Clinicopathologic characterization and outcomes for patients with renal medullary carcinoma: Results from the National Cancer Database.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 456-456
Author(s):  
Harras B. Zaid ◽  
Robert Houston Thompson ◽  
Bradley C. Leibovich ◽  
William P. Parker ◽  
Brian Addis Costello ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Systemic Therapy ◽  
Multivariable Analysis ◽  
Medullary Carcinoma ◽  
Management Approach ◽  
National Cancer Database ◽  
Clinicopathologic Features ◽  
Cox Regression Analysis ◽  
Renal Medullary Carcinoma ◽  
Increased Risk

456 Background: Renal medullary carcinoma (RMC) is a rare, aggressive malignancy for which relatively limited characterization exists to date. We evaluated clinicopathologic features, treatment patterns, and variables associated with outcomes for patients with RMC. Methods: We reviewed the National Cancer Database to identify patients diagnosed with RMC between 1998-2012. Overall survival (OS) was estimated using the Kaplan-Meier method. Clinicopathologic features associated with all-cause mortality (ACM) were assessed using Cox regression analysis. Results: We identified 153 patients with RMC, comprising approximately 0.04% of renal malignancies during this time period. Median age at diagnosis for RMC was 24 years (IQR 20, 31). The majority of RMC patients were black (135; 88%), male (108; 71%), and presented with unilateral, right-sided tumors (101; 66%). Notably, nearly half (72; 48.9%) presented with metastatic disease. A total of 92 (64.3%) patients underwent radical nephrectomy (RN), and 2 (1.3%) were treated with partial nephrectomy. Pathologic stage at nephrectomy was ≤pT2 in 30 patients (32.6%), pT3 in 43 (46.7%), pT4 in 7 (7.6%), and N+ in 50 (55.6%). Of the patients who underwent RN, 60 (65.2%) received multimodal therapy (MMT), including radiation (3; 3.3%), systemic therapy (49; 53.3%), and radiation + systemic therapy (8; 8.7%). Of the 59 patients who did not undergo surgical resection, the majority (46; 77.8%) presented with M1 disease. Median OS was 7.8 months for the entire RMC cohort, with 1- and 3-year OS of 34% and 11%, respectively. Notably, median OS for patients presenting with M1 and M0 disease was 5.2 months versus 11.2 months, respectively (p< 0.01). On multivariable analysis, treatment with RN (HR 0.40; p=0.003) or RN+MMT (HR 0.44; p<0.001) were associated with decreased ACM, whereas the presence of metastatic disease at diagnosis remained associated with an increased risk of ACM (HR 1.74; p=0.02). Conclusions: The prognosis for patients with RMC is dismal, with a median OS under 8 months. Further studies, including the development of novel therapies, are needed to establish the optimal multimodal management approach for these patients.

Feasibility and clinical impact of next-generation sequencing (NGS) in patients with stage IV or recurrent malignancies.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14697-e14697
Author(s):  
Fahrettin Covut ◽  
Tariq Zuheir Kewan ◽  
Bicky Thapa ◽  
Abdo S. Haddad ◽  
Timothy Peter Spiro ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Systemic Therapy ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Cleveland Clinic ◽  
Stage Iv ◽  
Solid Cancer ◽  
Recurrent Cancer ◽  
Cox Regression Analysis ◽  
Best Response

e14697 Background: Feasibility and outcomes of routine NGS in patients with stage IV or recurrent malignancies remain debatable. Methods: We reviewed patients who underwent Foundation One NGS between 9/2012 and 10/2018 after diagnosis of stage IV or recurrent solid cancer at Cleveland Clinic. Overall survival (OS) was estimated by the Kaplan-Meier method. Logistic and Cox regression analysis were performed to identify predictors of receiving targeted gene therapy (TGT) and OS, respectively. Results: We identified 1699 patients, 825 (49%) were female, 1634 (96%) had stage IV and 65 (4%) had recurrent cancer. At diagnosis of stage IV/recurrent cancer, median age was 61 (range: 18 – 94) and ECOG performance score was 0, 1, and ≥ 2 for 578 (34%), 859 (51%), and 258 (15%) patients, respectively. Most common primary cancers were lung (20%), colorectal (17%), urothelial/prostate (12%), and breast (10%). NGS revealed median of 4 mutated genes (range: 0 – 34), ≥ 1 FDA approved TGT was available in 505 (30%) and 1114 (66%) patients for the same and different primary cancer, respectively. Overall, 219 (13%) patients received 247 lines of TGT for median of 3 months (range: 0.1 – 62) based on NGS results. TGT use was via clinical trials for 49 (22%) and off-label for 83 (38%) patients. Best response was complete/partial response for 63 (29%) and stable disease for 40 (18%) patients. Commonly targeted genes were EGFR (12%), ERBB2/3 (11%), BRAF (10%), BRCA1/2 (8%), and PIK3CA (7%). Median follow-up after diagnosis of stage IV/recurrent cancer was 19 months. Two-year OS for TGT and no TGT cohorts were 70% (95% CI: 64 – 77) and 55% (95% CI: 53 – 58), respectively (p < 0.0001). On multivariable analysis, ECOG ( < 2vs ≥2), systemic therapy between diagnosis of stage IV/recurrent cancer and NGS (≥2 vs < 2 lines), and each 1 increase in number of mutated genes were predictors of receiving TGT (p < 0.05 for all). On multivariable analysis, age (≤65 vs > 65), ECOG ( < 2vs ≥2), stage (recurrent vs IV), and systemic therapy before NGS (≥2 vs < 2 lines) predicted longer OS (p < 0.01 for all). Conclusions: In this large cohort, NGS provided further therapeutic options including clinical trials for approximately 1 out of 10 patients with stage IV or recurrent cancer.

The impact of screening for prostate cancer on the development of metastatic disease.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 192-192
Author(s):  
J. P. Ciezki ◽  
C. A. Reddy ◽  
P. Kupelian ◽  
E. A. Klein
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Metastatic Disease ◽  
Multivariable Analysis ◽  
Routine Screening ◽  
Meaningful Improvement ◽  
Psa Testing ◽  
Increased Risk ◽  
The Impact

192 Background: Routine screening for prostate cancer (CaP) was first advocated in 1993 in the US. Opponents of screening argue that the implementation of routine screening has not resulted in a meaningful improvement in survival. Since we are essentially unable to cure metastatic disease, the best measure of the efficacy of screening may not be overall survival but instead its ability to lessen the metastatic disease burden of the screened population. We assess the effect of screening on this endpoint. Methods: From 1986-1996, 1,721 patients with CaP were definitively treated with radical prostatectomy (RP) or radiotherapy (RT) at our institution. The cohort was divided into a pre screening era group (1986-1992; PRE, n=575) and a post screening era group (1993-1996; POST, n=1,146). Due to the potential for an imbalance in follow up time between the two groups, all patients were censored at ten years. Kaplan- Meier analysis was used to calculate the ten year metastases free survival rates (MFSR). Cox proportional hazards regression was used to examine if screening era along with disease, treatment, and follow-up characteristics was associated with an increased risk of developing metastatic disease. Results: The median follow up for all patients was 10 yrs (range: 0.1-10), 9.6 yrs (range: 0.1-10) for PRE patients, and 10 yrs (range: 0.1-10) for POST patients. The distribution by NCCN risk classification for the PRE patients was 44% high risk (H), 21% intermediate risk (I) and 28% low risk (L) vs. 36% H, 27% I, and 37% L for the POST patients (p < 0.0001). Within 10 years of treatment, 13% of all patients had developed metastatic disease. The 10 year MFSR for high risk PRE vs POST patients was 58% vs. 82% (p < 0.0001), 79% vs. 93% for I (p < 0.0001), and 90% vs. 98% (p = 0.0001) for L patients. On multivariable analysis, screening era (p < 0.0001, HR = 4.6, 95% CI = 3.4-6.1), T-stage, biopsy Gleason score, and post-treatment PSA testing frequency were significant. Conclusions: Screening for CaP results in a significant decrease in the risk of a patient developing metastatic disease within 10 years of treatment even after controlling for severity of disease. This risk reduction may yield improved quality of life and a cost savings to the medical care system. No significant financial relationships to disclose.

