Thromboembolism in children with sarcoma.
BACKGROUND
Thromboembolism (TE) is a common complication and cause of death in adults with cancer. Cancer has been identified as a major risk factor in children with TE. However, the information regarding the epidemiology of TE in children with cancer, especially in association with childhood solid tumors, is scant.


OBJECTIVE
To define the prevalence and epidemiology of TE in children with sarcoma.


METHODS
Hospital records of children </=18 years of age with sarcoma diagnosed and treated at McMaster Children's Hospital during January 1990 to December 2005 were reviewed for demographic details, details of diagnosis and therapy for sarcoma, and details of diagnosis and management of TE. Statistical analysis was performed using Fisher's exact t-test.


RESULTS
Ten of 70 (14.3%; 95% CI; 7.1, 24.7) patients with sarcoma developed symptomatic TE. Patients with CVL-dysfunction (n = 9) were at significantly higher risk for symptomatic TE compared to those without CVL dysfunction (n = 61) (55.5 vs. 8.2%; P = 0.002, 95% CI; 14.2, 80.5). Patients with pulmonary disease (n = 23) had higher prevalence of TE compared to those without pulmonary disease (n = 47) (26 vs.8.5%; P = 0.07, 95% CI; -2.06, 37.2). Older patients, patients with metastatic disease and those with Ewing sarcoma had higher prevalence of TE.


CONCLUSIONS
TE is a significant complication in children with sarcoma. Over 50% of patients with CVL dysfunction had symptomatic TE; such patients may warrant careful evaluation for associated TE. Large prospective studies are needed to define the epidemiology and identify risk factors predisposing to TE in children with sarcoma.
Athale
Uma
U
Department of Pediatrics, Division of Hematology, McMaster University, Hamilton, Ontario, Canada. athaleu@mcmaster.ca
Cox
Stephanie
S
Siciliano
Sabrina
S
Chan
Anthony K C
AK
D000293:Adolescent; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D020878:Device Removal; D019468:Disease Management; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000401:mortality; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012509:Sarcoma / Q000097:blood / Q000150:complications* / Q000401:mortality; D012512:Sarcoma, Ewing / Q000097:blood / Q000150:complications; D016019:Survival Analysis; D017131:Thrombectomy; D013923:Thromboembolism / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D019851:Thrombophilia / Q000209:etiology; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000601:surgery
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight