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Schuster J, Sheng IY, Reddy CA, Khorana AA, Nizam A, Gupta S, Gilligan T, Wee CE, Sussman TA, Bonham A, Maroli K, Martin A, Ornstein MC. Risk of Thromboembolism in Patients Receiving Immunotherapy-Based Combinations as Front-Line Therapy for Metastatic Renal Cell Carcinoma. Clin Genitourin Cancer 2024; 22:92-97. [PMID: 37932205 DOI: 10.1016/j.clgc.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Most patients with treatment-naïve metastatic renal cell carcinoma (mRCC) receive combination-based immunotherapy with either 2 immune-oncology checkpoint inhibitors (IO/IO) or an IO agent in combination with a vascular endothelial growth factor receptor (VEGF-R) tyrosine kinase inhibitor (IO/TKI). The rates of thromboembolism (TE) in these cohorts are not clearly described and can potentially impact decision-making between IO/IO and IO/TKI. METHODS We conducted a retrospective investigation of patients with treatment-naïve mRCC treated with IO-based combinations between January 2015 and April 2021 at the Cleveland Clinic. TE events, including venous and arterial, were identified in each group. Competing risk regression was done to identify factors associated with the development of TE following therapy, with all-cause mortality treated as a competing event. RESULTS Of 180 patients identified, 77 (43%) received IO/TKI and 103 (57%) received IO/IO. Median age was 65 years, 75% were male, and 80% had clear cell histology. Baseline characteristics were similar between the 2 groups. At a median follow-up of 22.0 months, 10.0% of all patients had a TE. The one-year incidence of TE was 8.1% (95% CI: 3.3%-15.8%) with IO/TKI and 9.8% (95% CI: 5.0%-16.5%) with IO/IO and was not significantly different between the 2 groups (HR 0.89, 95% CI: 0.35%-2.28%). Occurrence of TE was associated with decreased overall survival regardless of IO/IO or IO/TKI therapy (HR 2.80, 95% CI: 1.57-5.02). There was no difference in incidence of TE based on patient age, gender, prior history of TE, International Metastatic Renal Cell Carcinoma (IMDC) risk group, or Khorana score. CONCLUSIONS Incidence of TE is similar between IO/IO and IO/TKI regimens in treatment-naïve mRCC and is also associated with decreased overall survival. While risk of TE may not guide decision-making in choice of front-line mRCC therapy, careful attention should be given to the high risk of TE in this population.
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Khalilian S, Mohajer Z, Ghafouri-Fard S. Factor VIII as a Novel Biomarker for Diagnosis, Prognosis, and Therapy Prediction in Human Cancer and Other Disorders. Avicenna J Med Biotechnol 2024; 16:68-80. [PMID: 38618505 PMCID: PMC11007370 DOI: 10.18502/ajmb.v16i2.14857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/28/2023] [Indexed: 04/16/2024] Open
Abstract
Coagulation factor VIII (FVIII) is an essential cofactor in the coagulation cascade, encoded by the F8 gene on the long arm of chromosome X (Xq28). FVIII is normally circulated in complex with Von Willebrand factor (VWF) and has relevant emerging extracoagulative functions. Dysregulation of FVIII is associated with tumor progression, and could be used as a novel biomarker for tumor screening and monitoring. In breast cancer, bladder cancer, colorectal carcinoma, esophageal carcinoma, hepatocellular carcinoma and lung cancer, F8 is regarded as an oncogene. In coronary heart disease, hemophilia A and liver disease, F8 dysregulation has been recognized as a potential biomarker for disease diagnosis and prognosis. However, the basis of these differential expression levels remains to be understood. In this review, which is a mixture of literature review and bioinformatics analysis we described the biological functions and characteristics of FVIII, and also its expression level in non-malignant disorders and various cancers.