Primary Surgery vs Radiotherapy for Early Stage Oral Cavity Cancer

2017 ◽  
Vol 158 (4) ◽  
pp. 649-659 ◽  
Author(s):  
Mark A. Ellis ◽  
Evan M. Graboyes ◽  
Amy E. Wahlquist ◽  
David M. Neskey ◽  
John M. Kaczmar ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Oral Cavity ◽  
Cox Regression ◽  
Early Stage ◽  
Multivariable Analysis ◽  
Cox Regression Analysis ◽  
Factors Associated ◽  
Primary Surgery ◽  
Increased Risk ◽  
Low Volume

Objective The goal of this study is to determine the effect of primary surgery vs radiotherapy (RT) on overall survival (OS) in patients with early stage oral cavity squamous cell carcinoma (OCSCC). In addition, this study attempts to identify factors associated with receiving primary RT. Study Design Retrospective cohort study. Setting National Cancer Database (NCDB, 2004-2013). Subjects and Methods Reviewing the NCDB from 2004 to 2013, patients with early stage I to II OCSCC were identified. Kaplan-Meier estimates of survival, Cox regression analysis, and propensity score matching were used to examine differences in OS between primary surgery and primary RT. Multivariable logistic regression analysis was performed to identify factors associated with primary RT. Results Of the 20,779 patients included in the study, 95.4% (19,823 patients) underwent primary surgery and 4.6% (956 patients) underwent primary RT. After adjusting for covariates, primary RT was associated with an increased risk of mortality (adjusted hazard ratio [aHR], 1.97; 99% confidence interval [CI], 1.74-2.22). On multivariable analysis, factors associated with primary RT included age ≥70 years, black race, Medicaid or Medicare insurance, no insurance, oral cavity subsite other than tongue, clinical stage II disease, low-volume treatment facilities, and earlier treatment year. Conclusion Primary RT for early stage OCSCC is associated with increased mortality. Approximately 5% of patients receive primary RT; however, this percentage is decreasing. Patients at highest risk for receiving primary RT include those who are elderly, black, with public insurance, and treated at low-volume facilities.

scholarly journals Faecal immunochemical test after negative colonoscopy may reduce the risk of incident colorectal cancer in a population-based screening programme

Gut ◽  
2020 ◽  
pp. gutjnl-2020-320761
Author(s):  
Szu-Min Peng ◽  
Wen-Feng Hsu ◽  
Ying-Wei Wang ◽  
Li-Ju Lin ◽  
Amy Ming-Fang Yen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Programme ◽  
Multivariable Analysis ◽  
Study Cohort ◽  
Diagnostic Colonoscopy ◽  
Cox Regression Analysis ◽  
Faecal Immunochemical Test ◽  
Adenoma Detection ◽  
Increased Risk ◽  
Immunochemical Test

ObjectiveSubjects with a positive faecal immunochemical test (FIT) have a much higher likelihood of advanced neoplasms than the general population. Whether FIT-positive subjects with negative colonoscopy should receive subsequent FIT screening remain unclear.DesignSubjects with a negative colonoscopy after positive FIT in the first screening in the Taiwanese Colorectal Cancer (CRC) Screening Program 2004–2009 were followed until the end of 2014. CRC incidence was compared between those who did and did not receive subsequent FIT screening. Cox regression analysis was conducted, adjusting for major confounders to investigate whether subsequent FIT was associated with lower risk of incident CRC.ResultsThe study cohort was comprised of 9179 subjects who had negative diagnostic colonoscopy after positive FIT in 2004–2009, of whom 6195 received subsequent FIT during the study period. The CRC incidence (per 1000 person years) was 1.34 in those who received subsequent FIT and 2.69 in those who did not, with corresponding adjusted HR (aHR) of 0.47 (95% CI 0.31 to 0.71). Lower adenoma detection rate of diagnostic colonoscopy was associated with higher risk of incident CRC but became non-significant in multivariable analysis after adjustment for subsequent FIT. Higher baseline faecal haemoglobin concentration (FHbC, μg haemoglobin/g faeces) was associated with increased risk of incident CRC (reference: FHbC=20–39; aHR=1.93 (1.04–3.56), 0.95 (0.45–2.00), 2.26 (1.16–4.43) and 2.44 (1.44–4.12) for FHbC=40–59, 60–99, 100–149 and ≥150, respectively).ConclusionSubsequent FIT should be scheduled after negative colonoscopy to detect missed neoplasms and reduce the risk of incident CRC in a national FIT screening programme.

scholarly journals Comparison of Surgical Resection and Systemic Treatment for Hepatocellular Carcinoma with Vascular Invasion: National Cancer Database Analysis

