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Adramerina A, Economou M. Thrombotic Complications in Pediatric Cancer. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1096. [PMID: 39334628 PMCID: PMC11430297 DOI: 10.3390/children11091096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 08/30/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024]
Abstract
Thromboembolism (TE) complicates the course of pediatric cancer in a considerable number of cases. Cancer-related TE is attributed to an interaction of the underlying malignancy, the effects of therapy, and a possible thrombophilia predisposition. More specifically, recognized risk factors include a very young age and adolescence, non-O blood group, type and site of cancer, inherited thrombophilia, presence of central venous catheter, and type of chemotherapy. TE in children with cancer most commonly occurs in their extremities. In the absence of evidence-based guidelines for the management of thrombotic complications in pediatric oncology patients, TE management follows general recommendations for the management of pediatric TEs. Given the limitations of conventional anticoagulant therapy, direct oral anticoagulants could provide an alternative; however, their safety and efficacy in children with cancer remain to be seen. As for thromboprophylaxis, numerous studies have been conducted, albeit with conflicting results. Although the survival of pediatric oncology patients has significantly improved in recent years, morbidity due to cancer-related TE remains, underlying the need for large multicenter trials investigating both TE management with currently available agents and primary prevention.
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Affiliation(s)
- Alkistis Adramerina
- 1st Pediatric Department, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54250 Thessaloniki, Greece;
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Muggiolu G, Sauvaigo S, Libert S, Millet M, Daguenet E, Bouleftour W, Maillet T, Deutsch E, Magné N. Baseline DSB repair prediction of chronic rare Grade ≥ 3 toxicities induced by radiotherapy using classification algorithms. JOURNAL OF RADIATION RESEARCH 2024; 65:540-548. [PMID: 38899572 PMCID: PMC11262860 DOI: 10.1093/jrr/rrae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/29/2024] [Indexed: 06/21/2024]
Abstract
Small fractions of patients suffer from radiotherapy late severe adverse events (AEs Grade ≥ 3), which are usually irreversible and badly affect their quality of life. A novel functional DNA repair assay characterizing several steps of double-strand break (DSB) repair mechanisms was used. DNA repair activities of peripheral blood mononuclear cells were monitored for 1 week using NEXT-SPOT assay in 177 breast and prostate cancer patients. Only seven patients had Grade ≥ 3 AEs, 6 months after radiotherapy initiation. The machine learning method established the importance of variables among demographic, clinical and DNA repair data. The most relevant ones, all related to DNA repair, were employed to build a predictor. Predictors constructed with random forest and minimum bounding sphere predicted late Grade ≥ 3 AEs with a sensitivity of 100% and specificity of 77.17 and 86.22%, respectively. This multiplex functional approach strongly supports a dominant role for DSB repair in the development of chronic AEs. It also showed that affected patients share specific features related to functional aspects of DSB repair. This strategy may be suitable for routine clinical analysis and paves the way for modelling DSB repair associated with severe AEs induced by radiotherapy.
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Affiliation(s)
- Giovanna Muggiolu
- LXRepair, Research Department, 5 Avenue du Grand Sablon, La Tronche 38700, France
| | - Sylvie Sauvaigo
- LXRepair, Research Department, 5 Avenue du Grand Sablon, La Tronche 38700, France
| | - Sarah Libert
- LXRepair, Research Department, 5 Avenue du Grand Sablon, La Tronche 38700, France
| | - Mathias Millet
- LXRepair, Research Department, 5 Avenue du Grand Sablon, La Tronche 38700, France
| | - Elisabeth Daguenet
- Clinical Research Department, Cancerology and Hematology Institute, CHU de Saint Etienne, 108 Avenue Albert Raimond, 42055 Cedex 02, France
| | - Wafa Bouleftour
- Clinical Research Department, Cancerology and Hematology Institute, CHU de Saint Etienne, 108 Avenue Albert Raimond, 42055 Cedex 02, France
| | - Thierry Maillet
- LXRepair, Research Department, 5 Avenue du Grand Sablon, La Tronche 38700, France
| | - Eric Deutsch
- Gustave Roussy Cancer Campus (GRCC), 114 Rue Edouard Vaillant, 94805 Villejuif, France
| | - Nicolas Magné
- Department of Radiation Oncology, Institut Bergonié, 229 Cr de l'Argonne, 33076 Bordeaux, France