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Affiliation(s)
- Sheyda Khalilian
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Mohajer
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soudeh Ghafouri-Fard
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Yetiskul E, Kimyaghalam A, Khan S, Grabie Y, Rizvi TA, Khan S. Case of Circulating Tumor Cells Discovered in Extensive Deep Venous Thrombosis in a Patient with Known Urothelial Carcinoma. Case Rep Hematol 2024; 2024:6144020. [PMID: 38496264 PMCID: PMC10944343 DOI: 10.1155/2024/6144020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/20/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
Background Currently, minimal data are available to explore the composition of venous thromboembolism in patients with cancer. This case report discusses a presentation of venous thromboembolism in a patient with high-grade urothelial carcinoma and highlights the pathology findings in thrombi. Case Presentation. A 55-year-old female who was diagnosed with high-grade urothelial carcinoma with multiple metastases developed an extensive deep vein thrombosis in her left lower extremity. Endovascular revascularization was indicated due to left lower extremity pain and swelling not responsive to anticoagulation. A mechanical thrombectomy was performed, and samples were sent for pathology. Pathologic examination discovered minute fragments of metastatic carcinoma, admixed with laminated blood clots (thrombus). The morphology of metastatic carcinoma and the immunostain profile were compatible with metastatic carcinoma of bladder origin. Conclusion Cancer is a well-known risk factor for developing VTEs, and it is estimated that approximately 4-20% of cancer patients will experience VTE at some stage, the rate being the highest in the initial period following diagnosis. Annually, 0.5% of cancer patients will experience thrombosis compared with a 0.1% incidence rate in the general population (Elyamany et al., 2014). Despite knowing the increased incidence of VTEs in cancer patients, there are few studies to date that analyze the composition of thrombi in patients with cancer.
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Affiliation(s)
- Ekrem Yetiskul
- Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA
| | - Ali Kimyaghalam
- Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA
| | - Shahkar Khan
- Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA
| | - Yisroel Grabie
- Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA
| | - Taqi A. Rizvi
- Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA
| | - Salman Khan
- Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA
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Lu S, Zhang X, Cai Z, Xi Z, Wang F, Wang X, Li W, Dai P. Identification of novel lncRNA prognostic biomarkers and their associated ceRNAs in bladder urothelial carcinoma. J Biochem Mol Toxicol 2023; 37:e23441. [PMID: 37393523 DOI: 10.1002/jbt.23441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/19/2023] [Accepted: 06/14/2023] [Indexed: 07/03/2023]
Abstract
Bladder urothelial carcinoma (BUCA) is a common malignant tumor with a high rate of metastasis and recurrence. The lack of specific and sensitive biomarkers for the prognostic assessment makes it important to seek alternatives. Recent studies have demonstrated that long noncoding RNAs (lncRNAs) function as competitive endogenous RNAs (ceRNAs) and play an important role in BUCA prognosis. Therefore, this study aimed to establish a prognosis-related lncRNAs-microRNAs (miRNAs)-messenger RNA (mRNA) (pceRNA) network and identify novel prognostic biomarkers. Integrated weighted coexpression analysis, functional clustering, and ceRNA network were used for the prognostic assessment of BUCA. The transcriptome sequencing datasets of lncRNA, miRNA, and mRNA from The Cancer Genome Atlas database were used for the identification of key lncRNAs and construction of the lncRNAs expression signature for prognostic prediction of BUCA patients. Then, 14 differentially expressed lncRNAs (DE-lncRNAs) were identified as candidate prognostic RNAs based on the ceRNAs network and functional clustering. In the Cox regression analysis, two (AC008676.1 and ADAMTS9-AS1) of all DE-lncRNAs were significantly associated with overall survival (OS) of BUCA patients. This two DE-lncRNA signature was significantly correlated with OS and was an independent prognostic factor, which was confirmed in an independent dataset of GSE216037. Moreover, we constructed the pceRNA network that includes 2 DE-lncRNAs, 9 DE-miRNAs, and 10 DE-mRNAs. Pathway enrichment analysis showed that AC008676.1 and ADAMTS9-AS1 are involved in several cancer-related pathways such as proteoglycans in cancer and TGF-beta signaling pathway. The novel-identified DE-lncRNA prognostic signature and the pceRNA network in this study will be valuable risk predictors and diagnostic markers for BUCA.
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Affiliation(s)
- Sihai Lu
- School of Life Sciences, Northwest University, Xi'an, China
- Shaanxi Lifegen Co. Ltd., Xi'an, China
- National Engineering Research Center for Miniaturized Detection Systems, Northwest University, Xi'an, China
| | | | - Zhiye Cai
- School of Life Sciences, Northwest University, Xi'an, China
| | - Ziyi Xi
- School of Life Sciences, Northwest University, Xi'an, China
| | - Fei Wang
- School of Life Sciences, Northwest University, Xi'an, China
| | - Xuan Wang
- School of Life Sciences, Northwest University, Xi'an, China
| | - Wenqi Li
- School of Life Sciences, Northwest University, Xi'an, China
| | - Penggao Dai
- School of Life Sciences, Northwest University, Xi'an, China
- Shaanxi Lifegen Co. Ltd., Xi'an, China
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Sheng IY, Gupta S, Reddy CA, Angelini D, Funchain P, Sussman TA, Sleiman J, Ornstein MC, McCrae K, Khorana AA. Thromboembolism in Patients with Metastatic Urothelial Cancer Treated with Immune Checkpoint Inhibitors. Target Oncol 2022; 17:563-569. [PMID: 35986816 DOI: 10.1007/s11523-022-00905-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Immunotherapy has become one of the mainstays for metastatic urothelial carcinoma treatment. Whether immune checkpoint inhibitor therapy increases thromboembolism (TE) risk is unknown. OBJECTIVE We investigated the incidence of arterial thromboembolism (ATE) and venous thromboembolism (VTE) events and its associated outcomes in patients with metastatic urothelial cancer treated with immune checkpoint inhibitors. METHODS Patients with urothelial cancer treated with immune checkpoint inhibitors at the Cleveland Clinic from 1/1/2015 to 12/31/2019 were identified. The Kaplan-Meier method estimated overall survival and Cox proportional hazards regression evaluated the impact of TE on overall survival. RESULTS Of 279 patients, 72% were men with pure urothelial cancer (62%) who started atezolizumab (40%), nivolumab (3%), or pembrolizumab (57%). At a median follow-up of 5.6 months (range 0.3-51.6), 42 patients developed a TE (VTE n = 37, 13%, ATE n = 5, 2%). The cumulative incidence of TE after immune checkpoint inhibitor therapy was 9.1% (95% confidence interval 6.0-13.0) at 6 months and 13.6% (95% confidence interval 9.6-18.4) at 12 months. Most TE (VTE 62%, ATE 100%) occurred within 6 months of immune checkpoint inhibitor initiation (median doses 5, range 1-59), and the majority (VTE 81%, ATE 100%) resulted in hospitalization (median: 5 days, 4 days, respectively). Thromboembolism (hazard ratio 2.296, p = 0.0004), Bajorin score 1 or 2 (hazard ratio 1.490, p = 0.0315), and Bajorin score 2 (hazard ratio 3.50, p < 0.0001) were associated with worse overall survival. CONCLUSIONS Immune checkpoint inhibitors are associated with a high TE risk. Thromboembolism is associated with worsened survival, among other poor outcomes. Further investigation into the mechanism behind immune checkpoint inhibitor-associated TE is needed.
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Affiliation(s)
- Iris Y Sheng
- Department of Medicine, Beth Israel Lahey Mt. Auburn Hospital, Boston, MA, USA
| | - Shilpa Gupta
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA
| | - Chandana A Reddy
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Dana Angelini
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA
| | - Pauline Funchain
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA
| | - Tamara A Sussman
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Joseph Sleiman
- Department of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Moshe C Ornstein
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA
| | - Keith McCrae
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA
| | - Alok A Khorana
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA.
