Incidence and Effect of Thromboembolic Events in Radical Cystectomy Patients Undergoing Preoperative Chemotherapy for Muscle-invasive Bladder Cancer

Aditya Bagrodia, Ranjit Sukhu, Andrew G. Winer, Eric Levy, Michael Vacchio, Byron Lee, Eugene J. Pietzak, Timothy F. Donahue, Eugene Cha, Gopa Iyer, Daniel D. Sjoberg, Andrew J. Vickers, Jonathan E. Rosenberg, Dean F. Bajorin, Guido Dalbagni, Bernard H. Bochner

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Abstract

Background: We evaluated the incidence and effect of thromboembolic events (TEEs) in patients with muscle-invasive bladder cancer treated with preoperative chemotherapy (POC) and radical cystectomy (RC) with pelvic lymph node dissection (PLND). Patients and Methods: We performed a retrospective review of all patients who had undergone POC followed by RC plus PLND for muscle-invasive bladder cancer from June 2000 to January 2013 (n = 357). The chemotherapy type (neoadjuvant vs. induction), incidence and timing of TEE diagnosis (preoperatively vs. ≤ 90 days postoperatively), and effect of TEEs on clinical outcomes were recorded. Results: Overall, 79 patients (22%; 95% confidence interval [CI], 18%-27%) experienced a TEE: 57 (16%) occurred during POC and 22 (6.2%) were diagnosed postoperatively. Forty patients (11%; 95% CI, 8.1%-15%) required an inferior vena cava filter. We found no significant differences in neoadjuvant versus induction chemotherapy and the risk of TEEs (difference, 3.3%; 95% CI, -5% to 12%; P = .5). No significant difference were found in the rates of POC completion according to the presence of a TEE (difference, 1.0%; 95% CI, -11% to 13%; P = .9). The occurrence of TEE did not significantly affect other perioperative outcomes. The risk of recurrence and overall survival were not associated with TEE on multivariable analysis. Conclusion: We found a high incidence of TEEs (22%) in patients undergoing POC before RC plus PLND, with a 16% incidence in the preoperative period. TEEs in the POC setting leads to invasive procedures; however, we did not find a significant effect on POC completion or postoperative complication risk. Further research is required to determine whether preventative TEE measures during POC can improve clinical outcomes.

Original languageEnglish (US)
JournalClinical Genitourinary Cancer
DOIs
StateAccepted/In press - Jan 1 2017

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Cystectomy
Urinary Bladder Neoplasms
Drug Therapy
Muscles
Incidence
Lymph Node Excision
Confidence Intervals
Vena Cava Filters
Preoperative Period
Induction Chemotherapy
Recurrence
Survival

Keywords

  • Anticoagulation
  • Cisplatin
  • Deep venous thrombosis
  • Thromboembolism
  • Venous thromboembolism

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Incidence and Effect of Thromboembolic Events in Radical Cystectomy Patients Undergoing Preoperative Chemotherapy for Muscle-invasive Bladder Cancer. / Bagrodia, Aditya; Sukhu, Ranjit; Winer, Andrew G.; Levy, Eric; Vacchio, Michael; Lee, Byron; Pietzak, Eugene J.; Donahue, Timothy F.; Cha, Eugene; Iyer, Gopa; Sjoberg, Daniel D.; Vickers, Andrew J.; Rosenberg, Jonathan E.; Bajorin, Dean F.; Dalbagni, Guido; Bochner, Bernard H.

In: Clinical Genitourinary Cancer, 01.01.2017.

Research output: Contribution to journalArticle

Bagrodia, A, Sukhu, R, Winer, AG, Levy, E, Vacchio, M, Lee, B, Pietzak, EJ, Donahue, TF, Cha, E, Iyer, G, Sjoberg, DD, Vickers, AJ, Rosenberg, JE, Bajorin, DF, Dalbagni, G & Bochner, BH 2017, 'Incidence and Effect of Thromboembolic Events in Radical Cystectomy Patients Undergoing Preoperative Chemotherapy for Muscle-invasive Bladder Cancer', Clinical Genitourinary Cancer. https://doi.org/10.1016/j.clgc.2017.07.022
Bagrodia, Aditya ; Sukhu, Ranjit ; Winer, Andrew G. ; Levy, Eric ; Vacchio, Michael ; Lee, Byron ; Pietzak, Eugene J. ; Donahue, Timothy F. ; Cha, Eugene ; Iyer, Gopa ; Sjoberg, Daniel D. ; Vickers, Andrew J. ; Rosenberg, Jonathan E. ; Bajorin, Dean F. ; Dalbagni, Guido ; Bochner, Bernard H. / Incidence and Effect of Thromboembolic Events in Radical Cystectomy Patients Undergoing Preoperative Chemotherapy for Muscle-invasive Bladder Cancer. In: Clinical Genitourinary Cancer. 2017.
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abstract = "Background: We evaluated the incidence and effect of thromboembolic events (TEEs) in patients with muscle-invasive bladder cancer treated with preoperative chemotherapy (POC) and radical cystectomy (RC) with pelvic lymph node dissection (PLND). Patients and Methods: We performed a retrospective review of all patients who had undergone POC followed by RC plus PLND for muscle-invasive bladder cancer from June 2000 to January 2013 (n = 357). The chemotherapy type (neoadjuvant vs. induction), incidence and timing of TEE diagnosis (preoperatively vs. ≤ 90 days postoperatively), and effect of TEEs on clinical outcomes were recorded. Results: Overall, 79 patients (22{\%}; 95{\%} confidence interval [CI], 18{\%}-27{\%}) experienced a TEE: 57 (16{\%}) occurred during POC and 22 (6.2{\%}) were diagnosed postoperatively. Forty patients (11{\%}; 95{\%} CI, 8.1{\%}-15{\%}) required an inferior vena cava filter. We found no significant differences in neoadjuvant versus induction chemotherapy and the risk of TEEs (difference, 3.3{\%}; 95{\%} CI, -5{\%} to 12{\%}; P = .5). No significant difference were found in the rates of POC completion according to the presence of a TEE (difference, 1.0{\%}; 95{\%} CI, -11{\%} to 13{\%}; P = .9). The occurrence of TEE did not significantly affect other perioperative outcomes. The risk of recurrence and overall survival were not associated with TEE on multivariable analysis. Conclusion: We found a high incidence of TEEs (22{\%}) in patients undergoing POC before RC plus PLND, with a 16{\%} incidence in the preoperative period. TEEs in the POC setting leads to invasive procedures; however, we did not find a significant effect on POC completion or postoperative complication risk. Further research is required to determine whether preventative TEE measures during POC can improve clinical outcomes.",
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author = "Aditya Bagrodia and Ranjit Sukhu and Winer, {Andrew G.} and Eric Levy and Michael Vacchio and Byron Lee and Pietzak, {Eugene J.} and Donahue, {Timothy F.} and Eugene Cha and Gopa Iyer and Sjoberg, {Daniel D.} and Vickers, {Andrew J.} and Rosenberg, {Jonathan E.} and Bajorin, {Dean F.} and Guido Dalbagni and Bochner, {Bernard H.}",
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T1 - Incidence and Effect of Thromboembolic Events in Radical Cystectomy Patients Undergoing Preoperative Chemotherapy for Muscle-invasive Bladder Cancer

