Large retroperitoneal lymphadenopathy (RPLN) and increased risk of venous thromboembolism (VTE) in patients (pts) with metastatic germ cell tumours (mGCT): a global germ cell cancer group (G3) study

Background

Prior data indicate that large RPLN significantly increases the risk of VTE in pts with mGCT receiving first line platinum based chemotherapy (chemo). The aim of this multinational G3 study was to validate large RPLN as a risk factor for VTE and evaluate other predictive factors.

Methods

Data were collected retrospectively from sequential pts with mGCT receiving first line chemo from 2000-2014 at 22 centres. Pre-defined variables of interest included IGCCCG risk classification, axial long axis diameter of largest RPLN, Khorana score (validated predictor for chemo associated VTE), LDH, prior VTE and presence of venous access device (VAD). VTE occurring at baseline, during chemo and within 90 days of completion were analysed. Pts receiving thromboprophylaxis (TP) were excluded. Predictive accuracy was assessed using logistic regression and discriminatory accuracy explored using area under the receiver operating curve (AUC).

Results

Data from 1135 pts were collected. Median age was 31 (range 10-74). Testicular primary (92%), non-seminoma histology (72%) and BEP chemo (82%) were most common. IGCCCG risk distribution was 64% good, 20% intermediate and 16% poor. VTE occurred in 150 pts (13%). RPLN >3.5cm demonstrated highest discriminatory accuracy (AUC 0.68, p 3.5cm was associated with significantly higher risk of VTE (22% versus 8%, OR 3.4, p 

Conclusions

This study confirms large RPLN (>3.5cm) as an independent risk factor for VTE in mGCT pts receiving first line chemo. Prospective trials examining TP in this high risk population are warranted.

Clinical trial identification

Not applicable

Legal entity responsible for the study

N/A

Funding

N/A

Disclosure

All authors have declared no conflicts of interest.