Venous thromboembolism in metastatic urothelial carcinoma or variant histologies: incidence, associative factors, and effect on survival.

Jorge D. Ramos, Martin F. Casey, Simon J. Crabb, Aristotelis Bamias, Lauren C. Harshman, Yu Ning Wong, Joaquim Bellmunt, Ugo De Giorgi, Sylvain Ladoire, Thomas Powles, Sumanta K. Pal, Guenter Niegisch, Federica Recine, Ajjai Alva, Neeraj Agarwal, Andrea Necchi, Ulka N. Vaishampayan, Jonathan E. Rosenberg, Matthew D. Galsky, Evan Y. Yu

Research output: Contribution to journalArticle

Abstract

Venous thromboembolism (VTE) is common in cancer patients. However, little is known about VTE risk in metastatic urothelial carcinoma or variant histologies (UC/VH). We sought to characterize the incidence, associative factors, including whether various chemotherapy regimens portend different risk, and impact of VTE on survival in metastatic UC/VH patients. Patients diagnosed with metastatic UC/VH from 2000 to 2013 were included in this multicenter retrospective, international study from 29 academic institutions. Cumulative and 6-month VTE incidence rates were determined. The association of first-line chemotherapy (divided into six groups) and other baseline characteristics on VTE were analyzed. Each chemotherapy treatment group and statistically significant baseline clinical characteristics were assessed in a multivariate, competing-risk regression model. VTE patients were matched to non-VTE patients to determine the impact of VTE on overall survival. In all, 1762 patients were eligible for analysis. There were 144 (8.2 and 90 (5.1 events cumulative and within the first 6 months, respectively. VTE rates based on chemotherapy group demonstrated no statistical difference when gemcitabine/cisplatin was used as the comparator. Non-urotheilal histology (SHR: 2.67; 95% CI: 1.72-4.16, P textless 0.001), moderate to severe renal dysfunction (SHR: 2.12; 95% CI: 1.26-3.59, P = 0.005), and cardiovascular disease (CVD) or CVD risk factors (SHR: 2.27; 95% CI: 1.49-3.45, P = 0.001) were associated with increased VTE rates. Overall survival was worse in patients with VTE (median 6.0 m vs. 10.2 m, P textless 0.001). Thus, in metastatic UC/VH patients, VTE is common and has a negative impact on survival. We identified multiple associated potential risk factors, although different chemotherapy regimens did not alter risk.
Original languageUndefined/Unknown
Pages (from-to)186-194
Number of pages9
JournalCancer Medicine
Volume6
Issue number1
DOIs
Publication statusPublished - Jan 1 2017

Keywords

  • Bladder cancer, chemotherapy survival, Urothelial, venous thromboembolism

Cite this

Ramos, J. D., Casey, M. F., Crabb, S. J., Bamias, A., Harshman, L. C., Wong, Y. N., ... Yu, E. Y. (2017). Venous thromboembolism in metastatic urothelial carcinoma or variant histologies: incidence, associative factors, and effect on survival. Cancer Medicine, 6(1), 186-194. https://doi.org/10.1002/cam4.986

Venous thromboembolism in metastatic urothelial carcinoma or variant histologies: incidence, associative factors, and effect on survival. / Ramos, Jorge D.; Casey, Martin F.; Crabb, Simon J.; Bamias, Aristotelis; Harshman, Lauren C.; Wong, Yu Ning; Bellmunt, Joaquim; De Giorgi, Ugo; Ladoire, Sylvain; Powles, Thomas; Pal, Sumanta K.; Niegisch, Guenter; Recine, Federica; Alva, Ajjai; Agarwal, Neeraj; Necchi, Andrea; Vaishampayan, Ulka N.; Rosenberg, Jonathan E.; Galsky, Matthew D.; Yu, Evan Y.

In: Cancer Medicine, Vol. 6, No. 1, 01.01.2017, p. 186-194.

Research output: Contribution to journalArticle

Ramos, JD, Casey, MF, Crabb, SJ, Bamias, A, Harshman, LC, Wong, YN, Bellmunt, J, De Giorgi, U, Ladoire, S, Powles, T, Pal, SK, Niegisch, G, Recine, F, Alva, A, Agarwal, N, Necchi, A, Vaishampayan, UN, Rosenberg, JE, Galsky, MD & Yu, EY 2017, 'Venous thromboembolism in metastatic urothelial carcinoma or variant histologies: incidence, associative factors, and effect on survival.', Cancer Medicine, vol. 6, no. 1, pp. 186-194. https://doi.org/10.1002/cam4.986
Ramos, Jorge D. ; Casey, Martin F. ; Crabb, Simon J. ; Bamias, Aristotelis ; Harshman, Lauren C. ; Wong, Yu Ning ; Bellmunt, Joaquim ; De Giorgi, Ugo ; Ladoire, Sylvain ; Powles, Thomas ; Pal, Sumanta K. ; Niegisch, Guenter ; Recine, Federica ; Alva, Ajjai ; Agarwal, Neeraj ; Necchi, Andrea ; Vaishampayan, Ulka N. ; Rosenberg, Jonathan E. ; Galsky, Matthew D. ; Yu, Evan Y. / Venous thromboembolism in metastatic urothelial carcinoma or variant histologies: incidence, associative factors, and effect on survival. In: Cancer Medicine. 2017 ; Vol. 6, No. 1. pp. 186-194.
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AU - Ramos, Jorge D.