AU - Bagrodia, Aditya

AU - Sukhu, Ranjit

AU - Winer, Andrew G.

AU - Levy, Eric

AU - Vacchio, Michael

AU - Lee, Byron

AU - Pietzak, Eugene J.

AU - Donahue, Timothy F.

AU - Cha, Eugene

AU - Iyer, Gopa

AU - Sjoberg, Daniel D.

AU - Vickers, Andrew J.

AU - Rosenberg, Jonathan E.

AU - Bajorin, Dean F.

AU - Dalbagni, Guido

AU - Bochner, Bernard H.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: We evaluated the incidence and effect of thromboembolic events (TEEs) in patients with muscle-invasive bladder cancer treated with preoperative chemotherapy (POC) and radical cystectomy (RC) with pelvic lymph node dissection (PLND). Patients and Methods: We performed a retrospective review of all patients who had undergone POC followed by RC plus PLND for muscle-invasive bladder cancer from June 2000 to January 2013 (n = 357). The chemotherapy type (neoadjuvant vs. induction), incidence and timing of TEE diagnosis (preoperatively vs. ≤ 90 days postoperatively), and effect of TEEs on clinical outcomes were recorded. Results: Overall, 79 patients (22%; 95% confidence interval [CI], 18%-27%) experienced a TEE: 57 (16%) occurred during POC and 22 (6.2%) were diagnosed postoperatively. Forty patients (11%; 95% CI, 8.1%-15%) required an inferior vena cava filter. We found no significant differences in neoadjuvant versus induction chemotherapy and the risk of TEEs (difference, 3.3%; 95% CI, -5% to 12%; P = .5). No significant difference were found in the rates of POC completion according to the presence of a TEE (difference, 1.0%; 95% CI, -11% to 13%; P = .9). The occurrence of TEE did not significantly affect other perioperative outcomes. The risk of recurrence and overall survival were not associated with TEE on multivariable analysis. Conclusion: We found a high incidence of TEEs (22%) in patients undergoing POC before RC plus PLND, with a 16% incidence in the preoperative period. TEEs in the POC setting leads to invasive procedures; however, we did not find a significant effect on POC completion or postoperative complication risk. Further research is required to determine whether preventative TEE measures during POC can improve clinical outcomes.

AB - Background: We evaluated the incidence and effect of thromboembolic events (TEEs) in patients with muscle-invasive bladder cancer treated with preoperative chemotherapy (POC) and radical cystectomy (RC) with pelvic lymph node dissection (PLND). Patients and Methods: We performed a retrospective review of all patients who had undergone POC followed by RC plus PLND for muscle-invasive bladder cancer from June 2000 to January 2013 (n = 357). The chemotherapy type (neoadjuvant vs. induction), incidence and timing of TEE diagnosis (preoperatively vs. ≤ 90 days postoperatively), and effect of TEEs on clinical outcomes were recorded. Results: Overall, 79 patients (22%; 95% confidence interval [CI], 18%-27%) experienced a TEE: 57 (16%) occurred during POC and 22 (6.2%) were diagnosed postoperatively. Forty patients (11%; 95% CI, 8.1%-15%) required an inferior vena cava filter. We found no significant differences in neoadjuvant versus induction chemotherapy and the risk of TEEs (difference, 3.3%; 95% CI, -5% to 12%; P = .5). No significant difference were found in the rates of POC completion according to the presence of a TEE (difference, 1.0%; 95% CI, -11% to 13%; P = .9). The occurrence of TEE did not significantly affect other perioperative outcomes. The risk of recurrence and overall survival were not associated with TEE on multivariable analysis. Conclusion: We found a high incidence of TEEs (22%) in patients undergoing POC before RC plus PLND, with a 16% incidence in the preoperative period. TEEs in the POC setting leads to invasive procedures; however, we did not find a significant effect on POC completion or postoperative complication risk. Further research is required to determine whether preventative TEE measures during POC can improve clinical outcomes.

KW - Anticoagulation

KW - Cisplatin

KW - Deep venous thrombosis

KW - Thromboembolism

KW - Venous thromboembolism

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