Germany
| | - Uwe Pichlmeier
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Eppendorf, Hamburg, Zentrum für Experimentelle Medizin, Hamburg, Germany
| | | |
Collapse
|
10
|
Fankhauser CD, Tran B, Pedregal M, Ruiz-Morales JM, Gonzalez-Billalabeitia E, Patrikidou A, Amir E, Seidel C, Bokemeyer C, Hermanns T, Rumyantsev A, Tryakin A, Brito M, Fléchon A, Kwan EM, Cheng T, Castellano D, del Muro XG, Hamid AA, Ottaviano M, Palmieri G, Kitson R, Reid A, Heng DY, Bedard PL, Sweeney CJ, Connors JM. A Risk-benefit Analysis of Prophylactic Anticoagulation for Patients with Metastatic Germ Cell Tumours Undergoing First-line Chemotherapy. Eur Urol Focus 2020; 7:1130-1136. [DOI: 10.1016/j.euf.2020.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
|
11
|
Thorsen L, Haugnes HS, Fosså SD, Brydøy M, Tandstad T, Wisløff T, Gjerset GM, Edvardsen E, Larsen KO, Sandset PM, Henriksson CE, Raastad T, Negaard HFS. Thromboembolic events after high-intensity training during cisplatin-based chemotherapy for testicular cancer: Case reports and review of the literature. Int J Cancer 2020; 147:3189-3198. [PMID: 32525564 DOI: 10.1002/ijc.33151] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/21/2020] [Accepted: 05/15/2020] [Indexed: 12/22/2022]
Abstract
The randomized "Testicular cancer and Aerobic and Strength Training trial" (TAST-trial) aimed to evaluate the effect of high-intensity interval training (HIIT) on cardiorespiratory fitness during cisplatin-based chemotherapy (CBCT) for testicular cancer (TC). Here, we report on an unexpected high number of thromboembolic (TE) events among patients randomized to the intervention arm, and on a review of the literature on TE events in TC patients undergoing CBCT. Patients aged 18 to 60 years with a diagnosis of metastatic germ cell TC, planned for 3 to 4 CBCT cycles, were randomized to a 9 to 12 weeks exercise intervention, or to a single lifestyle counseling session. The exercise intervention included two weekly HIIT sessions, each with 2 to 4 intervals of 2 to 4 minutes at 85% to 95% of peak heart rate. The study was prematurely discontinued after inclusion of 19 of the planned 94 patients, with nine patients randomized to the intervention arm and 10 to the control arm. Three patients in the intervention arm developed TE complications; two with pulmonary embolism and one with myocardial infarction. All three patients had clinical stage IIA TC. No TE complications were observed among patients in the control arm. Our observations indicate that high-intensity aerobic training during CBCT might increase the risk of TE events in TC patients, leading to premature closure of the TAST-trial.
Collapse
Affiliation(s)
- Lene Thorsen
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway.,Department of Clinical Service, Oslo University Hospital, Oslo, Norway
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Institute of Clinical Medicine, University of Tromsø - The Arctic University, Tromsø, Norway
| | - Sophie D Fosså
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marianne Brydøy
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | | | - Torbjørn Wisløff
- Institute of Clinical Medicine, University of Tromsø - The Arctic University, Tromsø, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Gunhild M Gjerset
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Elisabeth Edvardsen
- Department of Pulmonary Medicine, Oslo University Hospital, Oslo, Norway.,Department of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway
| | - Karl-Otto Larsen
- Department of Pulmonary Medicine, Oslo University Hospital, Oslo, Norway
| | - Per Morten Sandset
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Carola E Henriksson
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Truls Raastad
- Department of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway
| | | |
Collapse
|
12
|
Nitta S, Kawai K, Kimura T, Kawahara T, Kandori S, Hoshi A, Kojima T, Nishiyama H. Predictors of venous thromboembolism development before and during chemotherapy for advanced germ cell tumor. Jpn J Clin Oncol 2020; 50:338-343. [PMID: 32037439 DOI: 10.1093/jjco/hyz177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/10/2019] [Accepted: 10/23/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We retrospectively analyzed the incidence and localization of venous thromboembolism in patients undergoing chemotherapy for advanced germ cell tumor and separately evaluated the risk factors for venous thromboembolism development before and during chemotherapy. METHODS We included 121 patients treated with cisplatin-based chemotherapy between 2005 and 2018. Venous thromboembolism was defined as venous thrombosis diagnosed using radiological imaging with or without thromboembolic symptoms. We analyzed the clinical parameters for identifying the possible venous thromboembolism risk factors. Khorana score was used to calculate the venous thromboembolism risk. RESULTS Thirteen patients showed prechemotherapy venous thromboembolism and 13 developed venous thromboembolism during chemotherapy. The most common venous thromboembolism was deep vein thrombosis (10 patients), followed by inferior vena cava thrombus (eight patients) and pulmonary thrombus (six patients). Compared to the group without venous thromboembolism, the group with prechemotherapy venous thromboembolism showed higher proportion of patients with tumors originating in the right testis (10 out of 13), significantly higher lactate dehydrogenase levels (828 IU/L versus 436 IU/L, P = 0.013), significantly higher proportion of patients with retroperitoneal lymph node (RPLN) metastases >5 cm in diameter (76.9% versus 33.7%, P = 0.003) and slightly higher proportion of patients with high-risk Khorana score (≥ 3; 30.8% versus 11.6%). No significant differences were observed between the clinical characteristics of patients with venous thromboembolism developed during chemotherapy and patients without venous thromboembolism. CONCLUSIONS We show that both RPLN mass > 5 cm and high lactate dehydrogenase levels are significant risk factors for prechemotherapy venous thromboembolism but not for venous thromboembolism development during chemotherapy.
Collapse
Affiliation(s)
- Satoshi Nitta
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Koji Kawai
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomokazu Kimura
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Kawahara
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shuya Kandori
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akio Hoshi
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takahiro Kojima
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
13
|
Groot HJ, van Leeuwen FE, Lubberts S, Horenblas S, de Wit R, Witjes JA, Groenewegen G, Poortmans PM, Hulshof MCCM, Meijer OWM, de Jong IJ, van den Berg HA, Smilde TJ, Vanneste BGL, Aarts MJB, Jóźwiak K, van den Belt-Dusebout AW, Gietema JA, Schaapveld M. Platinum exposure and cause-specific mortality among patients with testicular cancer. Cancer 2019; 126:628-639. [PMID: 31730712 PMCID: PMC7004069 DOI: 10.1002/cncr.32538] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 11/06/2022]
Abstract
Background Although testicular cancer (TC) treatment has been associated with severe late morbidities, including second malignant neoplasms (SMNs) and ischemic heart disease (IHD), cause‐specific excess mortality has been rarely studied among patients treated in the platinum era. Methods In a large, multicenter cohort including 6042 patients with TC treated between 1976 and 2006, cause‐specific mortality was compared with general population mortality rates. Associations with treatment were assessed with proportional hazards analysis. Results With a median follow‐up of 17.6 years, 800 patients died; 40.3% of these patients died because of TC. The cumulative mortality was 9.6% (95% confidence interval [CI], 8.5%‐10.7%) 25 years after TC treatment. In comparison with general population mortality rates, patients with nonseminoma experienced 2.0 to 11.6 times elevated mortality from lung, stomach, pancreatic, rectal, and kidney cancers, soft‐tissue sarcomas, and leukemia; 1.9‐fold increased mortality (95% CI, 1.3‐2.8) from IHD; and 3.9‐fold increased mortality (95% CI, 1.5‐8.4) from pneumonia. Seminoma patients experienced 2.5 to 4.6 times increased mortality from stomach, pancreatic, bladder cancer and leukemia. Radiotherapy and chemotherapy were associated with 2.1 (95% CI, 1.8‐2.5) and 2.5 times higher SMN mortality (95% CI, 2.0‐3.1), respectively, in comparison with the general population. In a multivariable analysis, patients treated with platinum‐containing chemotherapy had a 2.5‐fold increased hazard ratio (HR; 95% CI, 1.8‐3.5) for SMN mortality in comparison with patients without platinum‐containing chemotherapy. The HR for SMN mortality increased 0.29 (95% CI, 0.19‐0.39) per 100 mg/m2 platinum dose administered (Ptrend < .001). IHD mortality was increased 2.1‐fold (95% CI, 1.5‐4.2) after platinum‐containing chemotherapy in comparison with patients without platinum exposure. Conclusions Platinum‐containing chemotherapy is associated with a dose‐dependent increase in the risk of SMN mortality. Platinum‐containing chemotherapy is associated with a dose‐dependent increase in the risk of cancer mortality among patients with testicular cancer. Patients with testicular cancer experience increased mortality from second malignancies as well as causes other than cancer, particularly ischemic heart diseases.
Collapse
Affiliation(s)
- Harmke J Groot
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Flora E van Leeuwen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sjoukje Lubberts
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Simon Horenblas
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gerard Groenewegen
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Philip M Poortmans
- Department of Radiation Oncology, Dr. Bernard Verbeeten Institute, Tilburg, the Netherlands.,Department of Radiation Oncology, Curie Institute, Paris, France
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands
| | - Otto W M Meijer
- Department of Radiation Oncology, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Igle J de Jong
- Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Ben G L Vanneste
- Department of Radiotherapy, Maastro Clinic, Maastricht, the Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Katarzyna Jóźwiak
- Department of Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Institute of Biostatistics and Registry Research, Brandenburg Medical School-Theodor Fontane, Neuruppin, Germany
| | | | - Jourik A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Michael Schaapveld
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| |
Collapse
|
14
|
Tran B, Ruiz-Morales JM, Gonzalez-Billalabeitia E, Patrikidou A, Amir E, Seidel C, Bokemeyer C, Fankhauser C, Hermanns T, Rumyantsev A, Tryakin A, Brito M, Fléchon A, Kwan EM, Cheng T, Castellano D, Garcia Del Muro X, Hamid AA, Ottaviano M, Palmieri G, Kitson R, Reid A, Heng DYC, Bedard PL. 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). Cancer Med 2019; 9:116-124. [PMID: 31715650 PMCID: PMC6943085 DOI: 10.1002/cam4.2674] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 12/23/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | | | | | | | - Eitan Amir
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Christoph Seidel
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Thomas Hermanns
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexey Rumyantsev
- NN Blokhin Russian Cancer Research Centre and Research Institute of Oncology at BSMU, Moskva, Russia
| | - Alexey Tryakin
- NN Blokhin Russian Cancer Research Centre and Research Institute of Oncology at BSMU, Moskva, Russia
| | - Margarida Brito
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | | | - Edmond Michael Kwan
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Tina Cheng
- Tom Baker Cancer Centre, Calgary, AB, Canada
| | | | | | - Anis A Hamid
- Olivia Newton John Cancer, Wellness and Research Centre, Heidelberg, Vic., Australia
| | - Margaret Ottaviano
- CRTR Rare Tumors Reference Center, Università Degli Studi di Napoli Federico II, Napoli, Italy
| | - Giovannella Palmieri
- CRTR Rare Tumors Reference Center, Università Degli Studi di Napoli Federico II, Napoli, Italy
| | | | | | | | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
15
|
Predictors of thrombosis in testicular cancer during platinum-based chemotherapy. World J Urol 2018; 37:1907-1916. [PMID: 30547197 DOI: 10.1007/s00345-018-2598-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022] Open
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.
