Cancer-Associated Thrombosis in Genitourinary Malignancies: A Real-World Analysis From the TESEO Registry

Cancer-associated thrombosis (CAT) is a frequent and clinically relevant complication in patients with genitourinary (GU) malignancies, but real-world data focused on this population are limited. We describe the clinical characteristics, management, and outcomes of venous thromboembolism (VTE) in patients with GU cancers.

We performed a retrospective analysis of patients with GU malignancies included in the registry of Thrombosis and nEoplasia of SEOM (TESEO). Adult patients with histologically confirmed GU cancer and radiologically proven VTE were included.

Data on a total of 337 patients were analyzed; most of the patients (75.4%) had advanced disease. Pulmonary embolism was the most frequent presentation (56.2%), and 51.2% of events were incidentally diagnosed. Median time from cancer diagnosis to VTE was 9 months, with shorter intervals observed in germ cell tumors. Low-molecular-weight heparin was the most commonly used anticoagulant (88.2%). Bleeding complications occurred in 11.3% of patients, mainly during the first month of treatment, with GU bleeding being the most frequent. Recurrent VTE was observed in 4.1% of patients. Median overall survival was 59 months and did not differ according to thrombotic characteristics. However, among patients with bladder cancer, bleeding events were associated with worse overall survival (adjusted hazard ratio 2.82; 95% confidence interval, 1.13-7.04; p = 0.019 by log-rank test).

In this real-world cohort, CAT in GU malignancies predominantly occurred in advanced disease and was frequently diagnosed incidentally. Overall survival was mainly influenced by tumor-related factors, although bleeding events negatively affected outcomes in patients with bladder cancer, underscoring the need for individualized anticoagulation strategies.