Liver Cancer ◽  
2021 ◽  
pp. 1-12
Author(s):  
Rajalakshmi Govalan ◽  
Marie Lauzon ◽  
Michael Luu ◽  
Joseph C. Ahn ◽  
Kambiz Kosari ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Surgical Resection ◽  
Systemic Therapy ◽  
Vascular Invasion ◽  
Systemic Treatment ◽  
Multivariable Analysis ◽  
National Cancer Database ◽  
Factors Associated ◽  
The Usa

<b><i>Introduction:</i></b> Small studies from outside of the USA suggest excellent outcomes after surgical resection for hepatocellular carcinoma (HCC) with vascular invasion. The study aims to (1) compare overall survival after surgical resection and systemic therapy among patients with HCC and vascular invasion and (2) determine factors associated with receipt of surgical resection in a US population. <b><i>Methods:</i></b> HCC patients with AJCC clinical TNM stage 7th T3BN0M0 diagnosed between 2010 and 2017 from the National Cancer Database were analyzed. Cox and logistic regression analyses identified factors associated with overall survival and receipt of surgical resection. <b><i>Results:</i></b> Of 11,259 patients with T3BN0M0 HCC, 325 (2.9%) and 4,268 (37.9%) received surgical resection and systemic therapy, respectively. In multivariable analysis, surgical resection was associated with improved survival compared to systemic therapy (adjusted hazard ratio: 0.496, 95% confidence interval: 0.426–0.578) with a median survival of 21.4 and 8.1 months, respectively. Superiority of surgical resection was observed in noncirrhotic and cirrhotic subgroups and propensity score matching and inverse probability of treatment weighting adjusted analysis. Asians were more likely to receive surgical resection, whereas Charlson comorbidity ≥3, elevated alpha-fetoprotein, smaller tumor size, care in a community cancer program, and the South or West region were associated with a lower likelihood of surgical resection. <b><i>Conclusion:</i></b> HCC patients with vascular invasion may benefit from surgical resection compared to systemic therapies. Demographic and clinical features of HCC patients and region and type of treating facility were associated with surgical resection versus systemic treatment.

Renal Medullary Carcinoma in an Adolescent with Homozygous Hemoglobin SS

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4774-4774
Author(s):  
Anne M. Marsh ◽  
Keith C. Quirolo ◽  
Carla Golden ◽  
Elliott Vichinsky
Keyword(s):  
Abdominal Pain ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Metastatic Disease ◽  
Left Kidney ◽  
Psoas Muscle ◽  
Medullary Carcinoma ◽  
Cell Disease ◽  
Renal Medullary Carcinoma ◽  
Viable Tumor

