Incidental Venous Thromboembolism in Kidney Cancer Patients: A Retrospective Case-Control Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 5134-5134
Author(s):  
Daniel W Yokom ◽  
Ryma Ihaddadene ◽  
Gregoire Le Gal ◽  
Marc Carrier
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Kidney Cancer ◽  
Cancer Diagnosis ◽  
Case Control ◽  
Hazard Ratio ◽  
Cancer Type ◽  
Control Analysis ◽  
Retrospective Case ◽  
Risk Of Death

Abstract Abstract 5134 Introduction: The incidence of venous thromboembolism (VTE) in kidney cancer patients has been reported at 1. 2–3. 2% with an estimated hazard ratio for death of 1. 3–3. 2. Computed Tomography (CT) scans are used frequently to stage cancer, and as the resolution of the scans increases more incidentally discovered asymptomatic VTE are being diagnosed. Currently, it is unclear if incidentally found VTE have the same effect on survival as symptomatic VTE in kidney cancer patients. Methods: We undertook a retrospective case-control analysis of all kidney cancer patients treated at our institution between January 1, 2005 and July 1, 2012. Cases with VTE were matched in a ratio of 1:2 to controls by gender, age and stage at cancer diagnosis. All charts were reviewed for comorbidities at cancer diagnosis, cancer type, stage, and treatment plan. We reviewed imaging studies to identify the location of the VTE and whether it was unsuspected – which was defined as a VTE found on a CT which was indicated for cancer staging. Results: From a cohort of 1166 primary kidney cancer patients we identified 68 (5. 8%) patients who developed a VTE. There were 30 cases of pulmonary embolism (PE), 24 lower extremity deep vein thrombosis (DVT), 5 DVT of the upper extremity and neck and 9 intra-abdominal VTE. Of these, 35% were discovered incidentally and 65% were symptomatic. Compared to matched controls, all patients with VTE did not have worsened survival (hazard ratio [HR] = 0. 87; 95% CI: 0. 54–1. 42). As demonstrated in Figure 1, symptomatic and incidentally discovered VTE were at no increased risk of death compared to controls (HR = 0. 72; 95% CI: 0. 40 – 1. 31 and HR = 1. 12; 95% CI: 0. 61 – 2. 27 respectively). Also, when looking specifically at symptomatic and incidentally discovered pulmonary embolisms, no difference in survival was detected (HR = 1. 44; 95% CI: 0. 68 – 3. 06 and HR = 0. 78; 95% CI: 0. 31 – 1. 97 respectively). Conclusions: In this analysis of kidney cancer patients we found a high rate of VTE (5. 8%) of which 35% were found incidentally on CT staging. The results from this study show that kidney cancer patients with VTE do not have worse survival outcomes than those without VTE. Moreover, the difference in survival between patients with any symptomatic VTE or PE does not differ from incidentally found VTE or PE. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Comparison between the Khorana prediction score and Caprini risk assessment models for assessing the risk of venous thromboembolism in hospitalized patients with cancer: a retrospective case control study

2020 ◽  
Vol 31 (4) ◽  
pp. 454-460
Author(s):  
Yuehong Hu ◽  
Xiaoqian Li ◽  
Haixia Zhou ◽  
Ping Lin ◽  
Jiarui Zhang ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Cancer Patients ◽  
Case Control Study ◽  
Case Control ◽  
Hospitalized Patients ◽  
Retrospective Case ◽  
Patients With Cancer ◽  
Control Study

