Determining venous thromboembolism risk in patients with adult-type diffuse glioma.

Autor:	Burdett KB; Department of Preventive Medicine, Northwestern University, Chicago, IL., Unruh D; Bio-Techne, Minneapolis, MN., Drumm M; Department of Neurological Surgery, Northwestern University, Chicago, IL.; Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL., Steffens A; Department of Neurological Surgery, Northwestern University, Chicago, IL.; Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL., Lamano J; Department of Neurosurgery, Stanford University, Stanford, CA., Judkins J; Department of Medicine, Oregon Health and Science University, Portland, OR., Schwartz M; Department of Neurological Surgery, Northwestern University, Chicago, IL.; Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL., Javier R; University of Chicago Pritzker School of Medicine, Chicago, IL., Amidei C; Department of Neurological Surgery, Northwestern University, Chicago, IL.; Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL., Lipp ES; The Preston Robert Tisch Brain Tumor Center, Department of Neurosurgery, Duke University Medical Center, Durham, NC., Peters KB; The Preston Robert Tisch Brain Tumor Center, Department of Neurosurgery, Duke University Medical Center, Durham, NC., Lai A; Department of Neurology, University of California, Los Angeles, CA., Eldred BSC; Department of Neurology, University of California, Los Angeles, CA., Heimberger AB; Department of Neurological Surgery, Northwestern University, Chicago, IL.; Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL., McCortney K; Department of Neurological Surgery, Northwestern University, Chicago, IL.; Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL., Scholtens DM; Department of Preventive Medicine, Northwestern University, Chicago, IL., Horbinski C; Department of Neurological Surgery, Northwestern University, Chicago, IL.; Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL.; Department of Pathology, Northwestern University, Chicago, IL.
Jazyk:	angličtina
Zdroj:	Blood [Blood] 2023 Mar 16; Vol. 141 (11), pp. 1322-1336.
DOI:	10.1182/blood.2022017858
Abstrakt:	Venous thromboembolism (VTE) is a life-threating condition that is common in patients with adult-type diffuse gliomas, yet thromboprophylaxis is controversial because of possible intracerebral hemorrhage. Effective VTE prediction models exist for other cancers, but not glioma. Our objective was to develop a VTE prediction tool to improve glioma patient care, incorporating clinical, blood-based, histologic, and molecular markers. We analyzed preoperative arterial blood, tumor tissue, and clinical-pathologic data (including next-generation sequencing data) from 258 patients with newly diagnosed World Health Organization (WHO) grade 2 to 4 adult-type diffuse gliomas. Forty-six (17.8%) experienced VTE. Tumor expression of tissue factor (TF) and podoplanin (PDPN) each positively correlated with VTE, although only circulating TF and D-dimers, not circulating PDPN, correlated with VTE risk. Gliomas with mutations in isocitrate dehydrogenase 1 (IDH1) or IDH2 (IDHmut) caused fewer VTEs; multivariable analysis suggested that this is due to IDHmut suppression of TF, not PDPN. In a predictive time-to-event model, the following predicted increased VTE risk in newly diagnosed patients with glioma: (1) history of VTE; (2) hypertension; (3) asthma; (4) white blood cell count; (5) WHO tumor grade; (6) patient age; and (7) body mass index. Conversely, IDHmut, hypothyroidism, and MGMT promoter methylation predicted reduced VTE risk. These 10 variables were used to create a web-based VTE prediction tool that was validated in 2 separate cohorts of patients with adult-type diffuse glioma from other institutions. This study extends our understanding of the VTE landscape in these tumors and provides evidence-based guidance for clinicians to mitigate VTE risk in patients with glioma. (© 2023 by The American Society of Hematology.)
Databáze:	MEDLINE
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