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Bamias A, Tzannis K, Zakopoulou R, Sakellakis M, Dimitriadis J, Papatheodoridi A, Rallidis L, Halvatsiotis P, Tsiara A, Kaparelou M, Kostouros E, Barbarousi D, Koutsoukos K, Fragiadis E, Dellis AE, Anastasiou I, Stravodimos K, Pinitas A, Papatsoris A, Adamakis I, Varkarakis I, Fragoulis C, Pagoni S, Matsouka C, Skolarikos A, Mitropoulos D, Doumas K, Deliveliotis C, Constantinides C, Dimopoulos MA. Risk for Arterial Thromboembolic Events (ATEs) in Patients with Advanced Urinary Tract Cancer (aUTC) Treated with First-Line Chemotherapy: Single-Center, Observational Study. Curr Oncol 2022; 29:6077-6090. [PMID: 36135047 PMCID: PMC9498031 DOI: 10.3390/curroncol29090478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Arterial thromboembolism has been associated with cancer or its treatment. Unlike venous thromboembolism, the incidence and risk factors have not been extensively studied. Here, we investigated the incidence of arterial thromboembolic events (ATEs) in an institutional series of advanced urinary tract cancer (aUTC) treated with cytotoxic chemotherapy. The ATE definition included peripheral arterial embolism/thrombosis, ischemic stroke and coronary events. A total of 354 aUTC patients were analyzed. Most patients (95.2%) received platinum-based chemotherapy. A total of 12 patients (3.4%) suffered an ATE within a median time of 3.6 months from the start of chemotherapy. The most frequent ATE was ischemic stroke (n = 7). Two ATEs were fatal. The 6-month and 24-month incidence were 2.1% (95% confidence interval [CI]: 0.9–4.1) and 3.6% (95% CI: 1.9–6.2), respectively. Perioperative chemotherapy increased the risk for ATE by 5.55-fold. Tumors other than UTC and pure non-transitional cell carcinoma histology were also independent risk factors. No association with the type of chemotherapy was found. Overall, ATEs occur in 4.6% of aUTC patients treated with chemotherapy and represent a clinically relevant manifestation. Perioperative chemotherapy significantly increases the risk for ATE. The role of prophylaxis in high-risk groups should be prospectively studied.
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Affiliation(s)
- Aristotelis Bamias
- 2nd Propaedeutic Dept of Internal Medicine, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
- Hellenic GU Cancer Group, Evrou st 89, 11527 Athens, Attiki, Greece
- Correspondence: ; Tel.: +30-21-0583-1255; Fax: +30-21-0532-6454
| | - Kimon Tzannis
- 2nd Propaedeutic Dept of Internal Medicine, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
- Hellenic GU Cancer Group, Evrou st 89, 11527 Athens, Attiki, Greece
| | - Roubini Zakopoulou
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Minas Sakellakis
- Hellenic GU Cancer Group, Evrou st 89, 11527 Athens, Attiki, Greece
| | - John Dimitriadis
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Alkistis Papatheodoridi
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Loukianos Rallidis
- 2nd Department of Cardiology, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
| | - Panagiotis Halvatsiotis
- 2nd Propaedeutic Dept of Internal Medicine, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
| | - Anna Tsiara
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Maria Kaparelou
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Efthymios Kostouros
- Oncology Department, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Despina Barbarousi
- Haematology Division, Alexandra Hospital, Vasilissis Sofias 80, 11528 Athens, Attiki, Greece
| | - Konstantinos Koutsoukos
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Evangelos Fragiadis
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Athanasios E. Dellis
- 2nd Dept of Surgery, Aretaieion Academic Hospital, National & Kapodistrian University of Athens, Vas. Sofias Ave 76, 11528 Athens, Attiki, Greece
