Hematology-Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece; 2nd Propaedeutic Dept of Internal Medicine, ATTIKON Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Hematology-Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Clin Genitourin Cancer. 2020 Aug;18(4):e457-e472. doi: 10.1016/j.clgc.2019.12.021. Epub 2020 Jan 8.
Venous thromboembolic events (VTEs) frequently occur in cancer patients. Risk assessment models (RAMs) for cancer-associated thrombosis have been proposed. However, advanced urinary tract cancer (aUTC) was not adequately represented in these models. We studied the incidence of VTEs, the risk factors, and the applicability of recently described RAMs.
Data from 335 patients with aUTC treated with chemotherapy between April 1995 and September 2015 in a single institution were analyzed.
A total of 95.2% received platinum-based first-line chemotherapy. Twenty-nine patients (8.7%) experienced VTEs. The 6-, 12-, and 24-month VTE incidence was 7.4% (95% confidence interval [CI], 4.8-10.6), 8.1% (95% CI, 5.4-11.5) and 9.4% (95% CI, 6.4-13.1), respectively. No significant association of VTE incidence with the Khorana risk score was observed. History of vascular event (VTE and/or arterial thromboembolic event) was significantly associated with the development of VTE. Patients with such history had a 6-, 12-, and 24-month VTE incidence of 16.2% (95% CI, 6.6-29.7), 19.2% (95% CI, 8.4-33.3), and 25.2% (95% CI, 12.5-40.1) compared to 6.2% (95% CI, 3.7-9.4), 6.6% (95% CI, 4.1-10), and 7.1% (95% CI, 4.4-10.6) of those who did not. The discriminatory ability of this factor adjusted for leucocyte count, sex, Eastern Cooperative Oncology Group performance status, and type of chemotherapy reached 0.79 (95% CI, 0.71-0.87) compared to the 0.58 (95% CI, 0.49-0.66) for the Khorana risk score.
Development of tumor-specific algorithms for the risk of VTEs is advisable. Patients with aUTC and a history of vascular events are at high risk for VTE development, and prophylaxis should be prospectively studied in this group.
静脉血栓栓塞事件（VTE）在癌症患者中经常发生。已经提出了用于癌症相关血栓形成的风险评估模型（RAM）。然而，这些模型中没有充分体现晚期泌尿道癌（aUTC）。我们研究了 VTE 的发生率、危险因素以及最近描述的 RAM 的适用性。
分析了 1995 年 4 月至 2015 年 9 月期间在一家机构接受化疗的 335 例 aUTC 患者的数据。
95.2%的患者接受了铂类为基础的一线化疗。29 例（8.7%）发生 VTE。6、12 和 24 个月的 VTE 发生率分别为 7.4%（95%置信区间 [CI]，4.8-10.6）、8.1%（95% CI，5.4-11.5）和 9.4%（95% CI，6.4-13.1）。Khorana 风险评分与 VTE 发生率无显著相关性。血管事件（VTE 和/或动脉血栓栓塞事件）史与 VTE 的发生显著相关。有此类病史的患者在 6、12 和 24 个月时 VTE 的发生率分别为 16.2%（95% CI，6.6-29.7）、19.2%（95% CI，8.4-33.3）和 25.2%（95% CI，12.5-40.1），而无此类病史的患者 VTE 发生率为 6.2%（95% CI，3.7-9.4）、6.6%（95% CI，4.1-10）和 7.1%（95% CI，4.4-10.6）。白细胞计数、性别、东部合作肿瘤组表现状态和化疗类型调整后的该因素的判别能力为 0.79（95% CI，0.71-0.87），而 Khorana 风险评分的判别能力为 0.58（95% CI，0.49-0.66）。
制定针对 VTE 风险的肿瘤特异性算法是明智的。患有 aUTC 且有血管事件史的患者发生 VTE 的风险较高，应在该组中前瞻性研究预防措施。
