title: Large retroperitoneal lymphadenopathy as a predictor of venous thromboembolism in patients with disseminated germ cell tumors treated with chemotherapy.
abstract: OBJECTIVE
  Cisplatin-based chemotherapy, a mainstay of treatment for disseminated germ cell tumors (GCTs), is associated with venous thromboembolism (VTE). Many patients with disseminated GCTs have large retroperitoneal lymph node (RPLN) metastases that may cause venous stasis and increase the risk of VTE development. We hypothesized that there was an association between large RPLN and chemotherapy-associated VTE risk.
  
  
  METHODS
  The training cohort was composed of patients with disseminated GCT receiving first-line chemotherapy at Princess Margaret Cancer Centre between January 2000 and December 2010. Large RPLN was defined as more than 5 cm in maximal axial diameter. The predictive and discriminatory accuracies of a model using large RPLN in predicting VTE were compared with high-risk Khorana score (≥ 3) using logistic regression and area under receiver operator characteristic curves (AUROCs). The model was externally validated in a cohort of patients treated at the London Health Sciences Centre.
  
  
  RESULTS
  The training cohort comprised 216 patients, 21 (10%) of whom developed VTE during chemotherapy. VTE was associated with large RPLN (odds ratio [OR], 5.26; P = .001), high-risk Khorana score (OR, 11.8; P < .001), intermediate-/poor-risk disease (OR, 3.76; P = .005), and hospitalization during chemotherapy (OR, 4.24; P = .002). Large RPLN showed higher discriminatory accuracy than high-risk Khorana score (AUROC, 0.71 v 0.67, respectively). Superior discriminatory accuracy of large RPLN over high-risk Khorana score was validated in the London cohort (AUROC, 0.61 v 0.57, respectively).
  
  
  CONCLUSIONS
  Large RPLN is associated with VTE in patients with disseminated GCT and provides higher discriminatory accuracy than high-risk Khorana score. Results should be validated in larger, prospective studies. Prophylactic anticoagulation may be considered in high-risk patients.
authors.affiliation: Amirrtha Srikanthan, Ben Tran, Michael A.S. Jewett, Robert J. Hamilton, Lynn Anson-Cartwright, Peter W.M. Chung, Padraig R. Warde, Martin O'Malley, Malcolm J. Moore, Eitan Amir, and Philippe L. Bedard, Princess Margaret Cancer Centre, University of Toronto, Toronto; Michel Beausoleil and Eric Winquist, Western University and London Health Sciences Centre, London, Ontario; Jeremy F.G. Sturgeon, McGill University, Montreal, Quebec, Canada; and Ben Tran, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Amirrtha
authors.initials: A
authors.lastname: Srikanthan
authors.affiliation: Amirrtha Srikanthan, Ben Tran, Michael A.S. Jewett, Robert J. Hamilton, Lynn Anson-Cartwright, Peter W.M. Chung, Padraig R. Warde, Martin O'Malley, Malcolm J. Moore, Eitan Amir, and Philippe L. Bedard, Princess Margaret Cancer Centre, University of Toronto, Toronto; Michel Beausoleil and Eric Winquist, Western University and London Health Sciences Centre, London, Ontario; Jeremy F.G. Sturgeon, McGill University, Montreal, Quebec, Canada; and Ben Tran, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Tran
authors.affiliation: Amirrtha Srikanthan, Ben Tran, Michael A.S. Jewett, Robert J. Hamilton, Lynn Anson-Cartwright, Peter W.M. Chung, Padraig R. Warde, Martin O'Malley, Malcolm J. Moore, Eitan Amir, and Philippe L. Bedard, Princess Margaret Cancer Centre, University of Toronto, Toronto; Michel Beausoleil and Eric Winquist, Western University and London Health Sciences Centre, London, Ontario; Jeremy F.G. Sturgeon, McGill University, Montreal, Quebec, Canada; and Ben Tran, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Michel
