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)

• Published in: Cancer medicine (Malden, MA) Vol. 9; no. 1; pp. 116 - 124
• Main Authors: Tran, Ben, Ruiz‐Morales, Jose M., Gonzalez‐Billalabeitia, Enrique, Patrikidou, Anna, Amir, Eitan, Seidel, Christoph, Bokemeyer, Carsten, Fankhauser, Christian, Hermanns, Thomas, Rumyantsev, Alexey, Tryakin, Alexey, Brito, Margarida, Fléchon, Aude, Kwan, Edmond Michael, Cheng, Tina, Castellano, Daniel, Garcia del Muro, Xavier, Hamid, Anis A., Ottaviano, Margaret, Palmieri, Giovannella, Kitson, Robert, Reid, Alison, Heng, Daniel Y. C., Bedard, Philippe L.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.01.2020; John Wiley and Sons Inc; Wiley
• Subjects: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Cancer; Catheters, Indwelling - adverse effects; Chemotherapy; Child; Cisplatin - administration & dosage; Cisplatin - adverse effects; Classification; Clinical Cancer Research; Collaboration; deep vein thrombosis; germ cell tumor; Histology; Hospitalization; Humans; Lymph nodes; Lymph Nodes - pathology; Lymphadenopathy; Lymphatic Metastasis - drug therapy; Lymphatic system; Male; Metastases; Metastasis; Middle Aged; Neoplasms, Germ Cell and Embryonal - drug therapy; Neoplasms, Germ Cell and Embryonal - mortality; Neoplasms, Germ Cell and Embryonal - pathology; Original Research; Patients; Platinum; pulmonary embolism; Pulmonary embolisms; Retroperitoneal Neoplasms - drug therapy; Retroperitoneal Neoplasms - mortality; Retroperitoneal Neoplasms - secondary; Retroperitoneal Space - pathology; Retrospective Studies; Risk Assessment; Risk Factors; Testicular cancer; Thromboembolism; Thrombosis; Tumors; Variables; vascular access device; Vascular Access Devices - adverse effects; Veins & arteries; Venous access; venous thromboembolism; Venous Thromboembolism - epidemiology; Venous Thromboembolism - etiology; Venous Thromboembolism - prevention & control; Young Adult; testicular cancer; vascular access device; deep vein thrombosis; pulmonary embolism; germ cell tumor; venous thromboembolism
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.2674

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. Venous thromboembolism can cause morbidity in germ cell tumor patients receiving chemotherapy; large retroperitoneal lymphadenopathy (RPLN) and indwelling vascular access devices (VAD) are significant VTE risk factors. VAD insertion should be avoided and thromboprophylaxis can be considered for large RPLN.