scholarly journals Incidence and Risk Factors for Central Venous Catheter-Related Venous Thromboembolism in Breast Cancer Patients Under Neoadjuvant Chemotherapy: the Caveccas (Catheter Veineux Central et Cancer du Sein) Study

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2607-2607
Author(s):  
Philippe Debourdeau ◽  
Marc Espié ◽  
Sylvie Chevret ◽  
Joseph Gligorov ◽  
Antoine Elias ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Thrombin Generation ◽  
Lobular Carcinoma ◽  
Univariate Analysis ◽  
Central Venous ◽  
Cathéter Veineux Central

Abstract Background: Symptomatic Catheter Related Thrombosis (CRT) occurs in 3-5% of cancer patients with Central Venous Catheters (CVC) and, overall, the incidence of CRT could reach 30% when including asymptomatic cases (1). In women with Breast Cancer (BC), the most frequent cancer in females world-wide, the high risk of Venous Thromboembolism (VTE) during chemotherapy may be related in part to CRT (2). We therefore designed the CAVECCAS (Cathéter VEineux Central et CAncer du Sein) study to analyze CRT incidence and CRT risk factors in BC patients with CVC receiving (neo)adjuvant chemotherapy (NAC). Methods: CAVECCAS is a prospective, multicenter cohort study of patients with non metastatic invasive BC undergoing insertion of a single lumen CVC for at least 3 months of NAC. All included patients with signed informed consent between September 2008 and December 2011 underwent repeated double-blind Doppler US evaluation before (D0) and at 7, 30 and 90 days (D) after CVC insertion. In case of VTE symptoms, diagnosis was confirmed by venography, ultrasonography and/or computed tomography. Venous blood samples were systematically drawn before and 2 days after CVC insertion to determine D-Dimers levels (VIDAS® D-Dimer Exclusion™), Platelet-derived MPs (Pd-MPs) and Pd-MPs expressing phosphatidyl serin (Pd-MP/PS+) levels (3), thrombin generation (Calibrated Automated Thrombogram assay®, Stago) and endogenous thrombin potential (ETP). After completing recruitment and follow-up (D90), a nested case-control study analyzed additional individual thrombophilic risk factors (Antithrombin, Protein C and Protein S levels, presence of Factor V and Factor II Leiden mutations, presence of antiphospholipid, anticardiolipin and antiβ2GP1 antibodies) using two controls without CRT from the CAVECCAS cohort matched for TNM status with each symptomatic or asymptomatic CRT patient. Statistical analysis used Fisher or Wilcoxon tests for univariate analysis; step down selection procedure with p-values < 0.10 for multivariate models; conditional logistic model to study the occurrence of CRT based on thrombophilia testing (open-source software R Version 2.15.2 (2012-10-26). Results(expressed as median and inter-quartile range [IQR] for quantitative data and numbers and percentages for categorical data). 524 patients with non metastatic BC (85% ductal carcinoma, 12.2% Lobular carcinoma, 2.8% other) with respective T0/T1/T2/T3/T4 staging (0.5%/47.6%/43.3%/8.0%/0.7%), SBR 1/2/3 grading (11.2%/53%/35.8%), 49.2 % having node involvement and 79.5% steroid hormone receptors, were analyzed. During follow-up, the overall CRT incidence rate was 2.18 cases/100 patient-months, with 14 symptomatic and 46 asymptomatic patients, 27, 10 and 9 of the asymptomatic CRT being respectively diagnosed on D8, 30 and day 90 US. In univariate analysis, increased age (>50 years) (OR, 1.80; 95% CI, 1.01-3.22; p=0.048), BMI> 30 kg/m² (OR, 2.64; 95% CI, 1.46-4.76; p=0.001) and comorbidities (OR, 2.05; 95% CI, 1.18-3.56; p=0.011) were associated with CRT. CRT was less frequent in ductal (OR, 0.55; 95% CI, 0.28-1.07; p=0.078) versus lobular carcinoma (OR, 2.53; 95% CI, 1.32-4.85; p= 0.005). In multivariate analysis, BMI>30 kg/m² (OR, 2.66: 99%CI, 1.46-4.84, p=0.001) and lobular carcinoma histology (OR, 2.56; 95%CI, .32-4.96, p=0.005) remained CRT risk factors. Pd-MPs (981.5 [518-2147] vs 758.5 [416.5-373] /mL; p<0.0001) and Pd-MP/PS+(778 [409-1851] vs 730 [380.5-412]/mL; p=0.021) levels decreased after CVC insertion versus baseline, while D-Dimers levels increased (454[294.2-757] vs 586 [366-842] ng/mL; p<0.0001), as did all thrombin generation parameters increased except ETP (1322 [1052-582] vs 1304 [1063-652] nM/min; p=0.023). None of these biomarkers appeared significant predictors for CRT. Conclusion: In this large sample size study with serial measurements of clinical parameters and biomarkers for thrombosis, only obesity and lobular carcinoma histology appeared strong risk factors for CRT in non metastatic BC treated with NAC. Further studies will elucidate how individual stratification of BC patients may identify those who may benefit from CRT prophylaxis. 1) Debourdeau P and Farge D et al. J Thromb Haemost 2013; 11:71-80 2) Walker AJ et al. Blood 2016;127(7):849-57 3) Robert S et al J Thromb Haemost 2009;7:190-7 Disclosures No relevant conflicts of interest to declare.