| | - Ioannis Anastasiou
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Konstantinos Stravodimos
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Alexandros Pinitas
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Athanasios Papatsoris
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Ioannis Adamakis
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Ioannis Varkarakis
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Charalampos Fragoulis
- Department of Urology, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Stamatina Pagoni
- Oncology Department, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Charis Matsouka
- Oncology Department, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Andreas Skolarikos
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Dionysios Mitropoulos
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Konstantinos Doumas
- Department of Urology, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Charalampos Deliveliotis
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Constantinos Constantinides
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Meletios-Athanasios Dimopoulos
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
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Garas SN, McAlpine K, Ross J, Carrier M, Bossé D, Yachnin D, Mallick R, Cagiannos I, Morash C, Breau RH, Lavallée LT. Venous thromboembolism risk in patients receiving neoadjuvant chemotherapy for bladder cancer. Urol Oncol 2022; 40:381.e1-381.e7. [PMID: 35581123 DOI: 10.1016/j.urolonc.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/26/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION There is limited evidence to inform thromboprophylaxis use for patients receiving neoadjuvant chemotherapy prior to surgery in bladder cancer. We sought to determine the incidence of venous thromboembolism (VTE) in patients receiving neoadjuvant chemotherapy and cystectomy. We also assessed if the Khorana score was associated with VTE risk. METHODS A retrospective cohort study was performed on consecutive patients who received a radical cystectomy for bladder cancer at The Ottawa Hospital between January 2016 and August 2020. Demographic information, chemotherapy data, operative characteristics, VTE and bleeding outcomes were collected from the start of treatment to 90 days postoperative. A Khorana score was calculated for each patient who received neoadjuvant chemotherapy. The primary outcome for this study was the incidence of VTE from the time the patient started treatment with neoadjuvant chemotherapy until 90 days post-cystectomy. Secondary outcomes included risk factors for VTE during neoadjuvant chemotherapy. RESULTS Among 181 radical cystectomy cases during the study period, 123 had muscle-invasive disease and 72 (39.8%) received neoadjuvant chemotherapy. Eighteen (25.0%) patients who received neoadjuvant chemotherapy and radical cystectomy developed a VTE from the start of chemotherapy to 90 days postoperative. Thirteen of the 18 VTEs (72%) occurred while the patient was receiving chemotherapy. In multivariable analysis, the only factor associated with a significantly increased risk of VTE was treatment with neoadjuvant chemotherapy (Relative risk (RR) 3.05, 95% confidence interval [CI] 1.16-8.02; P = 0.02). A higher Khorana score was not associated with an increased risk of VTE in patients who received neoadjuvant chemotherapy (RR = 0.33, 95% CI 0.08-1.28, P = 0.11). One (1.4%) patient had a major bleeding event during neoadjuvant chemotherapy. CONCLUSIONS Patients receiving neoadjuvant chemotherapy and radical cystectomy are at very high-risk of VTE. Prospective studies that assess the benefits and harms of pharmacologic thromboprophylaxis in this population are needed.
