Incidence, Characteristics and Implications of Thromboembolic Events in Patients with Muscle Invasive Urothelial Carcinoma of the Bladder Undergoing Neoadjuvant Chemotherapy

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Duivenvoorden , W C M , Daneshmand , S , Canter , D , Lotan , Y , Black , P C , Abdi , H , van Rhijn , B W G , van de Putte , E E F , Zareba , P , Koskinen , I , Kassouf , W , Traboulsi , S L , Kukreja , J E , Bostrom , P J , Shayegan , B & Pinthus , J H 2016 , ' Incidence, Characteristics and Implications of Thromboembolic Events in Patients with Muscle Invasive Urothelial Carcinoma of the Bladder Undergoing Neoadjuvant Chemotherapy ' Journal of Urology , vol. 196 , no. 6 , pp. 1627-1633 . DOI: 10.1016/j.juro.2016.06.017

Title: Incidence, Characteristics and Implications of Thromboembolic Events in Patients with Muscle Invasive Urothelial Carcinoma of the Bladder Undergoing Neoadjuvant Chemotherapy
Author: Duivenvoorden, Wilhelmina C. M.; Daneshmand, Siamak; Canter, Daniel; Lotan, Yair; Black, Peter C.; Abdi, Hamidreza; van Rhijn, Bas W. G.; van de Putte, Elisabeth E. Fransen; Zareba, Piotr; Koskinen, Ilmari; Kassouf, Wassim; Traboulsi, Samer L.; Kukreja, Janet E.; Bostrom, Peter J.; Shayegan, Bobby; Pinthus, Jehonathan H.
Other contributor: University of Helsinki, Department of Surgery
Date: 2016-12
Language: eng
Number of pages: 7
Belongs to series: Journal of Urology
ISSN: 0022-5347
DOI: https://doi.org/10.1016/j.juro.2016.06.017
URI: http://hdl.handle.net/10138/229283
Abstract: Purpose: Neoadjuvant chemotherapy and pelvic surgery are significant risk factors for thromboembolic events. Our study objectives were to investigate the timing, incidence and characteristics of thromboembolic events during and after neoadjuvant chemotherapy and subsequent radical cystectomy in patients with muscle invasive bladder cancer. Materials and Methods: We performed a multi-institutional retrospective analysis of 761 patients who underwent neoadjuvant chemotherapy and radical cystectomy for muscle invasive bladder cancer from 2002 to 2014. Median followup from diagnosis was 21.4 months (range 3 to 272). Patient characteristics included the Khorana score, and the incidence and timing of thromboembolic events (before vs after radical cystectomy). Survival was calculated using the Kaplan-Meier method. The log rank test and multivariable Cox proportional hazards regression were used to compare survival between patients with vs without thromboembolic events. Results: The Khorana score indicated an intermediate thromboembolic event risk in 88% of patients. The overall incidence of thromboembolic events in patients undergoing neoadjuvant chemotherapy was 14% with a wide variation of 5% to 32% among institutions. Patients with thromboembolic events were older (67.6 vs 64.6 years, p = 0.02) and received a longer neoadjuvant chemotherapy course (10.9 vs 9.7 weeks, p = 0.01) compared to patients without a thromboembolic event. Of the thromboembolic events 58% developed preoperatively and 72% were symptomatic. On multivariable regression analysis the development of a thromboembolic event was not significantly associated with decreased overall survival. However, pathological stage and a high Khorana score were adverse risk factors for overall survival. Conclusions: Thromboembolic events are common in patients with muscle invasive bladder cancer who undergo neoadjuvant chemotherapy before and after radical cystectomy. Our results suggest that a prospective trial of thromboembolic event prophylaxis during neoadjuvant chemotherapy is warranted.
Subject: urinary bladder neoplasms
cystectomy
thromboembolism
neoadjuvant therapy
drug therapy
PATIENTS RECEIVING CHEMOTHERAPY
UNSUSPECTED PULMONARY EMBOLI
VENOUS THROMBOEMBOLISM
RADICAL CYSTECTOMY
CANCER-PATIENTS
RISK-FACTORS
BREAST-CANCER
THROMBOPROPHYLAXIS
PROPHYLAXIS
PREVENTION
3126 Surgery, anesthesiology, intensive care, radiology
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