scholarly journals Risk Factors for Arm Lymphedema in a Cohort of Breast Cancer Patients Followed up for 10 Years

Breast Care ◽  
2015 ◽  
Vol 11 (1) ◽  
pp. 45-50 ◽  
Author(s):  
René Aloisio da Costa Vieira ◽  
Allini Mafra da Costa ◽  
Josue Lopes de Souza ◽  
Rafael Richieri Coelho ◽  
Cleyton Zanardo de Oliveira ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Regression Analysis ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Multivariate Regression ◽  
Axillary Dissection ◽  
Breast Cancer Patients ◽  
Arm Lymphedema

Background: The etiology of lymphedema is multifactorial, and definition criteria of lymphedema, its limitation, and follow-up must be considered in studies related to risk factors. The aim of this study is to evaluate risk factors related to arm lymphedema in a cohort study with a long follow-up. Patients and Methods: The study was performed in 622 breast cancer patients. The main endpoint reported was the presence of clinical lymphedema reported in medical records. Univariate and multivariate regression analyses were performed to identify factors related to lymphedema. Results: 66.4% of the patients were submitted to mastectomy, 88.4% to level III axillary lymphadenectomy, 34.9% to radiotherapy in the supraclavicular fossa, and 4.3% to axillary radiotherapy. The mean follow-up was 96.7 months. 45 patients (7.2%) developed lymphedema, of which 82.2% had developed lymphedema at 60 months. Univariate regression analysis showed that supraclavicular radiotherapy, adjuvant/palliative chemotherapy, ≥ 15 lymph nodes dissected, and axillary surgery increase the lymphedema rate by 1.87, 2.28, 2.03, and 6.17, respectively. Adjusted multivariate regression analysis showed that the combination of axillary dissection and number of lymph nodes dissected was the main factor related to lymphedema (p = 0.017). Conclusion: In the pre-sentinel era, axillary dissection and the number of lymph nodes resected are related to 10-year lymphedema.

scholarly journals CAN WE Predict Risk Factors of Venous Thromboembolism Among Cancer Inpatients?

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5871-5871 ◽  
Author(s):  
Shiva Shrotriya ◽  
Prajwal Dhakal ◽  
Mukta Sharma ◽  
Joseph Gardiner ◽  
Anas Al-Janadi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Renal Disease ◽  
Predictive Model ◽  
Cancer Patients ◽  
Validation Cohort ◽  
Univariate Analysis ◽  
Renal Diseases ◽  
Operating Characteristics ◽  
Increased Risk

