Patients with testicular germ cell tumors (TGCT) have an increased risk for venous thromboembolism (VTE). We identified risk factors for VTE in this patient cohort and developed a clinical risk model.
In this retrospective cohort study at the Medical University of Graz we included 657 consecutive TGCT patients across all clinical stages. A predictive model for VTE was developed and externally validated in 349 TGCT patients treated at the University Hospital Zurich.
Venous thromboembolic events occurred in 34 (5.2%) patients in the Graz cohort. In univariable competing risk analysis, higher clinical stage (cS) and a retroperitoneal lymphadenopathy (RPLN) were the strongest predictors of VTE (p<0.0001). As the presence of a RPLN with more than 5cm in greatest dimension without coexisting visceral metastases is classified as cS IIC, we constructed an empirical VTE risk model with the following four categories (12-month-cumulative incidence): cS IA-B 8/463 patients (1.7%), cS IS-IIB 5/86 patients (5.9%), cS IIC 3/21 patients (14.3%) and cS IIIA-C 15/70 patients (21.4%). This risk model was externally validated in the Zurich cohort (12-month-cumulative incidence): cS IA-B (0.5%), cS IS-IIB (6.0%), cS IIC (11.1%) and cS IIIA-C (19.1%). Our model had a significantly higher discriminatory performance than a previously published classifier (RPLN-VTE-risk-classifier) which is based on the size of RPLN alone (AUC-ROC: 0.75 vs. 0.63, p = 0.007).
According to our risk stratification, TGCT patients with cS IIC and cS III disease have a very high risk of VTE and may benefit from primary thromboprophylaxis for the duration of chemotherapy.
PloS one. 2017 Apr 21*** epublish ***
Angelika Bezan, Florian Posch, Ferdinand Ploner, Thomas Bauernhofer, Martin Pichler, Joanna Szkandera, Georg C Hutterer, Karl Pummer, Thomas Gary, Hellmut Samonigg, Joerg Beyer, Thomas Winder, Thomas Hermanns, Christian D Fankhauser, Armin Gerger, Michael Stotz
Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria., Department of Urology, Medical University of Graz, Graz, Austria., Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria., Department of Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland., Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland.