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Large retroperitoneal lymphadenopathy predicted VTE risk in disseminated germ cell tumors
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Large retroperitoneal lymph nodes demonstrated greater discriminatory accuracy than a high-risk Khorana score for the prediction of risk for chemotherapy-associated venous thromboembolism in patients with disseminated germ cell tumors, according to study results.
“Patients with germ cell tumors have increased risk of developing venous thromboembolism [VTE] compared with other cancer types, and there is no consensus on the role of thromboprophylaxis in patients with germ cell tumors,” Amirrtha Srikanthan, MD, of Princess Margaret Cancer Centre, and colleagues wrote. “The increased risk of VTE in patients with disseminated germ cell tumors may relate to the presence of large retroperitoneal lymph node metastases that produce venous stasis or simply reflect greater burden of disease and a more advanced stage of malignancy.”
The analysis included a training cohort of 216 patients with disseminated germ cell tumors undergoing first-line chemotherapy. Twenty-one (10%) of these patients developed VTE during chemotherapy.
Researchers identified 59 (27%) patients with large retroperitoneal lymph nodes, 13 (22%) of whom experienced VTE.
Retroperitoneal lymph nodes ˃5cm were significantly associated with an increased risk for VTE (OR=5.26; 95% CI, 2.06-13.49).
The risk for VTE also was significantly greater in patients with intermediate- or poor-risk disease (OR=3.76; 95% CI, 1.5-9.46), those with a pre-chemotherapy leukocyte count ≥11 x 109/L (OR=5.61; 95% CI, 2.13-14.76), those with a pre-chemotherapy platelet count ≥350 x 109/L (OR=4.26; 95% CI, 1.69-10.74) and those who were hospitalized during chemotherapy (OR=4.24; 95% CI, 1.67-10.81).
Patients with a high-risk Khorana score — the previous predictive model for chemotherapy-associated thrombosis — also demonstrated a significantly increased risk for VTE (OR=11.8; 95% CI, 3.93-35.39).
The analysis included a validation cohort comprised of 108 patients. Ten (9%) of these patients experienced VTE during chemotherapy, six of whom had large retroperitoneal lymph nodes.
Researchers found the discriminatory accuracy to predict VTE was greater for retroperitoneal lymph nodes ˃5 cm compared with high-risk Khorana score in the training cohort (area under receiver operator characteristic curves [AUROCs], 0.71 vs. 0.67) and the validation cohort (AUROC, 0.61 vs. 0.57). In both instances, large retroperitoneal lymph nodes had a higher sensitivity but lower specificity for VTE.
“We have identified large retroperitoneal lymph nodes as a valid predictive marker for the development of VTE,” Srikanthan and colleagues wrote. “High-risk Khorana score is also a valid predictive tool; however, large retroperitoneal lymph nodes offer greater discriminatory accuracy than high-risk Khorana score and increased simplicity of use.”
Disclosure: The researchers report employment/leadership and consultant/advisory roles with, honoraria and research funding from, and stock ownership in Astellas, Boehringer Ingelheim, Eisai, Exelixis, GlaxoSmithKline, Hoffman-La Roche, ImClone Systems, Impact Genetics, Medivation, Myriad Genetics, Novartis, Pfizer, OncoGeneX, Oncolytics Biotech, Oncothyreon, Sanofi and Theralase.
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