Abstract / Summary
Background/Objectives: Cancer-associated thrombosis (CAT) increases morbidity and mortality in cancer patients. To describe CAT in urological malignancies and explore associated factors, timing, Khorana score performance and systemic inflammatory indices. Methods: This retrospective study included 1044 patients. Oncological, cardiovascular and laboratory data from medical records were compared by CAT status. Firth penalized logistic regression was used for sparse-event analyses. Results: Thirty-one patients (2.97%) developed CAT, including 17 arterial thrombotic events (ATE) and 14 venous thromboembolic events (VTE). Advanced stage was associated with CAT (adjusted odds ratio [aOR] per stage 1.60, 95% confidence interval [CI] 1.21–2.17; p < 0.001) in the primary and sensitivity analyses. In an exploratory analysis, cardiovascular disease was associated with ATE (odds ratio [OR] 4.58, 95% CI 1.67–15.16; Benjamini–Hochberg [BH]-adjusted q = 0.031), although the small number of ATE precluded a reliable subgroup conclusion. Median time from cancer diagnosis to CAT was 3 months. The Khorana score did not show useful VTE discrimination in the systemic chemotherapy subgroup (77 patients; four VTE; area under the receiver operating characteristic curve [AUC] 0.437, 95% CI 0.127–0.746). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII) showed no useful discrimination (AUCs 0.487–0.513) or improvement of the clinical model (all BH-adjusted q = 0.963). Conclusions: Advanced stage was the most consistent correlate of CAT. Arterial and venous events occurred in similar proportions and were concentrated early after diagnosis. Exploratory analyses suggested a possible relationship between cardiovascular disease and ATE, whereas the Khorana findings were inconclusive and the inflammatory indices lacked discriminatory value. Larger prospective studies are needed to confirm these findings.