Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Mar 24, 2021; 12(3): 183-194
Published online Mar 24, 2021. doi: 10.5306/wjco.v12.i3.183
Thromboembolic events in metastatic testicular cancer treated with cisplatin-based chemotherapy
Lisa B E Shields, Michael W Daniels, Nataliya Mar, Arash Rezazadeh Kalebasty
Lisa B E Shields, Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, United States
Michael W Daniels, Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY 40292, United States
Nataliya Mar, Arash Rezazadeh Kalebasty, Division of Hematology/Oncology, Department of Medicine, UCI Medical Center, Orange, CA 92868, United States
Author contributions: Shields LBE, Daniels MW, Mar N, and Rezazadeh Kalebasty A contributed to the conception, design, acquisition, analysis, and interpretation of data; Shields LBE drafted the manuscript; Shields LBE, Daniels MW, Mar N, and Rezazadeh Kalebasty A critically revised the manuscript and gave final approval.
Institutional review board statement: The University of Louisville Institutional Review Board determined that this study was exempt according to 45 CFR 46.101(b). The IRB number is 19.1288.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data were available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arash Rezazadeh Kalebasty, MD, Doctor, Division of Hematology/ Oncology, Department of Medicine, UCI Medical Center, 101 The City Drive South, Zot 4061, Orange, CA 92868, United States. arez@uci.edu
Received: August 11, 2020
Peer-review started: August 11, 2020
First decision: December 18, 2020
Revised: December 18, 2020
Accepted: February 11, 2021
Article in press: February 11, 2021
Published online: March 24, 2021
Processing time: 211 Days and 20.7 Hours
Abstract
BACKGROUND

Testicular germ cell tumor (TGCT) is the most curable solid tumor and most common cancer among men 18-39 years. While cisplatin-based chemotherapy has significantly lengthened the survival of patients with TGCT, it is associated with a high rate of thromboembolic events (TEE).

AIM

To summarize our single-center experience highlighting patients who were diagnosed with TGCT and received platinum-based chemotherapy, with special attention to those patients who suffered a TEE.

METHODS

A retrospective analysis of the medical records and imaging studies of 68 consecutive individuals who were diagnosed with TGCT and received platinum-based chemotherapy at our Institution in a metropolitan community between January 1, 2014 and December 31, 2019.

RESULTS

A total of 19 (28%) patients experienced a TEE following orchiectomy which occurred during chemotherapy in 13 (68%) of these patients. Patients with a higher pathologic stage (stage III) were significantly (P = 0.023) more likely to experience a TEE compared to patients who had a lower stage. Additionally, patients who were treated with 3 cycles of bleomycine, etoposide, and cisplatin and 1 cycle of etoposide and cisplatin or 4 cycles of etoposide and cisplatin were significantly 5 (P = 0.02) times more likely to experience a TEE compared to patients who were treated with only 3 cycles of bleomycine, etoposide, and cisplatin.

CONCLUSION

Due to numerous factors that predispose to a TEE such as large retroperitoneal disease, higher clinical stage, greater number of chemotherapy cycle, central venous catheter, cigarette smoking, and possible cannabis use, high-risk ambulatory patients with TGCT treated with cisplatin-based chemotherapy may benefit from prophylactic anticoagulation. Randomized studies to evaluate the safety and efficacy of prophylactic anticoagulants are warranted in this young patient population generally devoid of medical co-morbidities.

Keywords: Oncology; Testicular cancer; Thromboembolic; Cisplatin; Pulmonary embolism; Thromboprophylaxis

Core Tip: While cisplatin-based chemotherapy has significantly lengthened the survival of patients with testicular germ cell tumor, it is associated with a high rate of thromboembolic events (TEE). We analyzed 68 patients who were diagnosed with testicular germ cell tumor and received platinum-based chemotherapy. A total of 19 (28%) patients experienced a TEE following orchiectomy which occurred during chemotherapy in 13 (68%) of these patients. Patients with a higher pathologic stage (stage III) were significantly more likely to experience a TEE compared to patients with a lower stage. Randomized studies to evaluate the safety and efficacy of prophylactic anticoagulants are necessary in this young patient population generally without medical co-morbidities.