Jorge D Ramos1, Jonathan T Wingate2, Roman Gulati3, Elizabeth R Plimack4, Lauren C Harshman5, Thomas Powles6, Simon J Crabb7, Guenter Niegisch8, Joaquim Bellmunt9, Sylvain Ladoire10, Ugo De Giorgi11, Syed Hussain12, Ajjai S Alva13, Jack Baniel14, Neeraj Agarwal15, Jonathan E Rosenberg16, Ulka N Vaishampayan17, Matthew D Galsky18, Evan Y Yu19. 1. University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA. 2. Madigan Army Medical Center, Tacoma, WA. 3. Fred Hutchinson Cancer Research Center, Seattle, WA. 4. Fox Chase Cancer Center, Philadelphia, PA. 5. Dana Farber Cancer Institute, Boston, MA. 6. Barts and the London School of Medicine, London, England. 7. University of Southampton, Southampton, England. 8. Medical Faculty, Department of Urology, Heinrich-Heine-University, Düsseldorf, Germany. 9. Hospital del Mar, Barcelona, Spain. 10. Georges François Leclerc Center, Dijon, France; Université de Bourgogne, Dijon, France. 11. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. 12. University of Liverpool, Liverpool, England. 13. University of Michigan, Ann Arbor, MI. 14. Rabin Medical Center, Tel Aviv, Israel. 15. University of Utah, Salt Lake City, UT. 16. Memorial Sloan Kettering Cancer Center, New York, NY. 17. Karmanos Cancer Institute, Detroit, MI. 18. Icahn School of Medicine at Mount Sinai, New York, NY. 19. University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA. Electronic address: evanyu@u.washington.edu.
Abstract
BACKGROUND: Venous thromboembolism (VTE) is common in cancer patients, but there is limited data on patients with urothelial tract tumors (UTT). We previously identified several associative factors for increased VTE rates in patients with metastatic UTT. In this study, we assessed the frequency, associative factors, and impact on survival of VTE in patients with locoregional UTT. METHODS: Patients with locoregional bladder, upper urinary tract, or urethral cancer were included in this multi-center study from 29 academic institutions. Patients with < cT2, > N1, or M1 disease at diagnosis were excluded. Patients with incomplete clinical staging or miscoded/missing data were excluded. Cumulative, unadjusted VTE incidence was calculated from time of diagnosis of muscle-invasive disease, excluding VTEs diagnosed in the metastatic setting. χ2 statistics tested differences in VTE rates across baseline and treatment-related factors. Significant covariates were incorporated into a multivariate, logistic regression model. Overall survival stratified by VTE was estimated using Kaplan-Meier methods and evaluated using the log-rank test. RESULTS: A total of 1732 patients were eligible. There were 132 (7.6%) VTEs. On multivariate analysis, non-urothelial histology (P < .001), clinical Nx stage (P < .001), cardiovascular disease (P = .01), and renal dysfunction (P = .04) were statistically significant baseline factors associated with VTE. Using surgery alone as reference, surgery with perioperative chemotherapy (P = .04) and radiation with concurrent chemotherapy (P = .04) also were significant. CONCLUSIONS: The VTE incidence of 7.6% in locoregional disease is comparable with our previously reported rate in the metastatic setting (8.2%). Similar to our findings in metastatic UTT, non-urothelial histology, renal dysfunction, and CVD was associated with increased VTE risk.
BACKGROUND:Venous thromboembolism (VTE) is common in cancerpatients, but there is limited data on patients with urothelial tract tumors (UTT). We previously identified several associative factors for increased VTE rates in patients with metastatic UTT. In this study, we assessed the frequency, associative factors, and impact on survival of VTE in patients with locoregional UTT. METHODS:Patients with locoregional bladder, upper urinary tract, or urethral cancer were included in this multi-center study from 29 academic institutions. Patients with < cT2, > N1, or M1 disease at diagnosis were excluded. Patients with incomplete clinical staging or miscoded/missing data were excluded. Cumulative, unadjusted VTE incidence was calculated from time of diagnosis of muscle-invasive disease, excluding VTEs diagnosed in the metastatic setting. χ2 statistics tested differences in VTE rates across baseline and treatment-related factors. Significant covariates were incorporated into a multivariate, logistic regression model. Overall survival stratified by VTE was estimated using Kaplan-Meier methods and evaluated using the log-rank test. RESULTS: A total of 1732 patients were eligible. There were 132 (7.6%) VTEs. On multivariate analysis, non-urothelial histology (P < .001), clinical Nx stage (P < .001), cardiovascular disease (P = .01), and renal dysfunction (P = .04) were statistically significant baseline factors associated with VTE. Using surgery alone as reference, surgery with perioperative chemotherapy (P = .04) and radiation with concurrent chemotherapy (P = .04) also were significant. CONCLUSIONS: The VTE incidence of 7.6% in locoregional disease is comparable with our previously reported rate in the metastatic setting (8.2%). Similar to our findings in metastatic UTT, non-urothelial histology, renal dysfunction, and CVD was associated with increased VTE risk.
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