Abstract Introduction Increased risk of venous thromboembolism (VTE) has been noted among cancer patients as compared to non-cancer. VTE identified as leading cause of death among those with cancer. Cancer associated thrombosis caused increased hospitalizations, increased inpatient/outpatient medical and prescription claims, and increased total health care costs per patient. Our objective was to study demographic, clinical and laboratory risk factors for venous thromboembolism (VTE) among hospitalized cancer patients and built a predictive model for VTE risk. Methods Ours was a retrospective cohort study focused on patients with VTE and cancer from January 2013 - September 2015. Univariate and multivariate logistic regression analysis using stepwise approach was performed. A final predictive model was derived using receiver-operating characteristics (ROC) curves and concordance indices (c-statistics). Results N=3948 cancer inpatients were identified which was split into a derivation cohort and a validation cohort, each with 1957. Mean age 65.9±13.8 years; 52.6% were male; 85.6% Caucasian, 7% African Americans; 15.5% were obese; common comorbidities were hypertension (46%), pulmonary disease (34.5%), diabetes (22.9%), renal disease (20.9%) and congestive heart failure (10.4%). Overall, there was 152 (3.9%) events of VTE with 77 (3.9%) in derivation and 75 (3.8%) in validation cohort. On univariate analysis, comorbidities such as infection and renal diseases, laboratory findings such as low hemoglobin and low albumin was associated with high VTE risk. The derivation set had a c-statistic or AUC of 0.668 while the validation set had an AUC of 0.65. Conclusions Infection, renal disease (comorbidity) and low albumin levels were associated with a higher risk of VTE. Digestive and respiratory cancers were associated with higher VTE risk. We identified three clinical and laboratory variable that was associated with increased risk of VTE in addition to the cancer group. Future research could use this analysis as a basis for forming a risk score that could be used by clinicians to identify those cancer patients at risk for VTE. Disclosures No relevant conflicts of interest to declare.

Predictors of venous thromboembolism in cancer patients using machine learning.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24042-e24042
Author(s):  
Ayse Ece Cali Daylan ◽  
Danai Khemasuwan ◽  
Hyun S. Kim ◽  
Parvathy Geetha ◽  
Sylvia Vania Alarcon Velasco ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Lung Cancer ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Hematological Malignancies ◽  
Cancer Subtypes ◽  
Kaplan Meier ◽  
Increased Risk

e24042 Background: The increased risk of venous thromboembolism (VTE) in cancer patients is clearly documented. However, given the heterogeneity and increased risk of bleeding in cancer population, patient selection for thromboprophylaxis is still challenging. Methods: In order to predict risk factors of VTE in cancer patients, we performed a retrospective study of 706 patients who were diagnosed with either solid or hematological malignancies between 2015 and 2019. Demographics, body mass index, complete blood count with differential, kidney function tests, electrolytes, liver function tests, lipid profile and cancer staging were recorded. Random forest analysis with bagging was used to rank these variables and the Kaplan-Meier survival analysis was implemented to stratify cancer subtypes based on the risk of VTE occurrence. Results: The mean follow-up time was 19 months. 8.2% of the patients developed VTE. Based on the random forest analysis, the most important five factors in prediction of VTE in cancer patients were determined as cancer subtype, white blood cell count, platelets, neutrophil and hemoglobin. At one-year mark, the risk of VTE in lung cancer and hematological malignancies was found to be significantly higher than breast, colorectal and endometrial cancer (p<0.05). Conclusions: Machine learning approach is infrequently used in risk factor prediction of VTE in cancer patients. The risk factors identified by the machine learning algorithm in our study are consistent with prior studies and show a clear difference in risk of VTE in various cancer subtypes. Moreover, hematological malignancies and lung cancer patients may develop VTE earlier than other cancer subtypes based on the Kaplan-Meier analysis. Further prospective studies with longer follow up are needed to better risk-stratify cancer patients and explore the temporal associations of VTE risk factors. [Table: see text]

Professionals’ opinion on follow-up in breast cancer patients; perceived purpose and influence of patients’ risk factors

2011 ◽  
Vol 37 (3) ◽  
pp. 217-224 ◽  
Author(s):  
M. van Hezewijk ◽  
E.T.M. Hille ◽  
A.N. Scholten ◽  
C.A.M. Marijnen ◽  
A.M. Stiggelbout ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Patients ◽  
Breast Cancer Patients

scholarly journals Frequency of Brain Metastasis in Breast Cancer Patients and Factors Leading to it

2019 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Cancer Patients ◽  
Tumor Size ◽  
Triple Negative ◽  
Univariate Analysis ◽  
Axillary Lymph ◽  
Breast Cancer Patients

