Bezan Angelika, Posch Florian, Ploner Ferdinand, Bauernhofer Thomas, Pichler Martin, Szkandera Joanna, Hutterer Georg C, Pummer Karl, Gary Thomas, Samonigg Hellmut, Beyer Joerg, Winder Thomas, Hermanns Thomas, Fankhauser Christian D, Gerger Armin, Stotz Michael
Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Research Unit Genetic Epidemiology and Pharmacogenetics, Medical University of Graz, Graz, Austria.
PLoS One. 2017 Apr 21;12(4):e0176283. doi: 10.1371/journal.pone.0176283. eCollection 2017.
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.
In 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.
Venous 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).
According 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.
睾丸生殖细胞肿瘤(TGCT)患者发生静脉血栓栓塞(VTE)的风险增加。我们在该患者队列中确定了VTE的危险因素,并建立了一个临床风险模型。
在格拉茨医科大学进行的这项回顾性队列研究中,我们纳入了所有临床分期的657例连续TGCT患者。建立了VTE预测模型,并在苏黎世大学医院治疗的349例TGCT患者中进行了外部验证。
格拉茨队列中有34例(5.2%)患者发生静脉血栓栓塞事件。在单变量竞争风险分析中,较高的临床分期(cS)和腹膜后淋巴结病(RPLN)是VTE最强的预测因素(p<0.0001)。由于最大直径超过5cm且无并存内脏转移的RPLN被归类为cS IIC,我们构建了一个经验性VTE风险模型,分为以下四类(12个月累积发病率):cS IA-B,463例患者中有8例(1.7%);cS IS-IIB,86例患者中有5例(5.9%);cS IIC,21例患者中有3例(14.3%);cS IIIA-C,70例患者中有15例(21.4%)。该风险模型在苏黎世队列中得到外部验证(12个月累积发病率):cS IA-B(0.5%),cS IS-IIB(6.0%),cS IIC(11.1%)和cS IIIA-C(19.1%)。我们的模型比之前发表的仅基于RPLN大小的分类器(RPLN-VTE风险分类器)具有显著更高的区分性能(AUC-ROC:0.75对0.63,p = 0.007)。
根据我们的风险分层,cS IIC和cS III期的TGCT患者发生VTE的风险非常高,在化疗期间可能从一级血栓预防中获益。