Black Destin, Iasonos Alexia, Ahmed Hina, Chi Dennis S, Barakat Richard R, Abu-Rustum Nadeem R
Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
Gynecol Oncol. 2007 Oct;107(1):66-70. doi: 10.1016/j.ygyno.2007.05.040. Epub 2007 Jul 5.
Venous thromboembolism (VTE) affects 15% of cancer patients and is the second leading cause of death in hospitalized cancer patients. The purpose of this study was to describe the overall survival of patients with ovarian, primary peritoneal, and fallopian tube cancers treated for VTE within 30 days of initial surgery.
We reviewed the medical records of all patients who developed VTE within 30 days of primary surgery for stage I-IV epithelial ovarian, tubal, or primary peritoneal cancer at our institution from 1/99 to 4/05. Standard statistical tests were used.
Fifty-seven (10%) of 559 patients developed VTE within 30 days of initial surgery. There were no deaths from VTE within 30 days of surgery. With a median follow-up of 2.8 years (range, 0.11-7.3 years), the median overall survival for the entire cohort was 5.9 years (95% CI, 4.6-NR). The proportion of advanced-stage (III-IV) patients within the VTE group compared to the group with no VTE was higher (90% versus 72%; P=0.0078), as was the proportion of patients with ascites compared to those with none (74% versus 54%; P=0.0045), and the proportion of patients with residual disease >1 cm compared to those with <or=1 cm (37% versus 19%; P=0.0021). On multivariate analysis, advanced stage (P<0.0001), the presence of ascites (P=0.0210), and residual disease>1 cm (P<0.0001) were significant predictors of poorer overall survival. VTE within 30 days of surgery was not found to be independently associated with overall survival (hazard ratio, 1.1; 95% CI, 0.71-1.7); P=0.65).
Previous studies have shown that a significant number of patients undergoing primary surgery for ovarian cancer will develop postoperative VTE, especially those undergoing extensive cytoreductive procedures. In this large cohort of patients with ovarian, tubal, or primary peritoneal cancer, we found no detrimental effects of perioperative VTE on overall survival.
静脉血栓栓塞症（VTE）影响15%的癌症患者，是住院癌症患者的第二大死因。本研究的目的是描述在初次手术后30天内接受VTE治疗的卵巢癌、原发性腹膜癌和输卵管癌患者的总生存期。
我们回顾了1999年1月至2005年4月在我院接受I-IV期上皮性卵巢癌、输卵管癌或原发性腹膜癌初次手术的所有患者的病历，这些患者在初次手术后30天内发生了VTE。使用标准统计检验。
559例患者中有57例（10%）在初次手术后30天内发生VTE。手术后30天内无VTE死亡病例。中位随访2.8年（范围0.11 - 7.3年），整个队列的中位总生存期为5.9年（95%CI，4.6 - NR）。VTE组中晚期（III-IV期）患者的比例高于无VTE组（90%对72%；P = 0.0078），有腹水患者的比例高于无腹水患者（74%对54%；P = 0.0045），残留病灶>1 cm患者的比例高于≤1 cm患者（37%对19%；P = 0.0021）。多因素分析显示，晚期（P < 0.0001）、存在腹水（P = 0.0210）和残留病灶>1 cm（P < 0.0001）是总生存期较差的显著预测因素。未发现手术后30天内的VTE与总生存期独立相关（风险比，1.1；95%CI，0.71 - 1.7；P = 0.65）。
既往研究表明，大量接受卵巢癌初次手术的患者会发生术后VTE，尤其是那些接受广泛细胞减灭术的患者。在这个大型的卵巢癌、输卵管癌或原发性腹膜癌患者队列中，我们发现围手术期VTE对总生存期没有不利影响。
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