Objective: Breast cancer is the second commonest cause of brain metastasis after lung cancer.10-16% of patients diagnosed with breast cancer ultimately develop brain metastasis. As most of chemotherapeutic drugs do not cross blood brain barrier despite adequate management of breast cancer risk of CNS relapse persist. Prognosis for breast cancer patients after developing brain metastases is poor. Therefore, we sought to determine the frequency of brain metastasis in Pakistani breast cancer survivors, how often brain metastasis is the first site of recurrence and what are the risk factors that indicate greater likelihood of this event occurrence so that more accurate screening for patients at risk can be established. Methods: We retrospectively reviewed medical record of 507 patients with invasive breast cancer of all stages who received treatment in Liaquat National Hospital from January 2010 to December 2015. Patients who developed brain metastasis were identified and stratified according to risk factors. Result: Out of 507 patients 51(10%) developed brain metastasis. 14 patients had brain metastasis as first site of recurrence. On univariate analysis negative hormone receptor status, triple negative and her2 enriched subtype, higher tumor size, lymph node positivity, stages 3 and 4, lymphovascular and peri nodal extension, shorter diseasefree survival and recurrence with visceral metastasis had a statistically highly significant impact on brain metastasis occurrence, while young age at diagnosis (≤35 years), menopausal status, BMI and tumor histology showed no statistically significant impact. Conclusion: Brain metastases are more frequent in triple negative, Her2Neu positive and Estrogen and Progesterone receptor negative patients. Other factors associated with higher risk of brain metastases in breast cancer patients include larger tumor size, positive axillary lymph nodes, higher stage and lymphovascular and periodontal invasion. Frequency of brain metastasis in breast cancer patients and factors leading to it.

Incidence and impact of thromboembolic events in lung cancer patients treated with nivolumab.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20624-e20624
Author(s):  
Aparna Madhukeshwar Hegde ◽  
Chipman Robert Geoffrey Stroud ◽  
Cynthia R. Cherry ◽  
Meera Yogarajah ◽  
Sulochana Devi Cherukuri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Univariate Analysis ◽  
High Risk Population ◽  
Thromboembolic Events ◽  
Lung Cancer Patients ◽  
Established Risk Factor

e20624 Background: Lung cancer has one of the highest incidences of thromboembolic events (TEE) ranging from 8.4 to13.2%. Cisplatin-based chemotherapy in lung cancer is a well-established risk factor for TEE (11.8%). The incidence of TEE in lung cancer patients (pts) treated with nivolumab (nivo) is unclear. The objective of this study was to evaluate the incidence of TEE, risk factors and its impact on overall survival in lung cancer pts treated with nivo. Methods: This was a retrospective cohort study that included all lung cancer pts treated with nivo from April 2015 to October 2016 at our institution. Medical records were reviewed for incidence, timing, CTCAE grade, type and site of TEE, risk factors and patient demographics. Cox proportional hazard model was used to identify independent predictive factors for TEE. Risk factors with p <0.15 in univariate analysis were included in multivariate model using a stepwise approach. Kaplan-Meier method was used to estimate overall survival (OS). Results: The cumulative incidence (CI) of TEE over a median follow up of 10.8 months after starting nivo was 18.4% (14/76 pts). Of the 14 pts who had TEE, 8 had deep vein thrombosis (DVT), 7 had pulmonary embolism (PE), 1 had concurrent DVT/PE and 2 had arterial thrombosis (AT). 28.6% (4/14) of pts experienced recurrent TEE resulting in 18 total episodes. Median time to TEE after starting nivo was 2.9 months (95% CI 1.9 - 8.4). Gender was the only covariate included in multivariate analysis that showed a significant association with TEE (Female vs Male HR 3.1, 95% CI 1.02 – 9.5, p= 0.045). At a median follow up of 31.8 months since diagnosis of lung cancer, pts who had TEE before receiving nivo had worse OS. TEE occurring after nivo had no impact on OS. Conclusions: The CI of TEE is significantly high at 18.4% in lung cancer pts treated with nivo. However, it had no impact on OS. Further studies are needed to determine the role of prophylactic anticoagulation in this high-risk population. [Table: see text]

scholarly journals Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer

Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2070
Author(s):  
Alice Labianca ◽  
Tommaso Bosetti ◽  
Alice Indini ◽  
Giorgia Negrini ◽  
Roberto Francesco Labianca
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Central Venous Catheters ◽  
Thromboembolic Events ◽  
Efficacy And Safety ◽  
Central Venous ◽  
Additional Risk ◽  
Current Guidelines ◽  
Coagulation Pathway