- Cellular and Molecular Radiobiology Laboratory, Lyon-Sud Medical School, Unité Mixte de Recherche CNRS5822/IP2I, University of Lyon, Ouliins, 69600, France
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Mahé I, Frère C, Pernod G, Sanchez O, Baih AI. [Translation into French and republication of: "Management of venous thromboembolic disease in patients with malignant brain tumours"]. Rev Med Interne 2024; 45:300-311. [PMID: 38763817 DOI: 10.1016/j.revmed.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 05/21/2024]
Abstract
This article addresses the management of venous thromboembolism in patients with malignant brain tumours, including both primary and secondary (metastatic) tumours. The available data on patients on venous thromboembolism recurrence and bleeding risks in patients with brain tumours is limited, since these patients have been excluded from most randomised, interventional, head-to-head, clinical trials comparing low molecular weight heparins to vitamin K antagonists or to direct oral factor Xa inhibitors. More information is available from retrospective observational studies, which however were generally small, and carried a high risk of confounding. Their findings suggest that direct factor Xa inhibitor use is associated with lower rates of intracranial haemorrhage compared with low molecular weight heparins. Overall, the safety profile of direct oral factor Xa inhibitors when used to prevent venous thromboembolism recurrence in patients with either primary or secondary brain tumours appears to be favourable. The available data are in favour of using an anticoagulant at a full therapeutic dose in patients with primary and secondary brain tumours experiencing a venous thromboembolism, although they are not yet sufficiently robust to permit recommending a direct factor Xa inhibitor over low-molecular weight heparin.
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Affiliation(s)
- I Mahé
- Service de médecine interne, hôpital Louis-Mourier, Assistance publique-Hôpitaux de Paris, 92700 Colombes, France; Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; F-CRIN INNOVTE Network, Saint-Étienne, France.
| | - C Frère
- Hôpital de la Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Sorbonne université, Inserm UMRS 1166, GRC 27 Greco, DMU BioGeMH, Paris, France
| | - G Pernod
- F-CRIN INNOVTE Network, Saint-Étienne, France; Service de médecine vasculaire, université Grenoble-Alpes, Grenoble, France
| | - O Sanchez
- Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; F-CRIN INNOVTE Network, Saint-Étienne, France; Service de pneumologie et soins intensifs, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France
| | - A Id Baih
- Service de neuro-oncologie, Institut du cerveau - Paris Brain Institute, ICM, hôpitaux universitaires La Pitié-Salpêtrière - Charles-Foix, DMU Neurosciences, Sorbonne université, Assistance publique-Hôpitaux de Paris, Inserm, CNRS, Paris, France
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Elsherif S, Zidan A, Saville O, Othman M. ABO Blood Group and the Risk of Thrombosis in Cancer Patients: A Mini-Review. Semin Thromb Hemost 2024; 50:423-428. [PMID: 37751774 DOI: 10.1055/s-0043-1775568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Cancer-associated thrombosis (CT), especially venous thromboembolism (VTE), is a common occurrence with several factors contributing to a wide diversity in thrombosis risk. The association between ABO blood groups and the risk for CT has been examined in various studies, with non-O blood type associated with an increased thrombosis risk; however, these studies have reported varying results with recognized limitations. ABO blood groups are known to be implicated in hemostasis, in an association mediated through von Willebrand factor (VWF). In this narrative review, we aim to summarize the current knowledge surrounding the role of ABO blood groups in VTE, with a particular focus on the role of VWF and other contributing risk factors on VTE occurrence. We found evidence from literature for the impact of ABO blood groups in determining the risk of VTE in healthy populations, with a limited number of studies examining this effect in cancer patients. Additionally, research on the impact of ABO on different cancer types lacks rigor, particularly in regard to other risk factors. Overall, most studies showed strong association of increased risk of VTE amongst cancer patients with non-O blood groups and increased VWF levels. This association was weaker in a few studies. Further research is needed before a solid conclusion can be made about the ABO or ABO-VWF-mediated hypercoagulability and VTE risk in various cancers. These studies will help determine if ABO typing can be an added biomarker to improve VTE risk assessment models in cancer patients.
