妇科癌症患者深静脉血栓形成的临床病程。

The clinical course of deep vein thrombosis in patients with gynecologic cancer.

作者信息

Morgan Mark A, Iyengar Tara D, Napiorkowski Beata E, Rubin Stephen C, Mikuta John J

机构信息

Division of Gynecologic Oncology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA.

出版信息

Gynecol Oncol. 2002 Jan;84(1):67-71. doi: 10.1006/gyno.2001.6452.

DOI:10.1006/gyno.2001.6452

PMID:11748979

Abstract

OBJECTIVE

The aim of this study was to evaluate the survival of gynecologic cancer patients diagnosed with deep vein thrombosis.

METHODS

We retrospectively reviewed the charts of patients admitted to our institution with gynecologic malignancy who were diagnosed with deep vein thrombosis (DVT) between 1984 and 1995. Data were collected regarding site, stage, histology, treatment, and proximity of DVT to treatment with surgery, chemotherapy, and radiotherapy. This study was limited to cases of ovarian, uterine, and cervical cancer. Descriptive statistics were generated and the survival of patients from the time of DVT was calculated using the Kaplan and Meier method. Cases were then matched by site, stage, histology, and age to controls without DVT to evaluate the effect of DVT on survival. A Cox regression model was used to assess the effect of multiple variables on survival.

RESULTS

A total of 74 cases were identified. Ovarian, uterine, and cervical cancer accounted for 45, 27, and 28% of cases, respectively. Approximately 64% of patients had stage III or greater disease. The median survival of all patients from the time of DVT diagnosis was 7.8 months, with only about 20% of patients surviving at 5 years. Patients with cervical cancer or patients who had radiation therapy within 3 months of DVT diagnosis had significantly lessened survival (P < 0.01) than other patients with DVT. The survival of patients from the time of cancer diagnosis with venous thrombosis was significantly worse than a matched control group without DVT (P < 0.001). On multivariate analysis, there was a twofold greater risk of dying in those patients with gynecologic cancer and DVT.

CONCLUSION

The development of DVT in conjunction with a gynecologic malignancy connotes a poor prognosis, especially in patients with cervical cancer. It is possible that this poor prognosis is related to the pathophysiology that results in venous thrombosis and not just the presence of cancer.

摘要

目的

本研究旨在评估被诊断为深静脉血栓形成的妇科癌症患者的生存率。

方法

我们回顾性分析了1984年至1995年间入住我院且被诊断为深静脉血栓形成（DVT）的妇科恶性肿瘤患者的病历。收集了有关DVT的部位、分期、组织学类型、治疗情况以及与手术、化疗和放疗治疗时间的接近程度等数据。本研究仅限于卵巢癌、子宫癌和宫颈癌病例。进行了描述性统计，并使用Kaplan-Meier方法计算了患者自DVT诊断后的生存率。然后根据部位、分期、组织学类型和年龄将病例与无DVT的对照组进行匹配，以评估DVT对生存率的影响。使用Cox回归模型评估多个变量对生存率的影响。

结果

共识别出74例病例。卵巢癌、子宫癌和宫颈癌分别占病例的45%、27%和28%。约64%的患者疾病分期为III期或更高。所有患者自DVT诊断后的中位生存期为7.8个月，仅有约20%的患者在5年后存活。宫颈癌患者或在DVT诊断后3个月内接受放疗的患者的生存率明显低于其他DVT患者（P<0.01）。癌症诊断时伴有静脉血栓形成的患者的生存率明显低于无DVT的匹配对照组（P<0.001）。多因素分析显示，患有妇科癌症和DVT的患者死亡风险增加两倍。