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Affiliation(s)
- Shady N Garas
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Kristen McAlpine
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - James Ross
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Marc Carrier
- Division of Hematology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Dominic Bossé
- Division of Hematology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - David Yachnin
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Ranjeeta Mallick
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Chris Morash
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
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Balan D, Vartolomei MD, Magdás A, Balan-Bernstein N, Voidăzan ST, Mártha O. Inflammatory Markers and Thromboembolic Risk in Patients with Non-Muscle-Invasive Bladder Cancer. J Clin Med 2021; 10:jcm10225270. [PMID: 34830552 PMCID: PMC8617657 DOI: 10.3390/jcm10225270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Patients with bladder cancer have a high risk of venous thrombosis that represents a key challenge for physicians in the decision-making for initiating anticoagulation therapy. Non-muscle-invasive bladder cancer (NMIBC) represents more than 70% of all diagnosed bladder malignancies; therefore, we aimed to evaluate the relationship of the neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and risk of thrombosis by using the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score as well as the risk of bleeding by using the IMPROVE Bleeding Risk Assessment Score in a study cohort. Material and Methods: This was a retrospective observational study involving 130 patients who met the inclusion criteria: age > 18 years, stage pTa-pT1 NMIBC. The exclusion criteria were age < 18 years; stage pT2 or higher; or a presentation of metastasis, inflammatory, liver or autoimmune diseases, or other systemic neoplasms. In order to evaluate the risk of thromboembolic events as well as those of bleeding, the IMPROVE scores were calculated for each patient. Subjects were categorized in a Low IMPROVE group (< 4 points) or a High IMPROVE group. By using uni- and multivariate regression models, we analyzed CBC-derived parameters which could be associated with a higher risk of venous thrombosis in subjects with low or high IMPROVE scores. Results: Patients with IMPROVE score greater than 4 were associated with higher NLR, LMR and lymphocyte values (p < 0.05). In a multivariate regression model, the IMPROVE score was significantly influenced by lymphocyte count (p = 0.007) as well as the NLR value (p < 0.0001). Conclusions: In our study population, subjects with NMIBC with low lymphocytes and NLR > 3 were at a higher risk of developing venous thromboembolic events, reflected by an IMPROVE score of greater than 4. The IMPROVE and IMPROVE Bleeding Risk Assessment Scores are easy to use, and, complemented with the CBC-derived lymphocyte to monocyte ratio as a prothrombotic marker, could aid in the decision of prophylactic anticoagulation therapy during admission.
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Affiliation(s)
- Daniel Balan
- Department of Urology, University of Medicine, Pharmacy, Science and Technology “G.E.Palade” of Targu-Mures, 540142 Targu-Mures, Romania; (D.B.); (O.M.)
| | | | - Annamária Magdás
- Department of Internal Medicine, University of Medicine, Pharmacy, Science and Technology “G.E.Palade” of Targu-Mures, 540142 Targu-Mures, Romania
- Correspondence:
| | | | - Septimiu Toader Voidăzan
- Department of Epidemiology, “G. E. Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu-Mures, Romania;
| | - Orsolya Mártha
- Department of Urology, University of Medicine, Pharmacy, Science and Technology “G.E.Palade” of Targu-Mures, 540142 Targu-Mures, Romania; (D.B.); (O.M.)
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9
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Sheng IY, Gupta S, Reddy CA, Angelini D, Funchain P, Sussman TA, Sleiman J, Ornstein MC, McCrae K, Khorana AA. Thromboembolism in Patients with Metastatic Renal Cell Carcinoma Treated with Immunotherapy. Target Oncol 2021; 16:813-821. [PMID: 34741719 DOI: 10.1007/s11523-021-00852-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Metastatic renal cell carcinoma (mRCC) is associated with a high risk of thromboembolism (TE). OBJECTIVE We investigated whether immunotherapy (IO) increases the hypercoagulable state in this high-risk population. PATIENTS AND METHODS Patients with mRCC treated with IO between 1 January 2015 and 31 December 2019 at the Cleveland Clinic were identified. Cumulative incidence analysis calculated TE rates over time and Gray's test determined differences in TE rates among groups. The Kaplan-Meier method estimated survival, while Cox proportional hazard regression evaluated the impact of TE on OS. RESULTS Of 351 patients, 75% were men with clear cell mRCC (81%) and International Metastatic Renal Cell Carcinoma (IMDC) intermediate- to poor-risk disease (77%). Patients received single-agent IO (52%), doublet IO (31%), or IO with non-IO therapy (17%). The median number of IO doses was 8 (range 1-81). At a median follow-up of 12.8 months, 12% of patients (n = 43) had a TE event (venous n = 37 [11%], arterial n = 6 [2%]). The cumulative TE incidence at 6 months was 4.4% (95% confidence interval [CI] 2.6-6.9) and 9.8% (95% CI 6.8-13.4) at 12 months. No factors, including IMDC or Khorana score, were identified to predict TE development. Seventy-two percent of TE resulted in hospitalization (9% TE-related mortality and 21% TE-related dose delay). TE (p < 0.0001), poor IMDC score (p < 0.0001), and Khorana score ≥ 2 (p < 0.0001) were associated with worse OS. CONCLUSIONS Patients with mRCC treated with IO had a high incidence of TE. TE was associated with risk of treatment delay, hospitalization, and mortality, while TE, IMDC poor risk, and Khorana score ≥ 2 were associated with worse survival. Further investigations into IO-associated TE are needed to identify benefit from primary thromboprophylaxis.