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Affiliation(s)
- Salah Elsherif
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ali Zidan
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Olivia Saville
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Nursing, School of Baccalaureate Nursing, St. Lawrence College, Kingston, Ontario, Canada
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansura, Egypt
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Abrahão R, Brunson A, Chubak J, Wernli KJ, Nichols HB, Chao C, Ruddy KJ, Hahn EE, Li Q, Malogolowkin MH, Sauder CAM, Kushi LH, Wun T, Keegan THM. Late venous thromboembolism in survivors of adolescent and young adult cancer: A population-based study in California. Thromb Res 2024; 235:1-7. [PMID: 38244373 PMCID: PMC10989999 DOI: 10.1016/j.thromres.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/24/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Venous thromboembolism (VTE), a common complication in cancer patients, occurs more often during the initial phase of treatment. However, information on VTE beyond the first two years after diagnosis ('late VTE') is scarce, particularly in young survivors. METHODS We examined the risk of, and factors associated with, late VTE among adolescents and young adults (AYA, 15-39 years) diagnosed with cancer (2006-2018) who survived ≥2 years. Data were obtained from the California Cancer Registry linked to hospitalization, emergency department and ambulatory surgery data. We used non-parametric models and Cox proportional hazard regression for analyses. RESULTS Among 59,343 survivors, the 10-year cumulative incidence of VTE was 1.93 % (CI 1.80-2.07). The hazard of VTE was higher among those who had active cancer, including progression from lower stages to metastatic disease (Hazard Ratio (HR) = 10.41, 95 % confidence interval (CI): 8.86-12.22), second primary cancer (HR = 2.58, CI:2.01-3.31), or metastatic disease at diagnosis (HR = 2.38, CI:1.84-3.09). The hazard of late VTE was increased among survivors who underwent hematopoietic cell transplantation, those who received radiotherapy, had a VTE history, public insurance (vs private) or non-Hispanic Black/African American race/ethnicity (vs non-Hispanic White). Patients with leukemias, lymphomas, sarcoma, melanoma, colorectal, breast, and cervical cancers had a higher VTE risk than those with thyroid cancer. CONCLUSIONS VTE risk remained elevated ≥2 years following cancer diagnosis in AYA survivors. Active cancer is a significant risk factor for VTE. Future studies might determine if late VTE should prompt evaluation for recurrence or second malignancy, if not already known.
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Affiliation(s)
- Renata Abrahão
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America.
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America
| | - Hazel B Nichols
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Chun Chao
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - Erin E Hahn
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Qian Li
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America
| | - Marcio H Malogolowkin
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California Davis School of Medicine, Sacramento, CA, United States of America
| | - Candice A M Sauder
- Division of Surgical Oncology, Department of Surgery, University of California Davis, Sacramento, CA, United States of America; University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States of America
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Mahé I, Frère C, Pernod G, Sanchez O, Id Baih A. Management of venous thromboembolic disease in patients with malignant brain tumours. Arch Cardiovasc Dis 2024; 117:60-71. [PMID: 38087664 DOI: 10.1016/j.acvd.2023.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 12/27/2023]
Abstract
This article addresses the management of venous thromboembolism in patients with malignant brain tumours, including both primary and secondary (metastatic) tumours. The available data on patients on venous thromboembolism recurrence and bleeding risks in patients with brain tumours is limited, since these patients have been excluded from most randomised, interventional, head-to-head, clinical trials comparing low molecular weight heparins to vitamin K antagonists or to direct oral Factor Xa inhibitors. More information is available from retrospective observational studies, which however were generally small, and carried a high risk of confounding. Their findings suggest that direct Factor Xa inhibitor use is associated with lower rates of intracranial haemorrhage compared with low molecular weight heparins. Overall, the safety profile of direct oral Factor Xa inhibitors when used to prevent venous thromboembolism recurrence in patients with either primary or secondary brain tumours appears to be favourable. The available data are in favour of using an anticoagulant at a full therapeutic dose in patients with primary and secondary brain tumours experiencing a venous thromboembolism, although they are not yet sufficiently robust to permit recommending a direct Factor Xa inhibitor over low-molecular weight heparin.