Abstract OBJECTIVES This study aimed to evaluate the optimal risk assessment model (RAM) to stratify the risk of venous thromboembolism (VTE) in hospitalized patients with cancer. We examined and compared the VTE predictive ability of the Khorana score (KS) and the Caprini RAM in hospitalized cancer patients. METHODS We performed a retrospective case–control study among hospitalized cancer patients admitted to a comprehensive hospital in China from January 2015 to December 2016. A total of 221 cases were confirmed to have VTE during hospitalization and 221 controls were selected randomly. The Caprini RAM and KS were implemented and the individual scores of each risk factor were summed to generate a cumulative risk score. Meanwhile, the sensitivity, specificity, areas under curve of the receiver operating characteristic curve and calibration of these 2 models were analysed. RESULTS Significant differences were observed in risk factors between VTE and non-VTE hospitalized cancer patients and the VTE risk increased significantly with an increase in the cumulative KS or Caprini RAM score. A classification of ‘high risk’ according to KS and Caprini RAM was associated with 2.272-fold and 3.825-fold increases in VTE risk, respectively. However, the Caprini RAM could identify 82.4% of the VTE cases that required preventive anticoagulant therapy according to American College of Chest Physicians guidelines, whereas the KS could only identify 35.3% of the VTE cases. In addition, the areas under curve of Caprini RAM were significantly higher than those of the KS (0.705 ± 0.024 vs 0.581 ± 0.025, P < 0.001), with a best cut-off value of 5 score, which happened to be the cut-off value for high risk of VTE in Caprini RAM. Both Caprini RAM and KS showed an excellent calibration curve (0.612 vs 0.141, P > 0.05), but the risk of VTE events predicted by Caprini seemed closer to the observed risk of VTE events. CONCLUSIONS The Caprini RAM was found to be more effective than the KS in identifying hospitalized patients with cancer at risk of VTE.

scholarly journals Thrombocytopenia Among Patients with Hematologic Malignancies and Solid Tumors: Risk and Prognosis

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3156-3156
Author(s):  
Kasper Adelborg ◽  
Katalin Veres ◽  
Erzsébet Horváth-Puhó ◽  
Mary Clouser ◽  
Hossam A Saad ◽  
...  
Keyword(s):  
Platelet Count ◽  
Cancer Patients ◽  
Solid Tumors ◽  
Clinical Outcomes ◽  
Cancer Diagnosis ◽  
Hematologic Malignancies ◽  
Severe Thrombocytopenia ◽  
Cancer Type ◽  
Risk Of Death ◽  
Study Inclusion