authors.initials: M
authors.lastname: Beausoleil
authors.affiliation: Amirrtha Srikanthan, Ben Tran, Michael A.S. Jewett, Robert J. Hamilton, Lynn Anson-Cartwright, Peter W.M. Chung, Padraig R. Warde, Martin O'Malley, Malcolm J. Moore, Eitan Amir, and Philippe L. Bedard, Princess Margaret Cancer Centre, University of Toronto, Toronto; Michel Beausoleil and Eric Winquist, Western University and London Health Sciences Centre, London, Ontario; Jeremy F.G. Sturgeon, McGill University, Montreal, Quebec, Canada; and Ben Tran, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Michael A S
authors.initials: MA
authors.lastname: Jewett
authors.affiliation: Amirrtha Srikanthan, Ben Tran, Michael A.S. Jewett, Robert J. Hamilton, Lynn Anson-Cartwright, Peter W.M. Chung, Padraig R. Warde, Martin O'Malley, Malcolm J. Moore, Eitan Amir, and Philippe L. Bedard, Princess Margaret Cancer Centre, University of Toronto, Toronto; Michel Beausoleil and Eric Winquist, Western University and London Health Sciences Centre, London, Ontario; Jeremy F.G. Sturgeon, McGill University, Montreal, Quebec, Canada; and Ben Tran, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hamilton
authors.affiliation: Amirrtha Srikanthan, Ben Tran, Michael A.S. Jewett, Robert J. Hamilton, Lynn Anson-Cartwright, Peter W.M. Chung, Padraig R. Warde, Martin O'Malley, Malcolm J. Moore, Eitan Amir, and Philippe L. Bedard, Princess Margaret Cancer Centre, University of Toronto, Toronto; Michel Beausoleil and Eric Winquist, Western University and London Health Sciences Centre, London, Ontario; Jeremy F.G. Sturgeon, McGill University, Montreal, Quebec, Canada; and Ben Tran, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Jeremy F G
authors.initials: JF
authors.lastname: Sturgeon
authors.affiliation: Amirrtha Srikanthan, Ben Tran, Michael A.S. Jewett, Robert J. Hamilton, Lynn Anson-Cartwright, Peter W.M. Chung, Padraig R. Warde, Martin O'Malley, Malcolm J. Moore, Eitan Amir, and Philippe L. Bedard, Princess Margaret Cancer Centre, University of Toronto, Toronto; Michel Beausoleil and Eric Winquist, Western University and London Health Sciences Centre, London, Ontario; Jeremy F.G. Sturgeon, McGill University, Montreal, Quebec, Canada; and Ben Tran, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Martin
authors.initials: M
authors.lastname: O'Malley
authors.affiliation: Amirrtha Srikanthan, Ben Tran, Michael A.S. Jewett, Robert J. Hamilton, Lynn Anson-Cartwright, Peter W.M. Chung, Padraig R. Warde, Martin O'Malley, Malcolm J. Moore, Eitan Amir, and Philippe L. Bedard, Princess Margaret Cancer Centre, University of Toronto, Toronto; Michel Beausoleil and Eric Winquist, Western University and London Health Sciences Centre, London, Ontario; Jeremy F.G. Sturgeon, McGill University, Montreal, Quebec, Canada; and Ben Tran, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Lynn
authors.initials: L
authors.lastname: Anson-Cartwright
authors.affiliation: Amirrtha Srikanthan, Ben Tran, Michael A.S. Jewett, Robert J. Hamilton, Lynn Anson-Cartwright, Peter W.M. Chung, Padraig R. Warde, Martin O'Malley, Malcolm J. Moore, Eitan Amir, and Philippe L. Bedard, Princess Margaret Cancer Centre, University of Toronto, Toronto; Michel Beausoleil and Eric Winquist, Western University and London Health Sciences Centre, London, Ontario; Jeremy F.G. Sturgeon, McGill University, Montreal, Quebec, Canada; and Ben Tran, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Peter W M