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Affiliation(s)
- Isabelle Mahé
- Service de médecine interne, Hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92700 Colombes, France; Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France.
| | - Corinne Frère
- Hôpital de la Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Sorbonne université, Inserm UMRS 1166, GRC 27 GRECO, DMU BioGeMH, Paris, France
| | - Gilles Pernod
- Service de médecine vasculaire,Université Grenoble-Alpes, Grenoble, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Olivier Sanchez
- Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; Service de Pneumologie et soins intensifs, hôpital européen Georges Pompidou, APHP, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Ahmed Id Baih
- Sorbonne Université, AP-HP, Institut du Cerveau - Paris Brain Institute, ·ICM, Inserm, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, DMU Neurosciences, Service de Neuro-Oncologie, Paris, France
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Rachman A, Christine G, Betsy R, Juanputra S, Pratiwi W. The factors affecting the survivability of malignant cancer patients with deep vein thrombosis among subjects with gynecologic and non-gynecologic cancer: An ambispective cohort study. F1000Res 2023; 12:890. [PMID: 39479230 PMCID: PMC11522705 DOI: 10.12688/f1000research.135252.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 11/02/2024] Open
Abstract
Background Gynecologic cancer is a significant public health concern worldwide, with three of the top ten most common cancers affecting women. The increasing incidence of deep vein thrombosis (DVT) and the disproportionately poor outcomes in cancer patients necessitates urgent intervention. This study aimed to analyze the factors affecting the survivability of cancer patients with DVT, especially among gynecologic and non-gynecologic cancers. Methods An ambispective cohort study was conducted among gynecologic and non-gynecologic cancer patients with DVT, from January 2011 until August 2013. All subjects were observed for three months. The presence of DVT was confirmed using Doppler ultrasound. The analysis was performed using Kaplan-Meier survival analysis. The statistical significance was determined using the log-rank/Mantel-Cox test. Results Among 223 cancer subjects with DVT, 61.4% of the subjects developed short-term mortality. In the overall group, the survival time was significantly lower in subjects who developed immobilization status (p-value <0.001), advanced cancer stages (p-value <0.045), and infection status (p-value <0.001). In the gynecologic cancer group, the survival time was significantly lower in subjects who developed immobilization (p-value 0.007) and infection status (p-value 0.021). In the non-gynecologic cancer group, the survival time was significantly lower in subjects who developed immobilization (p-value 0.008), infection (p-value 0.002), undergo cancer surgery (p-value 0.024), and received high-risk systemic therapy (p-value 0.048). Additionally, the most common infection was pneumonia (29.6%). Conclusions Both gynecologic and non-gynecologic cancer patients who experienced DVT developed a high short-term mortality. Our finding of immobility, infection, advanced cancer stages, systemic therapy, and cancer surgery as risk factors that affect the survivability highlights the necessity of administering secondary prophylaxis as a standard procedure in clinical practice.
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Affiliation(s)
- Andhika Rachman
- Division of Hematology and Oncology, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Jakarta, 10430, Indonesia
| | - Griskalia Christine
- Division of Hematology and Oncology, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Jakarta, 10430, Indonesia
- Division of Hematology and Oncology, Department of Internal Medicine, Tarakan Regional Hospital, Central Jakarta, DKI Jakarta, 10150, Indonesia
| | - Rachelle Betsy
- Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital - Faculty of Medicine Universitas Indonesia, Central Jakarta, DKI Jakarta, 10430, Indonesia
| | - Samuel Juanputra
- Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital - Faculty of Medicine Universitas Indonesia, Central Jakarta, DKI Jakarta, 10430, Indonesia
| | - Widya Pratiwi
- Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital - Faculty of Medicine Universitas Indonesia, Central Jakarta, DKI Jakarta, 10430, Indonesia
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Albertsen IE, Lyhne NM, Larsen TB, Nielsen PB. Incidence of venous thromboembolism following head and neck surgery. Eur Arch Otorhinolaryngol 2023; 280:5081-5089. [PMID: 37458791 PMCID: PMC10562290 DOI: 10.1007/s00405-023-08112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/03/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Venous thromboembolism (VTE) is associated with significant morbidity and mortality in patients undergoing surgery, but conflicting data exist on VTE risk in patients undergoing head and neck surgery for malignant and non-malignant conditions. Our aim was to examine the risk of VTE among patients with and without cancer undergoing head and neck surgery. METHODS We conducted a nationwide cohort study to examine the risk of VTE among patients with an otolaryngological diagnosis using data from the Danish National Patient Register between 2010 and 2018. Analyses were stratified by cancer and anatomical areas of the surgical procedure. RESULTS In total, 116,953 patients were included of whom 10% (n = 12,083) had active cancer. After 3 months, 1.2% of the patients with cancer and 0.3% of the patients without cancer experienced VTE, respectively. For patients undergoing mouth/throat surgery, 0.8% with cancer and 0.2% without cancer had VTE, respectively. After nose/sinuses surgery 0.7% and 0.2%, respectively. No patients experienced VTE after ear surgery; and after endoscopies the numbers were 1.3% and 0.6% respectively. CONCLUSIONS While the minority of patients undergoing head and neck surgery develop VTE postoperatively, the risk increases among those with cancer. To support clinical decision making on anticoagulation, risk stratification tools could be further developed to recognize this hazard in patients with cancer undergoing head and neck surgery.
