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Venous thromboembolism risk in patients with locoregional urothelial tract tumors

Venous thromboembolism risk in patients with locoregional urothelial tract tumors
Venous thromboembolism risk in patients with locoregional urothelial tract tumors

BACKGROUND: Venous thromboembolism (VTE) is common in cancer patients, but there is limited data on patients with urothelial tract tumors (UTT). We previously identified several associative factors for increased VTE rates in patients with metastatic UTT. In this study, we assessed the frequency, associative factors, and impact on survival of VTE in patients with locoregional UTT.

METHODS: Patients with locoregional bladder, upper urinary tract, or urethral cancer were included in this multi-center study from 29 academic institutions. Patients with < cT2, > N1, or M1 disease at diagnosis were excluded. Patients with incomplete clinical staging or miscoded/missing data were excluded. Cumulative, unadjusted VTE incidence was calculated from time of diagnosis of muscle-invasive disease, excluding VTEs diagnosed in the metastatic setting. χ(2) statistics tested differences in VTE rates across baseline and treatment-related factors. Significant covariates were incorporated into a multivariate, logistic regression model. Overall survival stratified by VTE was estimated using Kaplan-Meier methods and evaluated using the log-rank test.

RESULTS: A total of 1732 patients were eligible. There were 132 (7.6%) VTEs. On multivariate analysis, non-urothelial histology (P < .001), clinical Nx stage (P < .001), cardiovascular disease (P = .01), and renal dysfunction (P = .04) were statistically significant baseline factors associated with VTE. Using surgery alone as reference, surgery with perioperative chemotherapy (P = .04) and radiation with concurrent chemotherapy (P = .04) also were significant.

CONCLUSIONS: The VTE incidence of 7.6% in locoregional disease is comparable with our previously reported rate in the metastatic setting (8.2%). Similar to our findings in metastatic UTT, non-urothelial histology, renal dysfunction, and CVD was associated with increased VTE risk.

Journal Article
1558-7673
Ramos, Jorge D.
4152fb92-a4bc-4b00-b635-289d75eae81c
Wingate, Jonathan T.
daefa2e1-0307-4dbb-89e6-08f56d968140
Gulati, Roman
d21bea49-0782-4b8d-acdf-ecdeff7f2c34
Plimack, Elizabeth R.
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Harshman, Lauren C.
65c2410e-23a7-49e4-b2ac-05409f320222
Powles, Thomas
55539b87-1c5e-45ae-9e07-5b2232c2236c
Crabb, Simon J.
bcd1b566-7677-4f81-8429-3ab0e85f8373
Niegisch, Guenter
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Bellmunt, Joaquim
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Ladoire, Sylvain
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De Giorgi, Ugo
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Hussain, Syed
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Alva, Ajjai S.
c20f8921-bce9-479c-ade0-b0686ff72d4d
Baniel, Jack
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Agarwal, Neeraj
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Rosenberg, Jonathan E.
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Vaishampayan, Ulka N.
377052c6-1d03-4f21-97b6-dd857cd5648c
Galsky, Matthew D.
57bcde2a-bfea-490b-8a09-8ee8e28563da
Yu, Evan Y.
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RISC Investigators
Ramos, Jorge D.
4152fb92-a4bc-4b00-b635-289d75eae81c
Wingate, Jonathan T.
daefa2e1-0307-4dbb-89e6-08f56d968140
Gulati, Roman
d21bea49-0782-4b8d-acdf-ecdeff7f2c34
Plimack, Elizabeth R.
1813cdc7-c75c-4161-834c-6dc10354c973
Harshman, Lauren C.
65c2410e-23a7-49e4-b2ac-05409f320222
Powles, Thomas
55539b87-1c5e-45ae-9e07-5b2232c2236c
Crabb, Simon J.
bcd1b566-7677-4f81-8429-3ab0e85f8373
Niegisch, Guenter
e155079b-8120-4472-901c-8a6ca3423024
Bellmunt, Joaquim
a9cece8e-55c5-4e2e-bb1f-aec7aa8cba91
Ladoire, Sylvain
62c6053f-7695-4c1e-aa07-eeb98caaf17e
De Giorgi, Ugo
86c9f3a7-1680-4a3f-a34f-32cab5d47b4f
Hussain, Syed
04946d73-9bda-446a-8fd1-fc98c63e9eed
Alva, Ajjai S.
c20f8921-bce9-479c-ade0-b0686ff72d4d
Baniel, Jack
fce42171-4c34-4bc1-896b-484471830852
Agarwal, Neeraj
ca5b2c21-6702-48d8-a138-56d7e9cfca17
Rosenberg, Jonathan E.
b9e011ca-9408-4366-baea-5f487a246938
Vaishampayan, Ulka N.
377052c6-1d03-4f21-97b6-dd857cd5648c
Galsky, Matthew D.
57bcde2a-bfea-490b-8a09-8ee8e28563da
Yu, Evan Y.
3f986437-70b2-4993-90d9-13d06e155d8c

