Satoh T, Oki A, Uno K, Sakurai M, Ochi H, Okada S, Minami R, Matsumoto K, Tanaka Y O, Tsunoda H, Homma S, Yoshikawa H
Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
Br J Cancer. 2007 Oct 22;97(8):1053-7. doi: 10.1038/sj.bjc.6603989. Epub 2007 Sep 25.
Venous thromboembolism (VTE) such as deep-vein thrombosis (DVT) and pulmonary thromboembolism (PTE) often occurs after surgery and rarely occurs even before surgery in patients with ovarian cancer. It is well known that levels of plasma D-dimer (DD) before treatment in most ovarian cancer patients are increased. This study therefore examined whether increased levels of DD are associated with presence of VTE before treatment of ovarian cancer. Between November 2004 and March 2007, DD levels prior to initial treatment were measured in 72 consecutive patients with presumed epithelial ovarian cancer (final diagnosis: epithelial ovarian cancer, n=60; and epithelial ovarian borderline malignancy, n=12). Venous ultrasound imaging (VUI) of the lower extremity was conducted for all patients except for two patients in whom DVT was detected by pelvic computed tomography (CT). When DVT was found, pulmonary scintigraphy was subsequently performed to ascertain presence of PTE. D-dimer levels were above the cut-off value (0.5 microg ml(-1)) in 65 of 72 patients (90.2%). Venous ultrasound imaging or CT revealed DVT in 18 of 72 patients (25.0%) and pulmonary scintigraphy found PTE in 8 patients (11.1%). All patients with VTE were asymptomatic when VTE was found. D-dimer levels were associated with incidence of VTE (0-1.4 microg ml(-1); 0 of 26 (0%), 1.5-7.4 microg ml(-1); 9 of 30 (30%) and > or =7.5 microg ml(-1); 9 of 16 (56.3%), P for trend=0.0003). However, even if 1.5 microg ml(-1) was used as a cut-off value, this had low specificity and positive predictive value (47.2, 38.3%), though it had high sensitivity and negative predictive value (100, 100%). Therefore, ovarian cancer patients with DD level > or =1.5 microg ml(-1) should be examined using VUI to detect silent DVT. Patients with VTE underwent preventive managements including anticoagulant therapy before initial treatment, chemotherapy or surgery, and after surgery. There was no clinical onset of postoperative VTE in all 72 patients. Measurement of DD levels and subsequent ultrasonography revealed that silent or subclinical VTE frequently occurs before surgery in ovarian cancer. The usefulness of preoperative assessment of VTE needs further confirmation in randomised controlled trials.
静脉血栓栓塞症（VTE），如深静脉血栓形成（DVT）和肺血栓栓塞症（PTE），在卵巢癌患者中常发生于手术后，术前则很少发生。众所周知，大多数卵巢癌患者治疗前血浆D - 二聚体（DD）水平会升高。因此，本研究探讨了DD水平升高是否与卵巢癌治疗前VTE的存在有关。在2004年11月至2007年3月期间，对72例连续的疑似上皮性卵巢癌患者（最终诊断：上皮性卵巢癌，n = 60；上皮性卵巢交界性恶性肿瘤，n = 12）进行了初始治疗前的DD水平测量。除2例通过盆腔计算机断层扫描（CT）检测到DVT的患者外，对所有患者进行了下肢静脉超声成像（VUI）检查。发现DVT后，随后进行肺闪烁扫描以确定是否存在PTE。72例患者中有65例（90.2%）的D - 二聚体水平高于临界值（0.5μg ml⁻¹）。静脉超声成像或CT显示72例患者中有18例（25.0%）存在DVT，肺闪烁扫描发现8例患者（11.1%）存在PTE。所有VTE患者在发现VTE时均无症状。D - 二聚体水平与VTE发生率相关（0 - 1.4μg ml⁻¹；26例中的0例（0%），1.5 - 7.4μg ml⁻¹；30例中的9例（30%），≥7.5μg ml⁻¹；16例中的9例（56.3%），趋势P值 = 0.0003）。然而，即使将1.5μg ml⁻¹用作临界值，其特异性和阳性预测值也较低（分别为47.2%、38.3%），尽管其敏感性和阴性预测值较高（均为100%）。因此，DD水平≥1.5μg ml⁻¹的卵巢癌患者应使用VUI检查以检测无症状DVT。VTE患者在初始治疗、化疗或手术前以及手术后接受了包括抗凝治疗在内的预防性管理。72例患者术后均未发生临床VTE。DD水平测量及随后的超声检查显示，卵巢癌患者术前常发生无症状或亚临床VTE。VTE术前评估的有效性需要在随机对照试验中进一步证实。
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