authors.initials: PW
authors.lastname: Chung
authors.affiliation: Amirrtha Srikanthan, Ben Tran, Michael A.S. Jewett, Robert J. Hamilton, Lynn Anson-Cartwright, Peter W.M. Chung, Padraig R. Warde, Martin O'Malley, Malcolm J. Moore, Eitan Amir, and Philippe L. Bedard, Princess Margaret Cancer Centre, University of Toronto, Toronto; Michel Beausoleil and Eric Winquist, Western University and London Health Sciences Centre, London, Ontario; Jeremy F.G. Sturgeon, McGill University, Montreal, Quebec, Canada; and Ben Tran, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Padraig R
authors.initials: PR
authors.lastname: Warde
authors.affiliation: Amirrtha Srikanthan, Ben Tran, Michael A.S. Jewett, Robert J. Hamilton, Lynn Anson-Cartwright, Peter W.M. Chung, Padraig R. Warde, Martin O'Malley, Malcolm J. Moore, Eitan Amir, and Philippe L. Bedard, Princess Margaret Cancer Centre, University of Toronto, Toronto; Michel Beausoleil and Eric Winquist, Western University and London Health Sciences Centre, London, Ontario; Jeremy F.G. Sturgeon, McGill University, Montreal, Quebec, Canada; and Ben Tran, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Eric
authors.initials: E
authors.lastname: Winquist
authors.affiliation: Amirrtha Srikanthan, Ben Tran, Michael A.S. Jewett, Robert J. Hamilton, Lynn Anson-Cartwright, Peter W.M. Chung, Padraig R. Warde, Martin O'Malley, Malcolm J. Moore, Eitan Amir, and Philippe L. Bedard, Princess Margaret Cancer Centre, University of Toronto, Toronto; Michel Beausoleil and Eric Winquist, Western University and London Health Sciences Centre, London, Ontario; Jeremy F.G. Sturgeon, McGill University, Montreal, Quebec, Canada; and Ben Tran, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Moore
authors.affiliation: Amirrtha Srikanthan, Ben Tran, Michael A.S. Jewett, Robert J. Hamilton, Lynn Anson-Cartwright, Peter W.M. Chung, Padraig R. Warde, Martin O'Malley, Malcolm J. Moore, Eitan Amir, and Philippe L. Bedard, Princess Margaret Cancer Centre, University of Toronto, Toronto; Michel Beausoleil and Eric Winquist, Western University and London Health Sciences Centre, London, Ontario; Jeremy F.G. Sturgeon, McGill University, Montreal, Quebec, Canada; and Ben Tran, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Eitan
authors.initials: E
authors.lastname: Amir
authors.affiliation: Amirrtha Srikanthan, Ben Tran, Michael A.S. Jewett, Robert J. Hamilton, Lynn Anson-Cartwright, Peter W.M. Chung, Padraig R. Warde, Martin O'Malley, Malcolm J. Moore, Eitan Amir, and Philippe L. Bedard, Princess Margaret Cancer Centre, University of Toronto, Toronto; Michel Beausoleil and Eric Winquist, Western University and London Health Sciences Centre, London, Ontario; Jeremy F.G. Sturgeon, McGill University, Montreal, Quebec, Canada; and Ben Tran, Royal Melbourne Hospital, Melbourne, Victoria, Australia. Philippe.Bedard@uhn.ca.
authors.forename: Philippe L
authors.initials: PL
authors.lastname: Bedard
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D006801:Humans; D008206:Lymphatic Diseases / Q000097:blood* / Q000473:pathology*; D008954:Models, Biological; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000188:drug therapy* / Q000473:pathology*; D054556:Venous Thromboembolism / Q000097:blood* / Q000139:chemically induced / Q000473:pathology*
chemical_list: D002945:Cisplatin