Ramos, Jorge D., Wingate, Jonathan T., Gulati, Roman, Plimack, Elizabeth R., Harshman, Lauren C., Powles, Thomas, Crabb, Simon J., Niegisch, Guenter, Bellmunt, Joaquim, Ladoire, Sylvain, De Giorgi, Ugo, Hussain, Syed, Alva, Ajjai S., Baniel, Jack, Agarwal, Neeraj, Rosenberg, Jonathan E., Vaishampayan, Ulka N., Galsky, Matthew D. and Yu, Evan Y. , RISC Investigators (2017) Venous thromboembolism risk in patients with locoregional urothelial tract tumors. Clinical Genitourinary Cancer. (doi:10.1016/j.clgc.2017.08.001).

Record type: Article

Abstract

BACKGROUND: Venous thromboembolism (VTE) is common in cancer patients, but there is limited data on patients with urothelial tract tumors (UTT). We previously identified several associative factors for increased VTE rates in patients with metastatic UTT. In this study, we assessed the frequency, associative factors, and impact on survival of VTE in patients with locoregional UTT.

METHODS: Patients with locoregional bladder, upper urinary tract, or urethral cancer were included in this multi-center study from 29 academic institutions. Patients with < cT2, > N1, or M1 disease at diagnosis were excluded. Patients with incomplete clinical staging or miscoded/missing data were excluded. Cumulative, unadjusted VTE incidence was calculated from time of diagnosis of muscle-invasive disease, excluding VTEs diagnosed in the metastatic setting. χ(2) statistics tested differences in VTE rates across baseline and treatment-related factors. Significant covariates were incorporated into a multivariate, logistic regression model. Overall survival stratified by VTE was estimated using Kaplan-Meier methods and evaluated using the log-rank test.

RESULTS: A total of 1732 patients were eligible. There were 132 (7.6%) VTEs. On multivariate analysis, non-urothelial histology (P < .001), clinical Nx stage (P < .001), cardiovascular disease (P = .01), and renal dysfunction (P = .04) were statistically significant baseline factors associated with VTE. Using surgery alone as reference, surgery with perioperative chemotherapy (P = .04) and radiation with concurrent chemotherapy (P = .04) also were significant.

CONCLUSIONS: The VTE incidence of 7.6% in locoregional disease is comparable with our previously reported rate in the metastatic setting (8.2%). Similar to our findings in metastatic UTT, non-urothelial histology, renal dysfunction, and CVD was associated with increased VTE risk.

Text
1-s2.0-S1558767317302422-main - Accepted Manuscript
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Accepted/In Press date: 13 August 2017
e-pub ahead of print date: 24 August 2017
Keywords: Journal Article

Identifiers

Local EPrints ID: 414393
URI: http://eprints.soton.ac.uk/id/eprint/414393
ISSN: 1558-7673
PURE UUID: 57fe6299-cfeb-420e-8735-6af829877776
ORCID for Simon J. Crabb: ORCID iD orcid.org/0000-0003-3521-9064

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Date deposited: 28 Sep 2017 16:31
Last modified: 16 Mar 2024 05:46

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Contributors

Author: Jorge D. Ramos
Author: Jonathan T. Wingate
Author: Roman Gulati
Author: Elizabeth R. Plimack
Author: Lauren C. Harshman
Author: Thomas Powles
Author: Simon J. Crabb ORCID iD
Author: Guenter Niegisch
Author: Joaquim Bellmunt
Author: Sylvain Ladoire
Author: Ugo De Giorgi
Author: Syed Hussain
Author: Ajjai S. Alva
Author: Jack Baniel
Author: Neeraj Agarwal
Author: Jonathan E. Rosenberg
Author: Ulka N. Vaishampayan
Author: Matthew D. Galsky
Author: Evan Y. Yu
Corporate Author: RISC Investigators

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