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
Research background

Cisplatin-based chemotherapy has significantly increased the survival of patients with testicular germ cell tumor (TGCT), although it is associated with a high rate of thromboembolic events (TEE).

Research motivation

As TGCT is the most curable solid tumor and most common cancer among men 18-39 years, we sought to evaluate our single-center experience of patients who were diagnosed with TGCT and received platinum-based chemotherapy. Patients who suffered a TEE were the primary focus of this study.

Research objectives

Our objective was to identify patients who were diagnosed with TGCT and received platinum-based chemotherapy, with particular attention to those patients who experienced a TEE.

Research methods

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 were reviewed. Statistical analysis was performed by stratisfying each metric (TEE, retroperitoneal lymph nodes ≥ 3.0 cm before chemotherapy, age, body mass index, cigarette smoker, marijuana use, side of orchiectomy, pathologic stage, central venous catheter, type of chemotherapy, number of chemotherapy cycles, retroperitoneal lymph nodes dissection, and recurrence after chemotherapy by those patients who experienced a TEE and by those who did not.

Research 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. 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.

Research conclusions

Since myriad factors 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.

Research perspectives

Randomized studies to evaluate the safety and efficacy of prophylactic anticoagulants are essential in this young patient population generally lacking medical co-morbidities.