Abstract Introduction: Despite the large body of research in cancer and increasing numbers of cancer survivors, knowledge about the risks and prognoses related to thrombocytopenia in the clinical care setting is scarce. Such information is important to understanding the need and potential impact of platelet transfusion and emerging drug therapies for thrombocytopenia. In this study, we examined the risk of thrombocytopenia among patients with incident cancer. Further, we studied the extent to which thrombocytopenia was associated with adverse clinical outcomes. Methods: This population-based cohort study was conducted using data from the Danish Cancer Registry. All patients diagnosed with incident hematologic malignancies and solid tumors (age of ≥18 years) during 2015─2018 were identified. Data were linked with routine laboratory test results from the primary care and hospital settings, as recorded in the Danish Register of Laboratory Results for Research. Based on platelet count levels (x 10 9/L), thrombocytopenia was categorized as grade 0 (any count)<150; grade 1:<100; grade 2:<75; grade 3:<50; and grade 4: <25. We tabulated the prevalence of thrombocytopenia at study inclusion and calculated the cumulative incidence proportion (risk) of thrombocytopenia, accounting for the competing risk of death. Each patient with thrombocytopenia was matched up to 5 cancer patients without thrombocytopenia by age, sex, cancer type, cancer stage, and time from cancer diagnosis and index date. Cox proportional hazards regression analysis was used to compute hazard ratios (HRs) with 95% confidence intervals (CIs) of adverse clinical outcomes, including any bleeding leading to hospitalization, site-specific bleeding leading to hospitalization, transfusion (red blood cell, platelet, or fresh frozen plasma), and death. HRs were adjusted for Charlson Comorbidity Index scores and matching factors by design. Results: The analytic cohort comprised 11,785 patients with hematologic malignancies and 57,600 patients with solid tumors (median age=70 years). Any thrombocytopenia was observed during the 6 months preceding study inclusion among 18% of patients with hematologic malignancies (grades 1-2: 6% and grades 3-4: 5%) and 4% of patients with solid tumors (grades 1-2: 1% and grades 3-4: 0%). The 1-year and 4-year risks of new-onset thrombocytopenia were 30% and 40% for hematologic malignancies and 21% and 28% for solid tumors, respectively (Figure 1). Among patients who initiated chemotherapy following their cancer diagnosis (n=33,165), the 1-year and 4-year risks of thrombocytopenia were 50% and 62% for hematologic malignancies and 39% and 49% for solid tumors, respectively (Figure 2). Patients with grade 4 thrombocytopenia had higher rates of any bleeding leading to hospitalization than patients without thrombocytopenia [hematologic malignancies: HR=2.31 (95% CI: 1.43-3.73) and solid tumors: HR=4.52 (95% CI: 2.00-10.24)], while grades 1-3 thrombocytopenia did not confer a significantly increased rate of hospitalization for bleeding (Table 1). All grades of thrombocytopenia were associated with an increased rate of transfusion [overall for hematologic malignancies: HR=2.06 (95% CI: 1.91-2.23), and overall for solid tumors: HR=2.13 (95% CI: 1.83-2.48)] and with death [overall for hematologic malignancies: HR=2.01 (95% CI: 1.84-2.20), and overall for solid tumors: HR=1.44 (95% CI: 1.39-1.49)]. These associations increased in magnitude with decreasing platelet count levels. Conclusions: The risk of thrombocytopenia was substantial following a diagnosis of incident hematologic malignancy and solid tumors, with higher risks among patients who initiated chemotherapy. While only severe thrombocytopenia was a predictor of any hospitalization for bleeding, all grades of thrombocytopenia were associated with increased rates of transfusion and death. Our findings support the need for regular assessment of platelet count levels to identify cancer patients at risk of serious clinical outcomes. Figure 1 Figure 1. Disclosures Clouser: Amgen: Current Employment, Other: This work is related to Chemotherapy Induced Thrombocytopenia as a disease state, in this essence it is not directly related to an Amgen product; CIT is an area of scientific interest to Amgen with Romiplostim under development for this potential indicati. Saad: Amgen: Current Employment, Current equity holder in publicly-traded company.

scholarly journals COVID-19 increases age- and sex-controlled 21-day fatality rates for patients with melanoma, hematologic malignancies, uterine cancer, or kidney cancer

2021 ◽  
Author(s):  
Haiquan Li ◽  
Edwin Baldwin ◽  
Xiang Zhang ◽  
Colleen Kenost ◽  
Wenting Luo ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Kidney Cancer ◽  
Distant Metastasis ◽  
Uterine Cancer ◽  
Hematologic Malignancies ◽  
Hazard Ratio ◽  
Cancer Type ◽  
Increased Risk ◽  
Cancer Types ◽  
The Impact

AbstractIntroductionPrior research has reported an increased risk of fatality for cancer patients, but most studies investigated the risk by comparing cancer patients to non-cancer patients among COVID-19 infections. Only a few studies have compared the impact of a COVID-19 infection to non-infection with matched cancer patients and types.Methods & MaterialsWe conducted survival analyses of 4,606 cancer patients with COVID-19 test results from March 16 to October 11, 2020 in UK Biobank and estimated the overall hazard ratio of fatality with and without COVID-19 infection. We also examined the hazard ratios of thirteen specific cancer types with at least 100 patients.ResultsCOVID-19 resulted in an overall hazard ratio of 7.76 (95% CI: [5.78, 10.40], p<10−10) by studying the survival rate of 4,606 cancer patients for 21-days after the tests. The hazard ratio was shown to vary among cancer type, with over a 10-fold increase in fatality rate (false discovery rate≤0.02) for melanoma, hematologic malignancies, uterine cancer, and kidney cancer using a stratified analysis on each of the cancer types. Although COVID-19 imposed a higher risk for localized cancers compared to distant metastasis ones, those of distant metastasis yielded higher fatality rates due to their multiplicative effects.ConclusionThe results highlight the importance of timely care for localized and hematological cancer patients and the necessity to vaccinate uninfected patients as soon as possible, particularly for the cancer types influenced most by COVID-19.

scholarly journals Risk factors for incident venous thromboembolism in active cancer patients: A population based case–control study

2016 ◽  
Vol 139 ◽  
pp. 29-37 ◽  
Author(s):  
Aneel A. Ashrani ◽  
Rachel E. Gullerud ◽  
Tanya M. Petterson ◽  
Randolph S. Marks ◽  
Kent R. Bailey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Case Control Study ◽  
Population Based ◽  
Case Control ◽  
Control Study ◽  
Active Cancer

scholarly journals Management of Esophageal Carcinoma Associated with Cirrhosis: A Retrospective Case-Control Analysis

2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Florence Trivin ◽  
Eveline Boucher ◽  
Elodie Vauléon ◽  
Isabelle Cumin ◽  
Elisabeth Le Prisé ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Esophageal Carcinoma ◽  
Case Control ◽  
Control Analysis ◽  
Retrospective Case ◽  
Compensated Cirrhosis ◽  
Dismal Prognosis ◽  
Chemotherapy Dose ◽  
Case Control Analysis ◽  
Control Study

Objectives. Esophageal carcinoma and cirrhosis have the overlapping etiologic factors.Methods. In a retrospective analysis conducted in 2 Breton institutions we wanted to asses the frequency of this association and the outcome of these patients in a case-control study where each case (cirrhosis and esophageal cancer) was paired with two controls (esophageal cancer).Results. In a 10-year period, we have treated 958 esophageal cancer patients; 26 (2.7%) had a cirrhosis. The same treatments were proposed to the 2 groups; cases received nonsignificantly different radiation and chemotherapy dose than controls. Severe toxicities and deaths were more frequent among the cases. At the end of the treatment 58% of the cases and 67% of the controls were in complete remission; median and 2-year survival were not different between the 2 groups. All 4 Child-Pugh B class patients experienced severe side effects and 2 died during the treatment.Conclusions. This association is surprisingly infrequent in our population! Child-Pugh B patients had a dismal prognosis and a bad tolerance to radiochemotherapy; Child-Pugh A patients have the same tolerance and the same prognosis as controls and the evidence of a well-compensated cirrhosis has not modified our medical options.

Differences in transitions of care among cancer patients with and without venous thromboembolism (VTE) events.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18636-e18636
Author(s):  
Cinduja Nathan
Keyword(s):  
Venous Thromboembolism ◽  
Patient Care ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Medical Center ◽  
Survival Rates ◽  
Transitions Of Care ◽  
Office Visits ◽  
Oncology Patient ◽  
History Of

e18636 Background: Transitions of care are an important part of medical care, as they provide opportunities to address patient concerns, refine goals to match current needs and prevent unforeseen complications and comorbidities. One such common and prevalent comorbidity amongst cancer patients is venous thromboembolism (VTE) events. Common VTE events include the occurrence of pulmonary embolism (PE), deep vein thrombosis (DVT) or both at the time of diagnosis or any time thereafter. It is estimated that approximately 4–20% of cancer patients will experience a VTE. Cancer patients developing VTE is a serious concern as it can adversely affect the patients’ quality of life and reduce overall survival rates and prognosis. Methods: This study is designed as a case control study. The subject group consists of 87 cancer patients who had one or several VTE events after their cancer diagnosis. Patients were selected from the UVM Medical Center electronic health record database. The goal of this project was to quantify and compare the average number of transitions of care in cancer patients with and without venous thromboembolism (VTE) events. This was achieved by reviewing the patients charts three months following a VTE event and evaluating whether these patients had a greater number of transitions compared to the three months prior to their VTE event. Transitions of care in our study were defined as office visits, ED visits, and inpatient admissions related to their VTE. Results: Initial evaluation of the results showed that there were more transitions of care amongst cancer patients with a VTE than without. Preliminary data of the 87 patients shows that patients who developed a VTE event after their cancer diagnosis had on average 1.3 more transitions of care within the three months following their VTE event compared to cancer patients without a VTE event. A t test will be used to determine whether the difference between the means (number of transitions of care) of the two groups (cancer patients with VTE and those without VTE) is significant. Conclusions: The implications of having greater transitions of care amongst cancer patients with VTE events are profound. Having more transitions of care exemplifies better implementation, patient care and involvement of health care teams given a history of VTE. Furthermore, the results of this study will provide further insight on ways to improve clinical outcomes and oncology patient care given a history of VTE.

Impact of cancer on the risk of unplanned 30-day readmissions.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6581-6581
Author(s):  
Alexander Qian ◽  
Edmund Qiao ◽  
Vinit Nalawade ◽  
Nikhil V. Kotha ◽  
Rohith S. Voora ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Hospital Admissions ◽  
Reference Group ◽  
Cancer Site ◽  
Cancer Type ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Initial Hospitalization ◽  
The Impact

6581 Background: Hospital readmission are associated with unfavorable patient outcomes and increased costs to the healthcare system. Devising interventions to reduce risks of readmission requires understanding patients at highest risk. Cancer patients represent a unique population with distinct risk factors. The purpose of this study was to define the impact of a cancer diagnosis on the risks of unplanned 30-day readmissions. Methods: We identified non-procedural hospital admissions between January through November 2017 from the National Readmission Database (NRD). We included patients with and without a cancer diagnosis who were admitted for non-procedural causes. We evaluated the impact of cancer on the risk of 30-day unplanned readmissions using multivariable mixed-effects logistic regression models. Results: Out of 18,996,625 weighted admissions, 1,685,099 (8.9%) had record of a cancer diagnosis. A cancer diagnosis was associated with an increased risk of readmission compared to non-cancer patients (23.5% vs. 13.6%, p < 0.001). However, among readmissions, cancer patients were less likely to have a preventable readmission (6.5% vs. 12.1%, p < 0.001). When considering the 10 most common causes of initial hospitalization, cancer was associated with an increased risk of readmission for each of these 10 causes (OR range 1.1-2.7, all p < 0.05) compared to non-cancer patients admitted for the same causes. Compared to patients aged 45-64, a younger age was associated with increased risk for cancer patients (OR 1.29, 95%CI [1.24-1.34]) but decreased risk for non-cancer patients (OR 0.65, 95%CI [0.64-0.66]). Among cancer patients, cancer site was the most robust individual predictor for readmission with liver (OR 1.47, 95%CI [1.39-1.55]), pancreas (OR 1.36, 95%CI [1.29-1.44]), and non-Hodgkin’s lymphoma (OR 1.35, 95%CI [1.29-1.42]) having the highest risk compared to the reference group of prostate cancer patients. Conclusions: Cancer patients have a higher risk of 30-day readmission, with increased risks among younger cancer patients, and with individual risks varying by cancer type. Future risk stratification approaches should consider cancer patients as an independent group with unique risks of readmission.