Collapse
|
16
|
Nestler T, Huber J, Laury AM, Isbarn H, Heidenreich A, Schmelz HU, Ruf CG. Thromboprophylaxis and the route of administration of chemotherapy in testicular cancer patients in German-speaking countries. World J Urol 2018; 36:913-920. [PMID: 29417289 DOI: 10.1007/s00345-018-2222-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/01/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Due to the excellent cure rates for testicular cancer (TC), focus has shifted towards decreasing therapy-related morbidities. Thrombosis is a frequent complication of cisplatin chemotherapy. Furthermore, the optimal route of administration for chemotherapy is still under debate. The purpose of this study was to assess the patterns of care concerning dosing and duration of thromboprophylaxis currently utilized in TC patients in German-speaking countries as well as the route of chemotherapy administration. METHODS A standardized questionnaire was sent to all members of the German TC Study Group (GTCSG) and to all the urological university hospitals in Germany. The questionnaire was also sent to the oncologic clinics at those universities where urologists do not administer chemotherapy. RESULTS The response rate was 87% (55/63). Prophylactic anticoagulation with low-molecular-weight heparin (LMWH) was administered in 94% of the clinics. The dosing of LMWH was prophylactic (85%), high prophylactic (adjusted to bodyweight) (7%), or risk adapted (9%). After completion of chemotherapy, anticoagulation was continued in 15 clinics (33%) for 2 to 24 weeks, while the remainder stopped the LMWH upon cessation of chemotherapy. Chemotherapy was administered via central venous access in 59%, peripheral IV in 27%, or both in 14% of the clinics. CONCLUSIONS Most of the institutions performed some form of thromboprophylaxis, although the modes of application varied by institution type and amongst the urologists and oncologists. Prospective studies are needed to evaluate the incidence, date of occurrence, and risk factors of venous thrombosis during TC chemotherapy to provide a recommendation concerning prophylactic anticoagulation.
Collapse
Affiliation(s)
- Tim Nestler
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany. .,Department of Urology, University Hospital Cologne, Cologne, Germany.
| | - Johannes Huber
- Department of Urology, University Hospital Dresden, Dresden, Germany
| | - Adrienne M Laury
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), Fort Sam Houston, Texas, USA
| | - Hendrik Isbarn
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Hans U Schmelz
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Christian G Ruf
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| |
Collapse
|
17
|
Pure Testicular Seminoma Relapsing Late with Somatic Type Malignancy. Case Rep Oncol Med 2017; 2017:2457023. [PMID: 28367345 PMCID: PMC5359450 DOI: 10.1155/2017/2457023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 02/27/2017] [Indexed: 11/21/2022] Open
Abstract
Background. Somatic type malignancy (STM) occurs in 2% of all germ cell tumours (GCTs). The prognosis is unfavourable and the origin is poorly understood. Pathogenetic hypotheses involve direct transformation of teratoma, origin from totipotent cancer cells, or derivation from yolk sac tumour elements. Case Presentation. A 31-year-old patient was cured from testicular seminoma clinical stage IIc by orchiectomy and cisplatin-based chemotherapy. Nine years later, he experienced a late relapse with a mass sized 5 × 6 cm located at the former metastatic site. As no remission occurred after chemotherapy with three cycles of cisplatin, ifosfamide and etoposide, the mass was surgically resected. Histologically, the specimen consisted of neurofibroma with areas of malignant peripheral nerve sheath tumour and spots with mature bone formation. FISH analysis disclosed isochromosome 12p in the majority of evaluated cells suggesting somatic type malignancy (STM) of GCT. The patient is well 1 year after surgery. Conclusion. The pathogenesis of this STM remains enigmatic. The origin from GCT was evidenced by documentation of isochromosome 12p. Unrecognized teratomatous elements in the primary and totipotent cancer cells surviving the first chemotherapy could be hypothesized to represent the origin. STM developing from seminoma cells would be another novel hypothesis.
Collapse
|
18
|
Hypercoagulation and complement: Connected players in tumor development and metastases. Semin Immunol 2016; 28:578-586. [PMID: 27876232 DOI: 10.1016/j.smim.2016.10.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/06/2016] [Accepted: 10/12/2016] [Indexed: 12/22/2022]
Abstract
Hypercoagulation is a common feature of several tumors to the extent that individuals with coagulation defects often present with occult visceral cancers. Recent evidence has shown that hypercoagulation is not just a mere secondary effect due to the presence of the tumor, rather it actively contributes to tumor development and dissemination. Among the numerous mechanisms that can contribute to cancer-associated hypercoagulation, the ones involving immune-mediated processes are gaining increasing attention. In particular, complement cascade and hypercoagulation are one inducing the other in a vicious circle that involves neutrophil extracellular traps (NETs) formation. Together, in this feedback loop, they can promote the protumorigenic phenotype of immune cells and the protection of tumor cells from immune attack, ultimately favouring tumor development, progression and metastases formation. In this review, we summarize the role of these processes in cancer development and highlight new possible intervention strategies based on anticoagulants that can arrest this vicious circle.
Collapse
|