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Affiliation(s)
- Ida E. Albertsen
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Nina M. Lyhne
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Torben B. Larsen
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Peter B. Nielsen
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
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Crichi B, Moati E, Cacciatore C, Farge D, Frere C. [Venous thromboembolism and breast cancer]. Bull Cancer 2023; 110:1051-1062. [PMID: 37474353 DOI: 10.1016/j.bulcan.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 07/22/2023]
Abstract
Breast cancer is the most common cancer in women. Patients with breast cancer have a 4-fold increased risk of venous thromboembolism (VTE) compared to age- and sex-matched controls without cancer. VTE remains the second leading cause of death in cancer patients and an independent risk factor for mortality. In women with breast cancer, the main risk factors for developing VTE are increasing age, obesity, disease stage, central catheter placement and cancer treatments, including surgery, chemotherapy, hormonotherapy and cyclin-dependent kinase 4/6 inhibitors. In women receiving tamoxifen, the risk of VTE is particularly increased within the first 6 months after initiation of hormonotherapy, although some evidence suggests that this risk may persist through the first 2 years of treatment. The risk of VTE appears to be lower in patients receiving aromatase inhibitors. In breast cancer patients receiving cyclin-dependent kinase 4/6 inhibitors, the rate of VTE is approximately 6%. Current clinical practice guidelines for the treatment and prevention of VTE in patients with cancer suggest that thromboprophylaxis should not be used routinely in ambulatory cancer patients receiving chemotherapy or hormonotherapy. The risk-benefit ratio of thromboprophylaxis should be assessed on a case-by-case basis and be the subject of multidisciplinary discussion.
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Affiliation(s)
- Benjamin Crichi
- Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, service de médecine interne, Paris, France.
| | - Emilie Moati
- Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, centre des maladies du sein, Paris, France
| | - Carlotta Cacciatore
- Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, service de médecine interne, Paris, France
| | - Dominique Farge
- Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, service de médecine interne, Paris, France
| | - Corinne Frere
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, service d'hématologie biologique, Paris, France
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Ohsumi S, Watanabe K, Kondo N, Kosaka Y, Ishikawa T, Kitahara M, Kubo S, Oba MS, Kimura T, Takita A, Mukai H. Venous thromboembolism in Japanese patients with breast cancer: subgroup analysis of the Cancer-VTE Registry. Breast Cancer 2023; 30:607-616. [PMID: 37069366 PMCID: PMC10284999 DOI: 10.1007/s12282-023-01452-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/07/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND This subgroup analysis of the Cancer-VTE Registry, a nationwide, large-scale, multicenter observational study with a 1-year follow-up, assessed real-world data on venous thromboembolism (VTE) among Japanese patients with breast cancer. METHODS Patients with stage II-IV pretreatment breast cancer screened for VTE at enrollment were included. During the 1-year follow-up period, incidences of VTE, bleeding, and all-cause death, and background factors associated with VTE risk were examined. RESULTS Of 9,630 patients in the Cancer-VTE Registry analysis set, 993 (10.3%) had breast cancer (973 [98.0%] did not have and 20 [2.0%] had VTE at baseline). The mean age was 58.4 years, 73.4% of patients had stage II cancer, and 94.8% had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0. Risk factors for VTE at baseline by univariable analysis were age ≥ 65 years, ECOG PS of 2, VTE history, and D-dimer > 1.2 μg/mL. During follow-up, the incidence of symptomatic VTE was 0.4%; incidental VTE requiring treatment, 0.1%; composite VTE (symptomatic VTE and incidental VTE requiring treatment), 0.5%; bleeding, 0.2%; cerebral infarction/transient ischemic attack/systemic embolic event, 0.2%; and all-cause death, 2.1%. One patient with symptomatic VTE developed pulmonary embolism (PE) and died. Incidences of VTE and all-cause death were higher in patients with VTE vs without VTE at baseline. CONCLUSIONS In Japanese patients with breast cancer, VTE screening before initiating cancer treatment revealed a 2.0% prevalence of VTE. During follow-up, one patient had a fatal outcome due to PE, but the incidences of VTE were low. CLINICAL TRIAL REGISTRATION UMIN000024942; UMIN Clinical Trials Registry: https://www.umin.ac.jp/ctr/ .
