Primary Thromboprophylaxis and the Risk of Venous Thromboembolic Events in Patients With Testicular Germ Cell Tumors Treated With Cisplatinum-Based Chemotherapy

• Published in: Clinical genitourinary cancer 2023-02, Vol.21 (1), p.24-31
• Main Authors: Terbuch, Angelika, Walser, Gudrun, Stotz, Michael, Gerger, Armin, Posch, Florian, Bauernhofer, Thomas
• Format: Article
• Language: English
• Subjects: Anticoagulants - therapeutic use; Anticoagulation; Cisplatin - adverse effects; Heparin, Low-Molecular-Weight - adverse effects; Humans; Lymphadenopathy; Male; Neoplasms, Germ Cell and Embryonal - drug therapy; Retrospective Studies; Risk of venous thromboembolism; Testicular cancer; Testicular Neoplasms - drug therapy; Thromboprophylaxis; Venous Thromboembolism - chemically induced; Venous Thromboembolism - epidemiology; Venous Thrombosis
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2022.10.005

•Testicular germ cell tumor (TGCT) patients undergoing cisplatinum-based chemotherapy have a high risk of venous thromboembolism (VTE).•Higher clinical tumor stage and a large retroperitoneal lymphadenopathy (RPLND >5 cm) are the strongest predictors of an elevated VTE risk.•TGCT patients undergoing cisplatinum-based chemotherapy have a significantly lower VTE risk when receiving primary thromboprophylaxis.•Given the low risk of bleeding in patients with TGCT, it might be worthwhile to consider thromboprophylaxis in patients of all clinical stages for the duration of cisplatinum-based chemotherapy. 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. 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. 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). 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. This retrospective cohort study shows that patients with Testicular Germ cell tumors (TGCT) undergoing cisplatinum-based chemotherapy have a high risk of venous thromboembolism (VTE). The ri