Background: Malignancies and cisplatin-based chemotherapy are both known to correlate with a high risk of venous thrombotic events (VTT). In testicular cancer, the information regarding the incidence and reason of VTT in patients undergoing cisplatin-based chemotherapy is still discussed controversially. Moreover, no risk factors for developing a VTT during cisplatin-based chemotherapy have been elucidated so far. Patients and Methods: We retrospectively analyzed 153 patients with testicular cancer undergoing cisplatin-based chemotherapy at our institution for the development of a VTT during or after chemotherapy. Clinical and pathological parameters for identifying possible risk factors for VTT were analyzed. The Khorana risk score was used to calculate the risk of VTT. Student t test was applied for calculating the statistical significance of differences between the treatment groups. Results: Twenty-six out of 153 patients (17%) developed a VTT during chemotherapy. When we analyzed the risk factors for developing a VTT, we found that Lugano stage ≥IIc was significantly (p = 0.0006) correlated with the risk of developing a VTT during chemotherapy. On calculating the VTT risk using the Khorana risk score model, we found that only 2 out of 26 patients (7.7%) were in the high-risk Khorana group (≥3). Conclusion: Patients with testicular cancer with a high tumor volume have a significant risk of developing a VTT with cisplatin-based chemotherapy. The Khorana risk score is not an accurate tool for predicting VTT in testicular cancer.

1.
La Vecchia C, Bosetti C, Lucchini F, et al: Cancer mortality in Europe, 2000-2004, and an overview of trends since 1995. Ann Oncol 2010;21:1323-1360.
2.
Nigam M, Aschebrook-Kilfoy B, Shikanov S, et al: Increasing incidence of testicular cancer in the United States and Europe between 1992 and 2009. World J Urol 2015;33:623-631.
3.
Motzer RJ, Sheinfeld J, Mazumdar M, Bajorin DF, Bosl GJ, Herr H, Lyn P, Vlamis V: Etoposide and cisplatin adjuvant therapy for patients with pathologic stage II germ cell tumors. J Clin Oncol 1995;13:2700-2704.
4.
Haugnes HS, Bosl GJ, Boer H, Gietema JA, Brydøy M, Oldenburg J, Dahl AA, Bremnes RM, Fosså SD: Long-term and late effects of germ cell testicular cancer treatment and implications for follow-up. J Clin Oncol 2012;30:3752-3763.
5.
Feldman DR, Voss MH, Jacobsen EP, Jia X, Suarez JA, Turkula S, Sheinfeld J, Bosl GJ, Motzer RJ, Patil S: Clinical features, presentation, and tolerance of platinum-based chemotherapy in germ cell tumor patients 50 years of age and older. Cancer 2013;119:2574-2581.
6.
Worst T, Sautter L, John A, Weiss C, Häcker A, Heinzelbecker J: Cisplatin-based chemotherapy for testicular germ cell tumors: complication rates of peripheral versus central venous administration. Urol Int 2016;96:177-182.
7.
Fosså SD, Gilbert E, Dores GM, et al: Noncancer causes of death in survivors of testicular cancer. J Natl Cancer Inst 2007;99:533-544.
8.
Fosså SD, Aass N, Harvei S, et al: Increased mortality rates in young and middle-aged patients with malignant germ cell tumours. Br J Cancer 2004;90:607-612.
9.
Blom JW, Doggen CJ, Osanto S, Rosendaal FR: Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 2005;293:715-722.
10.
Khorana AA, Connolly GC: Assessing risk of venous thromboembolism in the patient with cancer. J Clin Oncol 2009;27:4839-4847.
11.
Sørensen HT, Mellemkjaer L, Olsen JH, Baron JA: Prognosis of cancers associated with venous thromboembolism. N Engl J Med 2000;343:1846-1850.
12.
Noble S, Pasi J: Epidemiology and pathophysiology of cancer-associated thrombosis. Br J Cancer 2010;102(suppl 1):S2-S9.
13.
Weijl NI, Rutten MF, Zwinderman AH, Keizer HJ, Nooy MA, Rosendaal FR, Cleton FJ, Osanto S: Thromboembolic events during chemotherapy for germ cell cancer: a cohort study and review of the literature. J Clin Oncol 2000;18:2169-2178.
14.
Solari L, Krönig M, Ihorst G, Drognitz K, Heinz J, Jilg CA, Schultze-Seemann W, Engelhardt M, Waller CF: High rates of thromboembolic events in patients with germ cell cancer undergoing cisplatin-based polychemotherapy. Urol Int 2016;96:399-405.
15.
Heit JA: Epidemiology of venous thromboembolism. Nat Rev Cardiol 2015;12:464-474.
16.
Gupta A, Long JB, Chen J, Gross CP, Feldman DR, Steingart RM: Risk of vascular toxicity with platinum based chemotherapy in elderly patients with bladder cancer. J Urol 2016;195:33-40.
17.
Mellema WW, van der Hoek D, Postmus PE, Smit EF: Retrospective evaluation of thromboembolic events in patients with non-small cell lung cancer treated with platinum-based chemotherapy. Lung Cancer 2014;86:73-77.
18.
Honecker F, Koychev D, Luhmann AD, Langer F, Dieckmann KP, Bokemeyer C, Oechsle K: Venous thromboembolic events in germ cell cancer patients undergoing platinum-based chemotherapy. Onkologie 2013;36:663-668.
19.
Srikanthan A, Tran B, Beausoleil M, Jewett MA, Hamilton RJ, Sturgeon JF, O'Malley M, Anson-Cartwright L, Chung PW, Warde PR, Winquist E, Moore MJ, Amir E, Bedard PL: Large retroperitoneal lymphadenopathy as a predictor of venous thromboembolism in patients with disseminated germ cell tumors treated with chemotherapy. J Clin Oncol 2015;33:582-587.
20.
Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW: Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008;111:4902-4907.
21.
Lee YG, Lee E, Kim I, Lee KW, Kim TM, Lee SH, Kim DW, Heo DS: Cisplatin-based chemotherapy is a strong risk factor for thromboembolic events in small-cell lung cancer. Cancer Res Treat 2015;47:670-675.
22.
Nolan ME, Yadav H, Cawcutt KA, Cartin-Ceba R: Complication rates among peripherally inserted central venous catheters and centrally inserted central catheters in the medical intensive care unit. J Crit Care 2016;31:238-242.
23.
Hammes M, Desai A, Pasupneti S, Kress J, Funaki B, Watson S, Herlitz J, Hines J: Central venous catheters: incidence and predictive factors of venous thrombosis. Clin Nephrol 2015;84:21-28.
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