Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Jpn J Clin Oncol. 2020 Mar 9;50(3):338-343. doi: 10.1093/jjco/hyz177.
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.
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.
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.
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.
我们回顾性分析了晚期生殖细胞瘤患者接受化疗后静脉血栓栓塞症的发生率和定位，并分别评估了化疗前和化疗期间静脉血栓栓塞症发展的危险因素。
我们纳入了 2005 年至 2018 年间接受顺铂为基础的化疗的 121 例患者。静脉血栓栓塞症定义为通过影像学检查诊断出的静脉血栓形成，无论是否有血栓栓塞症状。我们分析了可能的静脉血栓栓塞症危险因素的临床参数。Khorana 评分用于计算静脉血栓栓塞症的风险。
13 例患者在化疗前出现静脉血栓栓塞症，13 例患者在化疗期间出现静脉血栓栓塞症。最常见的静脉血栓栓塞症是深静脉血栓形成（10 例），其次是下腔静脉血栓形成（8 例）和肺血栓形成（6 例）。与无静脉血栓栓塞症组相比，化疗前发生静脉血栓栓塞症组中源自右侧睾丸的肿瘤患者比例更高（13 例中有 10 例），乳酸脱氢酶水平显著更高（828 IU/L 比 436 IU/L，P=0.013），腹膜后淋巴结（RPLN）转移>5cm 直径的患者比例显著更高（76.9%比 33.7%，P=0.003），高危 Khorana 评分（≥3 分）的患者比例略高（30.8%比 11.6%）。在化疗期间发生静脉血栓栓塞症的患者和无静脉血栓栓塞症的患者之间，临床特征无显著差异。
我们表明，RPLN 肿块>5cm 和高乳酸脱氢酶水平是化疗前静脉血栓栓塞症的显著危险因素，但不是化疗期间静脉血栓栓塞症发展的危险因素。
