Neoadjuvant chemotherapy (NAC) and pelvic surgery are significant risk factors for thromboembolic events (TEE). The study objectives were to investigate the timing, incidence and characteristics of TEE during and after NAC and subsequent radical cystectomy (RC) in patients with muscle-invasive bladder cancer (MIBC).
A multi-institutional retrospective analysis of 761 patients undergoing NAC and RC for MIBC from 2002 to 2014 was performed. The median follow-up time from diagnosis was 21.4 months (range 3-272). Patient characteristics included Khorana score, and incidence and timing of TEE (before/after RC). Survival was calculated using the Kaplan-Meier method. Log-rank tests and multivariable Cox proportional hazards regression were used to compare survival between patients with or without TEE.
Khorana score indicated intermediate TEE risk in 88% of patients. The overall incidence of TEE in patients undergoing NAC was 14% with a wide variation between institutions (5%-32%). Patients with TEE were older (67.6 vs 64.6 years, p=0.02) and had longer NAC courses (10.9 vs 9.7 weeks, p=0.01) compared to non-TEE patients. The majority of TEEs (58%) occurred pre-operatively; 72% were symptomatic. On multivariable regression analysis, the development of a TEE was not significantly associated with decreased overall survival; however, pathological stage and high Khorana score were adverse risk factors for overall survival.
TEEs are very common in MIBC patients undergoing NAC both before and after RC. Our results suggest that a prospective trial of TEE prophylaxis during NAC is warranted.
The Journal of urology. 2016 Jun 13 [Epub ahead of print]
Wilhelmina Cm Duivenvoorden, Siamak Daneshmand, Daniel Canter, Yair Lotan, Peter C Black, Hamidreza Abdi, Bas Wg van Rhijn, Elisabeth E Fransen van de Putte, Piotr Zareba, Ilmari Koskinen, Wassim Kassouf, Samer L Traboulsi, Janet E Kukreja, Peter J Boström, Bobby Shayegan, Jehonathan H Pinthus
McMaster University and Juravinski Hospital, Hamilton, ON Canada., USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles., The Fox Chase Cancer Center, Einstein Health Network and The Urologic Institute of Southeastern Pennsylvania, Philadelphia., University of Texas Southwestern Medical Center, Dallas., Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada., Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada., The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands., The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands., McMaster University and Juravinski Hospital, Hamilton, ON Canada., Helsinki University Hospital and University of Helsinki, Helsinki, Finland., McGill University, Montreal, PQ, Canada., McGill University, Montreal, PQ, Canada., University of Rochester, Rochester, NY., Turku University Hospital and University of Turku, Turku, Finland., McMaster University and Juravinski Hospital, Hamilton, ON Canada., McMaster University and Juravinski Hospital, Hamilton, ON Canada. Electronic address: .