Predictors of thrombosis in testicular cancer during platinum-based chemotherapy



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.

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Fig. 1





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


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Author information




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.

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Correspondence to Axel Heidenreich.

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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.

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Paffenholz, P., Grein, K., Heidegger, I. et al. Predictors of thrombosis in testicular cancer during platinum-based chemotherapy. World J Urol 37, 1907–1916 (2019).

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  • Thrombosis
  • Germ cell tumor
  • Cisplatin
  • Chemotherapy