Background/Objectives: Germ cell tumors are the most common neoplasia in males < 50 y. In two case series, thromboembolic events (TEs) were reported in 8% and 13% of patients undergoing chemotherapy, whereas arterial thromboembolic events (ATEs) in other types of cancer treated with cisplatin had a frequency of 2% in a retrospective series and 0.67% in a meta-analysis. Recent data found a frequency of 2.4% for ATE in a large cohort of testicular cancer patients. Risk factors are not clearly identified, and given the severity of these events, further exploration is needed to determine appropriate preventive measures. Methods: We performed a retrospective cohort study of 171 patients undergoing chemotherapy for germ cell tumors in two centers in Switzerland and recorded the occurrence of ATE or venous thromboembolic events (VTEs) during chemotherapy or in the 3 months after its completion. Results: of 171 patients, 33.3% underwent adjuvant chemotherapy for stage I disease. Overall, 32 patients had a TE (18.7%, 95% CI 13.3–25.5%), 26 (15.2%, 95% CI 10.3–21.7%) had VTEs, and 11 (6.4%, 95% CI 3.4–11.5%) had ATEs. Five patients had both a VTE and ATE. VTEs were associated with disease stage (II, III, or relapse, with OR 15.6,p= 0.0002), retroperitoneal lymph nodes ≥ 3.5 cm (OR 3.2,p= 0.012), LDH > 500 UI/L (OR 5.3,p= 0.0025), and age > 35 y (OR 3.4,p= 0.005). The Khorana Score (KS) varied between 1 and 2 in 96% of the patients. ATEs were associated with active smoking (OR 6.5p= 0.010), KS of ≥2 (OR 6.4p= 0.004), and age > 35 y (OR 6.3,p= 0.01). Conclusions: Our findings show that ATEs are more frequent in our cohort than previous reports. We found a strong association between smoking and ATEs, which should be further assessed. Platinum-induced endothelial damage may be amplified by smoking in young patients in the absence of other risk factors and preventive medication.
背景/目的：生殖细胞肿瘤是50岁以下男性最常见的肿瘤。两项病例系列研究显示，接受化疗的患者中血栓栓塞事件发生率为8%和13%，而其他类型癌症患者接受顺铂治疗后动脉血栓栓塞事件的发生率在回顾性系列中为2%，在荟萃分析中为0.67%。最新数据显示，在大型睾丸癌患者队列中动脉血栓栓塞事件发生率为2.4%。其风险因素尚未明确，鉴于这些事件的严重性，需要进一步探索以确定合适的预防措施。方法：我们对瑞士两家中心接受生殖细胞肿瘤化疗的171例患者进行回顾性队列研究，记录化疗期间或结束后3个月内动脉或静脉血栓栓塞事件的发生情况。结果：171例患者中，33.3%因I期疾病接受辅助化疗。总体而言，32例患者发生血栓栓塞事件（18.7%，95% CI 13.3–25.5%），其中26例（15.2%，95% CI 10.3–21.7%）为静脉血栓栓塞，11例（6.4%，95% CI 3.4–11.5%）为动脉血栓栓塞。5例患者同时发生静脉和动脉血栓栓塞。静脉血栓栓塞与疾病分期（II期、III期或复发，OR 15.6，p=0.0002）、腹膜后淋巴结≥3.5 cm（OR 3.2，p=0.012）、乳酸脱氢酶>500 UI/L（OR 5.3，p=0.0025）及年龄>35岁（OR 3.4，p=0.005）相关。96%患者的Khorana评分介于1-2分之间。动脉血栓栓塞与当前吸烟（OR 6.5，p=0.010）、Khorana评分≥2分（OR 6.4，p=0.004）及年龄>35岁（OR 6.3，p=0.01）相关。结论：本研究发现动脉血栓栓塞事件发生率高于既往报道。研究揭示了吸烟与动脉血栓栓塞的强相关性，值得进一步评估。对于缺乏其他风险因素且未使用预防性药物的年轻患者，吸烟可能加剧铂类药物诱导的内皮损伤。
Risk Factors for Arterial Thromboembolic Events in Male Germ Cell Tumors Treated with Chemotherapy
肿瘤(癌症)患者之家