Published online Mar 24, 2021. doi: 10.5306/wjco.v12.i3.183
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
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).
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.
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.
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.
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.
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.
Randomized studies to evaluate the safety and efficacy of prophylactic anticoagulants are essential in this young patient population generally lacking medical co-morbidities.