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Affiliation(s)
- Iris Y Sheng
- Department of Medicine, Beth Israel Lahey Mt. Auburn Hospital, Boston, MA, USA
| | - Shilpa Gupta
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA
| | - Chandana A Reddy
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Dana Angelini
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA
| | - Pauline Funchain
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA
| | - Tamara A Sussman
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Joseph Sleiman
- Department of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Moshe C Ornstein
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA
| | - Keith McCrae
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA
| | - Alok A Khorana
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA.
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10
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Jahnson S, Gårdmark T, Hosseini A, Jerlström T, Liedberg F, Malmström PU, Hagberg O, Sherif A, Ströck V, Söderkvist K, Ullen A, Häggström C, Holmberg L, Aljabery F. Thromboembolism in Muscle-Invasive Bladder Cancer. A Population-based Nationwide Study. Bladder Cancer 2021; 7:161-171. [PMID: 38994539 PMCID: PMC11181779 DOI: 10.3233/blc-200409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/21/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Routine VTE prophylaxis within 30 days of radical cystectomy (RC) for urinary bladder cancer (UBC) is used to protect from venous thromboembolism (VTE). However, randomized studies and nationwide population-based studies are lacking. OBJECTIVE To study VTE and risk factors for VTE in muscle-invasive UBC in a nationwide population-based series, with a focus on the association with RC with and without chemotherapy. MATERIALS AND METHODS We studied all patients with clinical stage T2-T4 UBC diagnosed 1997 to 2014 in the Bladder Cancer Data Base Sweden (BladderBaSe). Previous VTE events and risk factors for VTE were registered from 1987. Cox regression analyses and Kaplan-Meier curves were performed to study risk factors for VTE and cumulative incidence of VTE. RESULTS In 9720 patients (71%males) with a median age of 74 years 546 (5.6%) had VTE after diagnosis. In Cox analyses controlling for patient's and tumour characteristics, and risk factors for VTE, VTE after diagnosis and first treatment date were associated with chemotherapy with or without RC. Cumulative incidence of VTE increased during 24 months after diagnosis and first treatment date. VTE were less common in patients with previous cardiovascular disease. CONCLUSIONS VTE was commonly observed after 30 days from diagnosis and from first treatment date in patients with T2-T4 UBC, particularly after chemotherapy. The findings suggest that long-term intervention studies of benefit and possible harms of VTE prophylaxis after UBC should be undertaken.