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Affiliation(s)
- Shozo Ohsumi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umemoto-machi, Matsuyama, Ehime, 791-0280, Japan.
| | - Kenichi Watanabe
- Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
| | - Naoto Kondo
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Yoshimasa Kosaka
- Department of Breast and Endocrine Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
- Department of Breast Surgery, Japanese Red Cross Sagamihara Hospital, Sagamihara, Kanagawa, Japan
| | - Takashi Ishikawa
- Department of Breast Oncology and Surgery, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Miyuki Kitahara
- Department of Breast Surgery, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Kasama, Ibaraki, Japan
| | - Shinichiro Kubo
- Division of Breast and Thyroid Gland Surgery, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Mari S Oba
- Department of Medical Statistics, Toho University, Ota-ku, Tokyo, Japan
- Department of Clinical Data Science, Clinical Research and Education Promotion Division, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Tetsuya Kimura
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd., Chuo-ku, Tokyo, Japan
| | - Atsushi Takita
- Data Intelligence Department, Daiichi Sankyo Co., Ltd., Shinagawa-ku, Tokyo, Japan
| | - Hirofumi Mukai
- Division of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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11
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Guntupalli SR, Spinosa D, Wethington S, Eskander R, Khorana AA. Prevention of venous thromboembolism in patients with cancer. BMJ 2023; 381:e072715. [PMID: 37263632 DOI: 10.1136/bmj-2022-072715] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Venous thromboembolism (VTE) is a major cause of both morbidity and mortality in patients with cancer. Venous thromboembolism, which includes both deep vein thrombosis and pulmonary embolism, affects a sizable portion of patients with malignancy and can have potentially life threatening complications. Accurate assessment of risk as well as diagnosis and treatment of this process is paramount to preventing death in this high risk population. Various risk models predictive of venous thromboembolism in patients with cancer have been developed, and knowledge of these rubrics is essential for the treating oncologist. Subgroups of particular interest are inpatients receiving chemotherapy, postoperative patients after surgical debulking, and patients undergoing radiotherapy. Numerous newer drugs have become available for the prevention of venous thromboembolism in patients with cancer who are at high risk of developing the disease. These include the class of drugs called direct oral anticoagulants, (DOACs) which do not require the same monitoring that other modalities have previously required and are taken by mouth, preventing the discomfort associated with subcutaneous strategies. The appropriate risk stratification and intervention to prevent venous thromboembolism are vital to the treatment of patients with cancer.