Genetic polymorphism of miR-218-2 (rs11134527) in cervical cancer: a case-control study in the Bangladeshi women

MicroRNA ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
Farhana Nazneen ◽  
Md. Shalahuddin Millat ◽  
Md. Abdul Barek ◽  
Md. Abdul Aziz ◽  
Mohammad Sarowar Uddin ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Case Control Study ◽  
Case Control ◽  
Recessive Model ◽  
Cancer Type ◽  
Increased Risk ◽  
Hardy Weinberg Equilibrium ◽  
Control Study ◽  
Healthy Females

Background: The prevalence of Cervical Cancer (CC) is disproportionately higher in developing countries. It is the second most frequent cancer type among Bangladeshi women and the primary cause of morbidity and mortality. However, no previous data reported the association of miR-218-2 gene polymorphisms in Bangladeshi cervical cancer patients. Aim: This case-control study was designed to find the link between the rs11134527 polymorphism in miR-218-2 and CC. Methods: A total of 488 subjects were recruited, comprising 256 cervical cancer patients and 232 healthy females. Genotyping was conducted with the tetra-primer ARMS-PCR technique to detect the association. Results: The results of genotype data showed that rs11134527 obeyed the Hardy-Weinberg equilibrium in both CC cases and controls (P >0.05). Overall, the polymorphism was found to be significantly associated with an increased risk of cervical cancer with AG genotype (AG vs. GG: OR = 2.26, 95% Cl = 1.40-3.66, P = 0.0008), AA genotype (AA vs. GG: OR = 3.64, 95% Cl = 2.17-6.10, P <0.0001), dominant model (AG+AA vs. GG: OR = 2.75, 95% Cl = 1.75-4.31, P <0.0001), recessive model (AA vs. GG+AG: OR = 2.08, 95% Cl = 1.41-3.08, P = 0.0002), and A allele (A vs. G: OR = 1.94, 95% Cl = 1.51-2.51, P <0.0001). All of these correlations remained statistically significant after performing Bonferroni correction (P <0.008). Conclusion: Our study suggests that the rs11134527 polymorphism in the miR-218-2 gene contributes to the susceptibility of CC in Bangladeshi women.

Predicting recurrences or major bleeding in cancer patients with venous thromboembolism

2008 ◽  
Vol 100 (09) ◽  
pp. 435-439 ◽  
Author(s):  
Javier Trujillo-Santos ◽  
José Nieto ◽  
Gregorio Tiberio ◽  
Andrea Piccioli ◽  
Pierpaolo Micco ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Major Bleeding ◽  
Bleeding Complications ◽  
Vein Thrombosis ◽  
Recurrent Pulmonary Embolism ◽  
Acute Venous Thromboembolism ◽  
Deep Vein

SummaryCancer patients with acute venous thromboembolism (VTE) have an increased incidence of recurrences and bleeding complications while on anticoagulant therapy. Methods RIETE is an ongoing registry of consecutive patients with acute VTE. We tried to identify which cancer patients are at a higher risk for recurrent pulmonary embolism (PE), deep vein thrombosis (DVT) or major bleeding. Up to May 2007, 3, 805 cancer patients had been enrolled in RIETE. During the first three months of follow-up after the acute, index VTE event, 90 (2.4%) patients developed recurrent PE, 100 (2.6%) recurrent DVT, 156 (4.1%) had major bleeding. Forty patients (44%) died of the recurrent PE,46 (29%) of bleeding. On multivariate analysis, patients aged <65 years (odds ratio [OR]: 3.0; 95% confidence interval [CI]: 1.9–4.9), with PE at entry (OR: 1.9; 95% CI: 1.2–3.1), or with <3 months from cancer diagnosis to VTE (OR: 2.0; 95% CI: 1.2–3.2) had an increased incidence of recurrent PE. Those aged <65 years (OR: 1.6; 95% CI: 1.0–2.4) or with <3 months from cancer diagnosis (OR: 2.4; 95% CI: 1.5–3.6) had an increased incidence of recurrent DVT. Finally, patients with immobility (OR: 1.8; 95% CI: 1.2–2.7), metastases (OR: 1.6; 95% CI: 1.1–2.3), recent bleeding (OR: 2.4; 95% CI: 1.1–5.1), or with creatinine clearance <30 ml/ min (OR: 2.2; 95% CI: 1.5–3.4), had an increased incidence of major bleeding. With some variables available at entry we may identify those cancer patients withVTE at a higher risk for recurrences or major bleeding.

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