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

Abstract

Venous thromboembolism (VTE) is a life-threatening 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 2-4 adult-type diffuse gliomas. Forty-six (17.8%) experienced VTE. Tumor expression of tissue factor (TF) and podoplanin each positively correlated with VTE, though only circulating TF and D-dimers, not circulating podoplanin, correlated with VTE risk. Gliomas with mutations in IDH1 or IDH2 (IDHmut) caused fewer VTEs; multivariable analysis suggested that this is due to IDHmut suppression of TF, not podoplanin. In a predictive time-to-event model based on LASSO, the following predicted increased VTE risk in newly diagnosed glioma patients: (1) prior history of VTE; (2) hypertension; (3) asthma; (4) white blood cell count; (5) WHO tumor grade; (6) patient age; (7) body mass index. Conversely, IDHmut, hypothyroidism, and MGMT promoter methylation predicted reduced VTE risk. These ten variables were used to create a web-based VTE prediction tool which was validated in two separate cohorts of adult-type diffuse glioma patients 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 glioma patients.

An MRI Radiomics Approach to Predict the Hypercoagulable Status of Gliomas

“…We constructed our radiomics model under these premises. While other genes in addition to F3 may be associated with the risk of VTE, their contribution remains unclear [4,6]. Importantly, we observed that Radscore high tumors tend to express high levels of a large array of genes related to coagulation, strongly suggesting that the Radscore reflects broader characteristics of the tumor coagulome than just the F3 expression that was used to build it.…”

“…More studies are required to link tumor radiomics with the occurrence of VTE and its complications. We propose that the optimal personalized prediction of the risk of VTE in LGG/GBM will require prospective integrative studies combining tumor radiomics with an extended set of clinical and biological parameters [6].…”

“…The most recent biological and clinical risk scores, such as the Khorana score, represent a significant advancement towards personalized VTE risk assessment in cancer patients, but their performance remains uncertain in the context of GBM [5]. The identification of new biomarkers that could predict the risk of VTE is a challenge for the optimization of medical care in LGG/GBM patients [6].…”

Palliative Care and Care Partner Support in Neuro-oncology

“…Patients and care partners should be encouraged to immediately reach out should they notice any unilateral limb swelling, pain, erythema, warmth, or any acute shortness of breath, chest pain, or hemoptysis. A 2023 study discusses the development of a tool to predict thromboembolism in patients with glioma, which may be helpful and can be integrated into practice 75 …”

“…A 2023 study discusses the development of a tool to predict thromboembolism in patients with glioma, which may be helpful and can be integrated into practice. 75 Caregiving needs are obviously high when patients have weakness that limits their mobility or ability to provide self-care. Evaluation for and arrangement of appropriate medical equipment (eg, wheelchairs, shower rails, walkers, braces, air mattresses) may be necessary to ensure patient safety at home and to alleviate care-partner burden.…”