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Affiliation(s)
- Saketh R Guntupalli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel Spinosa
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stephanie Wethington
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ramez Eskander
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology University of California School of Medicine, San Diego, CA, USA
| | - Alok A Khorana
- Department of Hematology Oncology, Taussig Cancer Institute and Case Comprehensive Cancer Center, Cleveland Clinic, Cleveland, OH, USA
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12
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Chen F, Sun Y, Zhang C, Li L, Du Y, Zhou M, Cheng W. Risk Factors of Venous Thromboembolism in Inpatients With Colorectal Cancer in China. Clin Appl Thromb Hemost 2023; 29:10760296231221133. [PMID: 38105233 PMCID: PMC10729642 DOI: 10.1177/10760296231221133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/14/2023] [Accepted: 11/26/2023] [Indexed: 12/19/2023] Open
Abstract
To explore the risk factors for venous thromboembolism (VTE) in inpatients with colorectal cancer. The demographic factors, comorbidities, and hematological indices of patients with colorectal cancer treated in our hospital from 2016 to 2021 were collected and recorded. Venous thromboembolism events, including deep venous thrombosis and/or pulmonary embolism, were recorded and the patients were divided into the VTE group and the non-VTE group. We compared clinical data between the two groups and explored risk factors for VTE. Comparing the clinical data of 293 cases of non-VTE group and 235 cases of VTE group, we found significant differences in age, smoking, temperature, amount of blood loss, differentiation degree, peripherally inserted central catheter (PICC), radiotherapy, anemia, infection, white blood cell count, prothrombin time (PT), PT%, prothrombin ratio, international normalized ratio, thrombin time, CA199 and CEA between the two groups (P < 0.05). Logistic regression analysis showed that age (P = 0.0444), temperature (P = 0.0317), amount of blood loss (P = 0.0067), PICC (P < 0.0001), chemotherapy (P = 0.0459), anemia (P = 0.0007), international normalized ratio (P = 0.003) and CA199 (p = 0.0234) were independent risk factors for VTE. Receiver operating characteristic curve analysis showed that the amount of blood loss predicted thrombosis better (AUC = 0.778, P < 0.001), when the cutoff value was 20 mL, the sensitivity was 76.17%, and the specificity was 79.18%, respectively. And PICC predicted thrombosis better (AUC = 0.808, P < 0.001), the sensitivity was 70.21%, and the specificity was 91.47%, respectively. Clinical parameters are associated with VTE in inpatients with colorectal cancer, which will help to guide clinicians to take effective measures to improve the patients' prognosis.
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Affiliation(s)
- Fengjiao Chen
- Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Yixin Sun
- Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Cui Zhang
- Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Lei Li
- Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Yu Du
- Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Mingyan Zhou
- Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Wen Cheng
- Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
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13
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Zhang L, Fang Y, Xing J, Cheng H, Sun X, Yuan Z, Xu Y, Hao J. The Efficacy of the Systemic Immune-Inflammation Index and Prognosis Nutritional Index for the Diagnosis of Venous Thromboembolism in Gastrointestinal Cancers. J Inflamm Res 2022; 15:4649-4661. [PMID: 35996687 PMCID: PMC9391990 DOI: 10.2147/jir.s376601] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to analyze the association between venous thromboembolism (VTE) and inflammatory markers like systemic immune-inflammation index (SII) and prognosis nutritional index (PNI), and to evaluate their efficacy for the diagnosis of VTE in patients with gastrointestinal malignancies. Patients and Methods A total of 1326 patients with the initial diagnosis of gastrointestinal cancer in the First Affiliated Hospital of Anhui Medical University (AHMU) were enrolled in the training cohort. Univariate and multivariate analysis was used to pinpoint independent predictors of VTE, which were eventually visualized as the nomogram models. The Akaike Information Criterion (AIC) was used to screen the best model. The receiver operating characteristic curve (ROC) and the clinical decision curve analysis (DCA) were utilized to evaluate the models’ predictive performance in the training queue and another external sample of 250 patients at the Second Affiliated Hospital of AHMU. Results A total of 476 patients were complicated with VTE in the training cohort. Multifactorial analysis of clinical characteristics and inflammatory markers showed that PNI, SII, age, tumor location, and therapy were independent risk factors of VTE, visualized as model A. Another model B was constructed by adding coagulation markers to the previous analysis. Model B was the best prediction model with the minimum AIC value, followed by model A with an AUC of 0.806 (95% CI 0.782~0.830) which was similar to model B’s 0.832 (95% CI 0.810~0.855) but significantly higher than the currently widely used Khorana score’s 0.592 (95% CI 0.562~0.621) and the CATS score’s 0.682 (95% CI 0.653~0.712). The external verification yielded similar findings, with the AUC being 0.792 (95% CI 0.734~0.851), 0.834 (95% CI 0.778~0.890), 0.655 (95% CI 0.582~0.729), and 0.774 (95% CI 0.699~0.849) respectively. The DCA curves demonstrated that new models had excellent usefulness in screening patients with a high VTE risk. Conclusion The SII and PNI were simple and viable inflammatory markers associated with VTE, and the nomogram based on them and clinical features had a meaningful clinical utility for VTE in patients with gastrointestinal malignancies.
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Affiliation(s)
- Lu Zhang
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Yue Fang
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Jianghao Xing
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Hao Cheng
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Xiaonan Sun
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Zhichao Yuan
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Yidan Xu
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Jiqing Hao
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
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