Abstract Abstract 4774 Renal medullary carcinoma (RMC) is a highly aggressive malignant neoplasm originally thought to be unique to individuals with sickle cell trait (SCT). Common symptoms include hematuria, abdominal pain, and weight loss. The disease is usually metastatic at presentation and is almost universally fatal within months of diagnosis. Herein, we describe an adolescent with homozygous hemoglobin SS (Hgb SS) and RMC. This is the third case of RMC reported in Hgb SS, and the first case with prior hydroxyurea therapy (Dimashkieh Arch Pathol Lab Med 2003 and Swartz Urology 2002). In addition to five reported cases in individuals with hemoglobin SC, it now appears that RMC is not unique to individuals with SCT and should instead be considered more inclusively related to the family of sickle hemoglobinopathies (Davis Am J Surg Pathol 1995, Luthra Intern Med 2010, Baig J Natl Med Assoc 2006, Swartz Urology 2002). A 13 year-old African American male with Hgb SS, treated with hydroxyurea since 2 months of age, presented with a several month history of recurrent abdominal pain and microscopic hematuria. An abdominal ultrasound demonstrated normal appearing kidneys that measured 8.4 cm and 9.7 cm on the right and left sides, respectively. He continued to have abdominal pain, often associated with intermittent sickle cell extremity pain. A repeat sonogram was obtained 9 months after the initial ultrasound due to a new complaint of scrotal pain. The formerly normal left kidney now had a 5 cm mass in the mid-to-lower pole, along with moderate caliceal dilation and cortical thinning of the superior pole. Computed tomography (CT) and positron emission tomography scans confirmed the renal mass along with local invasion into the psoas muscle, liver metastases, pulmonary metastases, and retroperitoneal lymphadenopathy. Multiple core needle biopsy specimens were obtained from the left kidney, diagnostic of RMC. Histopathology showed widespread areas of necrosis with only a few areas of viable tumor. The viable tumor cells formed gland-like structures and had infiltrating sheets with rhabdoid features, eosinophilic cytoplasm, and prominent nucleoli. Immunohistochemical analysis demonstrated strong positivity for EMA, P53 (>95%), and PAX8. CD117 was mostly negative, however there were focal areas of weak cytoplasmic reactivity. ALK-1 immunostain, INI-1, p63, and hepar-1 were all negative. Fluorescence in situ hybridization showed no evidence of t(9;22) BCR;ABL rearrangement but did show extra copies of the BCR gene in 73% of cells. Neoadjuvant chemotherapy with 3 cycles of carboplatin, gemcitabine, and paclitaxel and one cycle of carboplatin, gemcitabine and bortezomib resulted in an improvement on imaging in the primary tumor and metastatic sites. A left radical nephrectomy and lymph node dissection were then performed. Pathology showed 10–20% focally viable renal medullary carcinoma within the kidney with evidence of vascular invasion and positive margins. The sampled lymph nodes were free of tumor. Several weeks later he underwent thoracoscopic resection of left pleural and pulmonary nodules, both of which were positive for metastatic disease. Over the next 11 months, he received 5 cycles of chemotherapy consisting of alternating cycles of carboplatin, gemcitabine, paclitaxel and carboplatin, gemcitabine and bortezomib, followed by 5 additional cycles of methotrexate, vinblastine, doxorubicin and cisplatin. Palliative radiation therapy delivered to the psoas muscle for pain management was beneficial. After a brief initial response to therapy, interval imaging studies demonstrated stable disease followed by subsequent florid progression. Given disease progression, his therapy was changed to the tyrosine kinase and vascular endothelial growth factor receptor antagonist, axitinib. Sixteen months from the time diagnosis, he is ambulatory but with widespread metastatic disease. This case highlights the need for a heightened index of suspicion for RMC in all patients with sickle hemoglobinopathies, not just those with SCT. The lack of sensitivity of renal ultrasound in this case and two others suggests that CT may be required for early diagnosis of RMC (Blitman AJR 2005 and Wesche Pediatr Pathol Lab Med 1998). While hydroxyurea is an effective medication with an excellent safety margin in sickle cell disease, the carcinogenic risk of long-term exposure in sick cell disease remains unknown. Disclosures: Off Label Use: Hydroxyurea for sickle cell disease modulation.

The impact of lung and bone metastases on prognosis in advanced PDAC.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 494-494
Author(s):  
Grainne M. O'Kane ◽  
Adriana Fraser ◽  
Stephanie Moignard ◽  
Anna Dodd ◽  
Sean Creighton ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Metastatic Disease ◽  
Cox Regression ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Ductal Adenocarcinoma ◽  
Peritoneal Disease ◽  
Cox Regression Analysis ◽  
Cytotoxic Treatment ◽  
The Impact

494 Background: Pancreatic ductal adenocarcinoma (PDAC) remains a highly fatal disease inherently resistant to cytotoxic treatment. Despite the prevalence of liver and peritoneal metastases, subsets of patients also develop lung and bone metastases highlighting phenotypic heterogeneity. We reviewed the prognostic implications of metastatic sites on survival. Methods: This retrospective cohort study included all patients with PDAC who received surgical or oncological treatment at the University Health Network from September 2012 until December 2016. Clinical and pathological variables were obtained from patient electronic records. Radiological images and pathology reports were reviewed to ascertain sites of metastatic disease. The Kaplan-Meier method for survival and multivariable cox regression analysis identified prognostic factors. Results: 1153 patients were reviewed and 985 were included. 55% were male and the median age at diagnosis was 67 years. 287 (29%) completed curative surgery and 698 (71%) had locally advanced or metastatic disease; the median survival was 22 months and 9 months respectively. Lung and bone metastases were present in 18% (N = 180) and 6% (N = 58) of patients. In multivariable analysis increasing age and stage at diagnosis correlated with inferior survival (p < 0.0001) and the presence of any lung (HR 0.77; 95% CI 0.63-0.94, p = 0.01) or bone metastases (HR 0.74; 95% CI 0.54-1.0, p = 0.05) resulted in improved outcomes. Liver and peritoneal disease were not prognostic. Sex and family history of PDAC did not associate with survival. There was no association between site of metastases and sex however patients with bone metastases were significantly younger at first diagnosis (median age 63yrs, p < 0.01). Conclusions: Patients with advanced PDAC and metastases to lung or bone may represent distinct biological subtypes of PDAC. Molecular profiling of available tissue is ongoing.

