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The increased risk for thromboembolism pre-cystectomy in patients undergoing neoadjuvant chemotherapy for muscle-invasive urinary bladder cancer is mainly due to central venous access: a multicenter evaluation
Umea Univ, Sweden.
Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Urologiska kliniken i Östergötland.
Umea Univ, Sweden; Sundsvall Hosp, Sweden.
Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Urologiska kliniken i Östergötland.
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2019 (engelsk)Inngår i: International Urology and Nephrology, ISSN 0301-1623, E-ISSN 1573-2584Artikkel i tidsskrift (Fagfellevurdert) Epub ahead of print
Abstract [en]

Purpose To investigate if patients receiving neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) had an increased risk of thromboembolic events (TEE) and to evaluate when these events occur on a timeline starting from 6 months pre-cystectomy, during NAC-administration and 60 months post-cystectomy. Methods Two hundred and fifty five patients undergoing radical cystectomy during 2009-2014 at three Swedish cystectomy centers (Umea, Linkoping and Sundsvall) were in-detail reviewed retrospectively, using individual medical records. One hundred and twenty nine patients were ineligible for analysis. NAC patients (n = 67) were compared to NAC-naive NAC-eligible patients (n = 59). The occurrence of TEE was divided into different periods pre-cystectomy and post-cystectomy. Statistical analyses included Chi-squared and logistical regression tests. Results Significant associations were found between receiving NAC and acquiring a TEE during NAC therapy pre-cystectomy. All but one pre-cystectomy event was venous and all but one of the patients received NAC. 31% (14/45) of TEEs occurred pre-cystectomy. The incidence of TEEs pre-cystectomy in NAC-naive NAC-eligible patients was only 10% (2/20), whereas the incidence of TEEs in NAC patients occurred pre-cystectomy in 48% (12/25) and 11/12 incidents were detected during NAC therapy-this including 7/11 (64%) incidents affecting veins in anatomical conjunction with the placement of central venous access for chemotherapy administration. Conclusions There is a significantly increased risk for TEE pre-cystectomy during chemotherapy administration in MIBC patients receiving NAC, compared to the risk in NAC-naive NAC-eligible MIBC patients. In 64% of the pre-RC TEEs in NAC patients, there was a clinical connection to placement of central venous access.

sted, utgiver, år, opplag, sider
SPRINGER , 2019.
Emneord [en]
Complications; Cystectomy; Neoadjuvant therapy; Thromboembolism; Urinary bladder neoplasms
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Identifikatorer
URN: urn:nbn:se:liu:diva-162510DOI: 10.1007/s11255-019-02338-4ISI: 000497189400001PubMedID: 31745708OAI: oai:DiVA.org:liu-162510DiVA, id: diva2:1378759
Merknad

Funding Agencies|Umea University; Swedish Research Council funding for clinical research in medicine (ALF) in Vasterbotten, VLL, Sweden [Bas-ALF/VLL RV-848051]; Cancer Research Foundation in Norrland, Umea, Sweden [CFF LP 13-2000]

Tilgjengelig fra: 2019-12-13 Laget: 2019-12-13 Sist oppdatert: 2020-03-10

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