Abstract Number: LPB0125
Meeting: ISTH 2021 Congress
Background: Intravascular tumour extension is a rare but important complication of pediatric solid tumours. There is limited information regarding characteristics and outcomes of pediatric patients with tumour thrombus.
Aims: To look at incidence, risk factors, management, and outcomes of pediatric oncology patients with tumour thrombus.
Methods: A retrospective analysis was conducted on patients aged <18 years diagnosed with solid tumours from 2000 – 2020 at McMaster Children’s Hospital. Data collection included: demographics (age, gender, cancer details, staging, pathology report, treatment, outcomes), and tumour thrombus details (imaging, anticoagulation use, resolution, recurrence, complications of anticoagulation, thromboembolic phenomena).
Results: Of 347 patients identified with solid tumours, 53 were excluded due to lack of data. 294 were included: Neuroblastoma (67), Wilms tumour (WT) (40), renal cell carcinoma (2), Hepatoblastoma (15), germ cell tumour (GCT) (24), Ewing sarcoma (26), osteosarcoma (32), rhabdomyosarcoma (32), rhabdoid tumour (4), desmoplastic small round cell tumour (3), and other (49). Median age was 5.68 years. Tumour thrombus was identified in 10 patients (10/294; 3.4%), with WT having the highest incidence (12.5%). Vascular involvement included inferior vena cava (IVC) (n=8), pulmonary vein branches (n=1), sigmoid sinus (n=1), isolated renal vein (n=1), combined renal vein and IVC (n=4). One patient had >1 site involved. All patients with tumour thrombus were high risk or had metastatic disease except in WT (Table 1). Anticoagulation was initiated prior to surgical resection in four cases (40%) and post-operatively in three cases (30%). Progression of thrombus was identified in one patient. IVC thrombus recurrence was noted post-operatively in 3 patients with WT.
| Disease | Risk Factors | Patients with Tumour Thrombus | Patients without Tumour thrombus |
| Neuroblastoma |
Age (median in years) | 2.47 | 2.07 |
| Male gender | 0/2 (0%) | 36/65 (55.4%) | |
| High Risk Group | 2/2 (100%) | 30/65 (46.2%) | |
| Outcome Deceased On-therapy Remission Relapsed/Progression |
1/2 (50%) 1/2 (50%) 0/2 (0%) 1/2 (50%) |
14/65 (21.5%) 5/65 (7.7%) 46/65 (70.1%) 11/65 (16.9%) |
|
| Wilms |
Age (median) | 4.13 | 3.09 |
| Male Gender | 3/5 (60%) | 23/35 (65.7%) | |
| Metastatic disease | 1/5 (20%) | 5/35 (14.3%) | |
| Outcome Deceased Remission Relapsed/Progression |
0/5 (0%) 5/5 (100%) 1/5 (20%) |
3/35 (8.6%) 32/35 (91.4%) 5/35 (14.3%) |
|
| Hepatoblastoma | Age (median) | 1.05 | 2.78 |
| Male gender | 1/1 (100%) | 10/14 (71.4%) | |
| High Risk Group | 1/1 (100%) | 10/14 (71.4% | |
| Outcome Deceased Remission Relapsed/Progression |
1/1 (100%) 0/1 (0%) 1/1 (100%) |
4/14 (28.6%) 9/14 (64.2%) 3/14 (21.4%) |
|
| GCT | Age (median) | 9.2 | 13.4 |
| Male Gender | 1/2 (50%) | 10/22 (45.4%) | |
| High Risk Group | 2/2 (100%) | 5/22 (22.7%) | |
| Outcome Deceased Remission Relapsed/Progression |
0/2 (0%) 2/2 (100%) 0/2 (0%) |
0/22 (0%) 22/22 (100%) 0/22 (0%) |
Characteristics of patients with and without solid tumour thrombus.
Conclusions: This is the first study to document incidence of tumour thrombus in a large group of pediatric solid tumour patients. In our cohort, tumour thrombus was identified in neuroblastoma, WT, hepatoblastoma, and GTC patients. Risk factors, optimal management, and effect on overall patient outcome require further clarification.
To cite this abstract in AMA style:
Samji N, Fajardo AF, Chan AK, D Bhatt M. Characteristics of Pediatric Oncology Patients with Tumour Thrombus [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/characteristics-of-pediatric-oncology-patients-with-tumour-thrombus/. Accessed November 28, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/characteristics-of-pediatric-oncology-patients-with-tumour-thrombus/