scholarly journals Growth differentiation factor-15 as candidate predictor for mortality in adults with pulmonary hypertension

Heart ◽  
2019 ◽  
Vol 106 (6) ◽  
pp. 467-473 ◽  
Author(s):  
Laurie W Geenen ◽  
Vivan J M Baggen ◽  
Robert M Kauling ◽  
Thomas Koudstaal ◽  
Karin A Boomars ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Primary Endpoint ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Cox Regression Analysis ◽  
Growth Differentiation Factor 15 ◽  
Risk Of Death ◽  
Differentiation Factor ◽  
Right Heart Catheterisation ◽  
Increased Risk

ObjectiveDespite its predictive value for mortality in various diseases, the relevance of growth differentiation factor-15 (GDF-15) as prognostic biomarker in pulmonary hypertension (PH) remains unclear. This study investigated the association between GDF-15 and outcomes in adults with PH.MethodsThis is a single-centre prospective observational cohort study. All adults with PH were included at the day of their diagnostic right heart catheterisation between 2012 and 2016. PH due to left heart disease was excluded. Venous blood sampling was performed and included GDF-15 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements. Kaplan-Meier curves and Cox regression analysis were used to investigate the association between GDF-15 and a composite endpoint of death or lung transplantation. We adjusted for age and NT-proBNP in multivariable analysis. Reference values were established by GDF-15 measurements in healthy controls.ResultsGDF-15 was measured in 103 patients (median age 59.2 years, 65% women, 51% pulmonary arterial hypertension). GDF-15 was elevated in 76 patients (74%). After a median follow-up of 3.4 (IQR 2.3–4.6) years, 32 patients (31.1%) reached the primary endpoint. Event-free survival 2 years after diagnosis was 100% in patients with normal GDF-15 versus 72.4% in patients with elevated GDF-15 (p=0.007). A significant association was found between GDF-15 and the primary endpoint (HR per twofold higher value 1.77, 95% CI 1.39 to 2.27, p<0.001), also after adjustment for age and NT-proBNP (HR 1.41, 95% CI 1.02 to 1.94, p=0.038).ConclusionsHigh GDF-15 levels are associated with an increased risk of death or transplant in adults with PH, independent of age and NT-proBNP. As non-specific biomarker, GDF-15 could particularly be useful to detect low-risk patients.

scholarly journals Prognostic factors for venous thromboembolism in patients with solid tumours on systemic therapy: A systematic review

TH Open ◽  
2021 ◽  
Author(s):  
Sandra Lee ◽  
Anika Shenoy ◽  
Daniel Shi ◽  
Mootaz Husien ◽  
Pablo E. Serrano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Venous Thromboembolism ◽  
Prognostic Factor ◽  
Systemic Therapy ◽  
Performance Status ◽  
Multivariable Analysis ◽  
Risk Of Bias ◽  
Platinum Based Chemotherapy ◽  
Increased Risk

Background: Patients undergoing systemic cancer therapy are susceptible to developing venous thromboembolism (VTE). The most pertinent prognostic factors for VTE remain unclear. This systematic review aims to summarize prognostic factors associated with VTE in this population. Methods: MEDLINE, Embase, and CENTRAL databases were searched for observational or randomized studies that used multivariable analysis adjusted for tumour type and/or metastatic disease to model the risk of VTE. Adjusted effect estimates for each prognostic factor were collected for all of the included studies. Risk of bias was assessed using the Quality in Prognostic Factor Studies (QUIPS) tool. Results: From 5,988 search results, 15 eligible studies and 42 prognostic factors were identified. A total of 8,554 patients of whom 456 (5.33%) developed VTE were included. Fourteen studies had a high risk of bias and one study had a moderate risk. The most commonly reported prognostic factors include age, gender, tumour site, metastasis, performance status, and systemic therapy type. Poor performance status and the use of platinum-based chemotherapy compounds were associated with an increased risk of VTE across the majority of studies. The evidence to suggest that the other prognostic factors identified were associated with VTE development was inconclusive. Several individual studies identified novel biomarkers for VTE. Heterogeneity in statistical methods and prognostic factor definitions across studies precluded meta-analysis. Conclusion: Overall, many prognostic factors were identified; however, the evidence for association with development of VTE for most of the factors is inconclusive. Findings were limited by high heterogeneity and risk of bias in the included studies.

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