AU - Casey, Martin F.

AU - Crabb, Simon J.

AU - Bamias, Aristotelis

AU - Harshman, Lauren C.

AU - Wong, Yu Ning

AU - Bellmunt, Joaquim

AU - De Giorgi, Ugo

AU - Ladoire, Sylvain

AU - Powles, Thomas

AU - Pal, Sumanta K.

AU - Niegisch, Guenter

AU - Recine, Federica

AU - Alva, Ajjai

AU - Agarwal, Neeraj

AU - Necchi, Andrea

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AU - Galsky, Matthew D.

AU - Yu, Evan Y.

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N2 - Venous thromboembolism (VTE) is common in cancer patients. However, little is known about VTE risk in metastatic urothelial carcinoma or variant histologies (UC/VH). We sought to characterize the incidence, associative factors, including whether various chemotherapy regimens portend different risk, and impact of VTE on survival in metastatic UC/VH patients. Patients diagnosed with metastatic UC/VH from 2000 to 2013 were included in this multicenter retrospective, international study from 29 academic institutions. Cumulative and 6-month VTE incidence rates were determined. The association of first-line chemotherapy (divided into six groups) and other baseline characteristics on VTE were analyzed. Each chemotherapy treatment group and statistically significant baseline clinical characteristics were assessed in a multivariate, competing-risk regression model. VTE patients were matched to non-VTE patients to determine the impact of VTE on overall survival. In all, 1762 patients were eligible for analysis. There were 144 (8.2 and 90 (5.1 events cumulative and within the first 6 months, respectively. VTE rates based on chemotherapy group demonstrated no statistical difference when gemcitabine/cisplatin was used as the comparator. Non-urotheilal histology (SHR: 2.67; 95% CI: 1.72-4.16, P textless 0.001), moderate to severe renal dysfunction (SHR: 2.12; 95% CI: 1.26-3.59, P = 0.005), and cardiovascular disease (CVD) or CVD risk factors (SHR: 2.27; 95% CI: 1.49-3.45, P = 0.001) were associated with increased VTE rates. Overall survival was worse in patients with VTE (median 6.0 m vs. 10.2 m, P textless 0.001). Thus, in metastatic UC/VH patients, VTE is common and has a negative impact on survival. We identified multiple associated potential risk factors, although different chemotherapy regimens did not alter risk.

AB - Venous thromboembolism (VTE) is common in cancer patients. However, little is known about VTE risk in metastatic urothelial carcinoma or variant histologies (UC/VH). We sought to characterize the incidence, associative factors, including whether various chemotherapy regimens portend different risk, and impact of VTE on survival in metastatic UC/VH patients. Patients diagnosed with metastatic UC/VH from 2000 to 2013 were included in this multicenter retrospective, international study from 29 academic institutions. Cumulative and 6-month VTE incidence rates were determined. The association of first-line chemotherapy (divided into six groups) and other baseline characteristics on VTE were analyzed. Each chemotherapy treatment group and statistically significant baseline clinical characteristics were assessed in a multivariate, competing-risk regression model. VTE patients were matched to non-VTE patients to determine the impact of VTE on overall survival. In all, 1762 patients were eligible for analysis. There were 144 (8.2 and 90 (5.1 events cumulative and within the first 6 months, respectively. VTE rates based on chemotherapy group demonstrated no statistical difference when gemcitabine/cisplatin was used as the comparator. Non-urotheilal histology (SHR: 2.67; 95% CI: 1.72-4.16, P textless 0.001), moderate to severe renal dysfunction (SHR: 2.12; 95% CI: 1.26-3.59, P = 0.005), and cardiovascular disease (CVD) or CVD risk factors (SHR: 2.27; 95% CI: 1.49-3.45, P = 0.001) were associated with increased VTE rates. Overall survival was worse in patients with VTE (median 6.0 m vs. 10.2 m, P textless 0.001). Thus, in metastatic UC/VH patients, VTE is common and has a negative impact on survival. We identified multiple associated potential risk factors, although different chemotherapy regimens did not alter risk.

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