In the general population, the incidence of thromboembolic events is 117 cases/100,000 inhabitants/year, while in cancer patient incidence, it is four-fold higher, especially in patients who receive chemotherapy and who are affected by pancreatic, lung or gastric cancer. At the basis of venous thromboembolism (VTE) there is the so-called Virchow triad, but tumor cells can activate coagulation pathway by various direct and indirect mechanisms, and chemotherapy can contribute to VTE onset. For these reasons, several studies were conducted in order to assess efficacy and safety of the use of anticoagulant therapy in cancer patients, both in prophylaxis setting and in therapy setting. With this review, we aim to record principal findings and current guidelines about thromboprophylaxis in cancer patients, with particular attention to subjects with additional risk factors such as patients receiving chemotherapy or undergoing surgery, hospitalized patients for acute medical intercurrent event and patients with central venous catheters. Nonetheless we added a brief insight about acute and maintenance therapy of manifested venous thromboembolism in cancer patients.

scholarly journals CARDIOTOXICITY RISK PREDICTION IN BREAST CANCER PATIENTS

2021 ◽  
Vol 26 ◽  
pp. 498-512
Author(s):  
S. Kozhukhov ◽  
◽  
N. Dovganych ◽  
I. Smolanka ◽  
O. Lygyrda ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
High Risk ◽  
Retrospective Analysis ◽  
Cancer Patients ◽  
Risk Prediction ◽  
Risk Model ◽  
Heart Function ◽  
Breast Cancer Patients

S. M. Kozhukhov1, N. V. Dovganych1, I. I. Smolanka2, O. F. Lygyrda2, О. Ye. Bazyka1, S. A. Lyalkin2, O. M. Ivankova2, O. A. Yarinkina1, N. V. Tkhor1 1 National Scientific Center «The M.D. Strazhesko Institute of Cardiology», 5 Narodnoho Opolchennia Str., Kyiv, 03680, Ukraine 2 National Cancer Institute of the Ministry of Health of Ukraine, 33/43 Lomonosova Str., Kyiv, 03022, Ukraine CARDIOTOXICITY RISK PREDICTION IN BREAST CANCER PATIENTS Breast cancer patients receive combined antitumor treatment (surgery, chemotherapy, targeted drugs and radiation), so they are considered to be the patients with potentially high risk of cardiotoxicity (CT). Risk stratification of cardiovascular complications before the beginning and during the cancer treatment is an important issue. Objective: to develop a CT risk model score taking into account cardiological, oncological and individual risks. Material and methods. The study included 52 breast cancer patients with retrospective analysis of their medical history, risk factors, and echocardiographic parameters before the onset and in 12 months follow up. Based on the analysis of the data, a CT risk model score was developed and recommended. The patients were divided into groups according to the score: Group 1 – low risk of CT development – score ≤ 4 points, Group 2 – moderate risk – 5–7 points, Group 3 – high risk ≥ 8 points. According to the scale, BC patients with a total of ≥ 8 points are considered to be at high risk for CT complications. Radiation therapy and anthracyclines, as well as associated cardiovascular diseases were the most important risk factors of CT. Results. Based on the study of retrospective analysis of risk factors, data of heart function monitoring during follow-up, the risk model score of cardiotoxicity has been developed for the BC patients’ stratification. According to the proposed score risk model, BC patients with a total score of ≥ 8 points considered to have high risk of cardiotoxic complications. Conclusions. Using of the proposed risk model score with calculation of CT risk factors both before the beginning and during cancer therapy is important, because it allows predicting the risk of CT development – to identify highrisk patients, accordingly, to develop an individualized plan for cardiac function monitoring and to start timely cardioprotective therapy. Key words: breast cancer, cardiotoxicity, heart failure, risk scale, prognosis.

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