INNV-42. VENOUS THROMBOEMBOLISM RISK ASSESSMENT IN PATIENTS WITH GLIOMA. (11th November 2019)

• Record Type: Journal Article
• Authors: Unruh, Dusten; Lamano, Jonathan; Haider, Qazi; Judkins, Jonathon; Schwartz, Margaret; Li, Yuping; McCortney, Kathleen; Amidei, Christina; Scholtens, Denise; Horbinski, Craig
• Is Part Of: Neuro-oncology. Volume 21(2019)Supplement 6
• Page Start: vi138
• Page End: vi138
• Publication Date: 2019-11-11
• Subjects: Brain Neoplasms -- Periodicals; Brain -- Tumors -- Periodicals; Brain -- Cancer -- Periodicals; Nervous system -- Cancer -- Periodicals; 616.99481
• DOI: 10.1093/neuonc/noz175.581
• Languages: English
• ISSNs: 1522-8517

Abstract

Abstract: BACKGROUND: Venous thromboembolism (VTE) is a debilitating and life-threating condition that is common in patients with cancer, especially glioma. Antithrombotic prophylaxis is controversial in glioma patients because of possible intracerebral hemorrhage. Effective VTE prediction models exist for patients with other cancers, but not glioma. Our prior publications suggested a protective role of IDH1 mutations (IDHmut) against VTE, as well as a positive association between elevated circulating Tissue Factor (TF), a procoagulant secreted by cancers, and VTE in glioma patients. Others have recently found a correlation between podoplanin, a platelet activator, and tumor-associated VTE, but this has not been proven in gliomas. Our objective is to develop a multidimensional VTE prediction tool to improve glioma patient care, incorporating clinical, blood-based, histologic, and molecular markers. METHODS: The Northwestern University Nervous System Tumor Bank provided preoperative arterial blood, tumor tissue, and clinical-pathologic data from 265 grade II-IV glioma patients over a 3-year interval. Molecular profiling was done by GlioSeq NGS. RESULTS: Seventy-seven out of 265 grade II-IV glioma patients (29%) experienced VTE during their disease course. VTE was itself a negative prognostic marker for median overall survival (18 vs. 54 months, P< 0.001). Positive risk factors for VTE included advanced patient age, high body mass index, high tumor grade, prior history of VTE, coronary artery disease, hyperlipidemia, hypertension, and elevated circulating TF activity. While tumor expression of podoplanin positively correlated with VTE, circulating podoplanin did not. Among molecular markers, only IDHmut correlated with VTE risk, and it was associated with greatly reduced risk (OR=0.28; 95% CI=0.12–0.64, P=0.001). CONCLUSIONS: This study identified multiple risk factors for glioma-associated VTE. Using these data, we are developing a multivariable prediction calculator that will improve patient care by identifying patients who would benefit most from prophylactic anticoagulation.