Predictors of thrombosis in testicular cancer during platinum-based chemotherapy

  • Pia Paffenholz
  • Katharina Grein
  • Isabel Heidegger
  • Tim Nestler
  • Markus Grabbert
  • Johannes Salem
  • Martin Hellmich
  • David Pfister
  • Axel HeidenreichEmail author
Original Article



To identify potential risk factors for the development of venous thromboembolic events in testicular cancer patients receiving platinum-based chemotherapy.


We performed a retrospective analysis including 255 patients with testicular germ cell tumors who received platinum-based chemotherapy from 2003 to 2018 as a multi-center observational cohort study. Patient and tumor characteristics of patients with and without a thromboembolic event were analyzed.


49 (19%) patients experienced a venous thromboembolic event, with the majority representing pulmonary embolism and deep venous thrombosis (47%). There were no significant differences regarding the development of a venous thromboembolic event between first- and second-line regimes. Multivariate analysis showed an increased risk for a venous thromboembolic event in patients with clinical stage ≥ IIC disease (OR 2.259 [95% CI 1.105–4.618], p = 0.026), elevated serum LDH (OR 2.162 [95% CI 1.018–4.593], p = 0.045), febrile neutropenia (OR 2.973 [95% CI 1.363–6.487], p = 0.006) and central venous access (OR 3.465 [95% CI 1.068–11.243], p = 0.039). Patients suffering from a venous thromboembolic event revealed a significantly reduced overall survival (p = 0.033) during a median follow-up of 8 months [IQR 2–18].


19% of all patients treated by platinum-based chemotherapy due to testicular cancer suffered from a venous thromboembolic event, associated with reduced overall survival. As a result, monitoring of cancer patients at risk as well as the improvement of patients’ awareness of a thromboembolic event should thus be the main goal of their treating physicians.


Thrombosis Germ cell tumor Cisplatin Chemotherapy 





Bleomycin, etoposide, cisplatin


Germ cell tumors


Human chorionic gonadotropin


International germ cell cancer collaborative group


Interquartile range


Lactate dehydrogenase


Cisplatin, etopside, ifosfamide


Post-chemotherapy retroperitoneal lymph node dissection


Cisplatin, ifosfamide, paclitaxel


Authors contribution

MG: manuscript editing. KG: data collection or management, data analysis. IH: manuscript editing. AH: project development, manuscript editing, supervision. MH: data analysis, manuscript editing. TN: manuscript editing. PP: project development, data collection or management, data analysis, manuscript writing/editing. DP: project development, manuscript editing, supervision. JS: manuscript editing.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Supplementary material

345_2018_2598_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 12 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic SurgeryUniversity Hospital CologneCologneGermany
  2. 2.Department of UrologyMedical University InnsbruckInnsbruckAustria
  3. 3.Institute of Medical Statistics and Computational BiologyUniversity of CologneCologneGermany

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