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Affiliation(s)
- Staffan Jahnson
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - Truls Gårdmark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Abolfazl Hosseini
- Department of Pelvic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Jerlström
- Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Fredrik Liedberg
- Department of Urology, Skåne University Hospital, Malmö, Sweden and Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Per-Uno Malmström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Oskar Hagberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Viveka Ströck
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden and Region Västra Götaland, Sahlgrenska University Hospital, Department of Urology, Gothenburg, Sweden
| | - Karin Söderkvist
- Department of Radiation Sciences – Oncology, Umeå University, SE-90185 Umeå, Sweden
| | - Anders Ullen
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden and Patient Area Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Solna, Sweden
| | - Christel Häggström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Holmberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Firas Aljabery
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
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11
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Benidir T, Herrera-Caceres J, Wallis C, Lajkosz K, Fleshner N. Population-based analysis of perioperative chemotherapy use, interventions requiring hospitalization and atheroembolic events among patients with non-metastatic muscle-invasive bladder cancer. Cancer Med 2021; 10:2636-2644. [PMID: 33710797 PMCID: PMC8026920 DOI: 10.1002/cam4.3805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Utilization of neoadjuvant chemotherapy (NC) in muscle invasive bladder cancer (MIBC) is increasingly recognized as standard of care but trends of use in Ontario remain unknown. Currently, there remains knowledge gaps regarding the effects of perioperative chemotherapy on the rates of interventions requiring hospitalization (IRH) and atheroembolic events (ATEs). Methods We conducted a population‐based retrospective study within the province of Ontario over 16 years. Patients with non‐metastatic MIBC receiving surgery only or planned for perioperative chemotherapy were included. Primary outcomes included 2‐year IRH and ATE rates. Univariate/multivariate analysis was used to identify predictors associated with IRHs and ATEs. Cochrane‐Armitage was used to assess treatment trends over time. Results Our study included 3281 patients. RC alone occurred in 2030 (60.9%), NC in 974 (29.6%) and adjuvant chemotherapy in 8.4% (n = 277). A total of 490/974 (50.3%) patients whom initiated NC with RC intent failed to undergo RC. This improved to 20.5% by 2015 (p < 0.001). Use of NC increased by an absolute value of 33% (p < 0.001). Overall, 4.2% of patients experienced IRHs and 11.5% ATEs. On multivariate analysis, advanced age and Charlson index score (CI) were strong predictors of outcomes, not timing of perioperative chemotherapy (p < 0.05.) Conclusion A total of 29.6% of MIBC patients are planned for NC with 20.5% not progressing to their surgery. Use of NC has substantially increased over time. IRHs and ATEs remain stubbornly high at 4.2% and 11.5% respectively. Older age and higher CI scores are the strongest predictors of IRHs and ATEs (p < 0.05), not perioperative chemotherapy.
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12
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The Impact of Circulating Tumor Cells on Venous Thromboembolism and Cardiovascular Events in Bladder Cancer Patients Treated with Radical Cystectomy. J Clin Med 2020; 9:jcm9113478. [PMID: 33126664 PMCID: PMC7692134 DOI: 10.3390/jcm9113478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cancer is a relevant risk factor for venous thromboembolism (VTE). Circulating tumor cells (CTC) are associated with an increased risk of VTE in breast cancer. In addition, circulating cell-free nucleic acids have been associated with cardiovascular events (CVE). OBJECTIVE To investigate the association of CTC status and the risk of VTE as well as CVE in urothelial carcinoma of the bladder (UCB) patients treated with radical cystectomy (RC). METHODS We collected data of 189 UCB patients treated with RC at our institution. Blood samples were acquired preoperatively and analyzed for CTC using the CellSearch® system. Thirty-day postoperative complications were extracted from digital charts and graded according to the Clavien-Dindo classification (CDC). Moreover, each patient's individual Comprehensive Complication Index® (CCI®) was calculated. RESULTS CTC were present in 43 patients (22.8%). Overall, six patients experienced VTE (3.2%) and eight patients (4.2%) experienced CVE. There was no association of VTE or CVE according to CTC status. In total, 168 patients (89%) experienced a total of 801 complications, of which the majority was classified as "minor" (CDC grade ≤ IIIa; 79%). There was no association between CTC status and any grade of a complication or CCI®. Presence of CTC was associated with more aggressive clinicopathological UCB features. CONCLUSIONS The overall rate of VTE and CVE was low in our study. Presence of CTC was neither associated with an increased risk of VTE nor CVE in UCB patients treated with RC. According to this study, CTC are not a qualified biomarker for individualized thromboprophylaxis management in these patients.
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