Subirà M, Mateo J, Souto J C, Altés A, Fontcuberta J
Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Am J Hematol. 1999 Mar;60(3):181-4. doi: 10.1002/(sici)1096-8652(199903)60:3<181::aid-ajh2>3.0.co;2-4.
Since the publication of Trousseau in 1865, several studies have documented an increased incidence of cancer in patients with deep venous thrombosis (DVT) especially those with idiopathic or recurrent DVT, but in young patients this association is not clear and is therefore a subject of controversy. We performed a retrospective study in a consecutive cohort of 40 young patients (age <40 years) with a DVT and without a known cancer. All patients were diagnosed in our hospital during the period of 1988-1992. At the time of diagnosis, a routine examination to detect the presence of malignant disease was made. For the follow-up, all patients included in the study were asked to return to our unit and were interviewed for symptoms that could suggest a malignant disease. The mean follow-up was five years (from three to eight years). Twenty-four patients had DVT in the lower limbs and three in the upper extremities, nine had pulmonary embolism (six of them with DVT) and four had DVT in other sites. Sixteen patients (40%) had secondary DVT due to nonbiological causes, abnormalities in hemostasis were found in 14 patients (35%), and biological or environmental triggering factors were not identified in 10 patients (25%). Malignancies were not detected at diagnosis and in the follow-up. In our experience, venous-thrombotic patients under the age of 40 have a low incidence of subsequent cancer. Further studies should be performed to confirm this observation and to ascertain whether extensive screening for cancer is a cost-effective approach.
自1865年特鲁索（Trousseau）的研究成果发表以来，多项研究记录了深静脉血栓形成（DVT）患者，尤其是特发性或复发性DVT患者癌症发病率的增加，但在年轻患者中，这种关联尚不清楚，因此存在争议。我们对40例年龄小于40岁、患有DVT且无已知癌症的连续队列患者进行了一项回顾性研究。所有患者均于1988年至1992年期间在我院确诊。确诊时，进行了常规检查以检测恶性疾病的存在。在随访中，研究纳入的所有患者均被要求返回我们科室，并就可能提示恶性疾病的症状接受访谈。平均随访时间为五年（从三年到八年）。24例患者下肢有DVT，3例上肢有DVT，9例有肺栓塞（其中6例伴有DVT），4例在其他部位有DVT。16例患者（40%）因非生物学原因出现继发性DVT，14例患者（35%）发现止血异常，10例患者（25%）未发现生物学或环境触发因素。在诊断和随访中均未检测到恶性肿瘤。根据我们的经验，40岁以下的静脉血栓形成患者后续患癌的发生率较低。应进行进一步研究以证实这一观察结果，并确定广泛的癌症筛查是否是一种具有成本效益的方法。
