Barginear Myra F, Lesser Martin, Akerman Meredith Lukin, Strakhan Marianna, Shapira Iuliana, Bradley Thomas, Budman Daniel R
Don Monti Division of Oncology, North Shore University Hospital, Manhasset, New York, USA.
Clin Appl Thromb Hemost. 2009 May-Jun;15(3):263-9. doi: 10.1177/1076029608315165. Epub 2008 Apr 1.
Cancer patients have an increased incidence of venous thromboembolism (VTE). Inferior vena cava (IVC) filters are used extensively in the US, and more than 40 000 are inserted annually. The impact on survival of cancer patients receiving IVC filters has not been studied.
A retrospective study examined 206 consecutive cancer patients with VTE to compare the effects of IVC filter placement with anticoagulation (AC) therapy on overall survival (OS), as measured from the time of VTE. Patients were classified into 3 treatment groups: AC (n = 62), IVC filter (77), or combination IVC filter + AC (67).
Treatment groups did not differ with respect to age, sex, or albumin levels. Median OS was significantly greater in patients treated with AC (13 months) compared with those treated with IVC filters (2 months) or IVC + AC (3.25 months; P < .0002). IVC patients were 1.9 times more at risk of death than AC only (hazard ratio = .528; 95% confidence interval = .374 to .745). Multivariate analysis revealed that performance status and type of thrombus were not confounders and had no effect on OS.
The need for the insertion of an IVC filter projected markedly reduced survival. Patients requiring an IVC filter rather than AC as initial therapy face a 2-fold increase in risk of death. Whether or not this therapeutic procedure has a positive impact on outcome in cancer patients is uncertain. Complications resulting from thrombosis were also analyzed in this cohort. A prospective randomized trial at our institution is addressing this issue.
癌症患者静脉血栓栓塞（VTE）的发生率增加。下腔静脉（IVC）滤器在美国被广泛使用，每年植入超过40000个。IVC滤器对癌症患者生存的影响尚未得到研究。
一项回顾性研究检查了206例连续的VTE癌症患者，比较IVC滤器置入与抗凝（AC）治疗对总生存期（OS）的影响，OS从VTE发生时开始计算。患者被分为3个治疗组：AC组（n = 62）、IVC滤器组（77例）或IVC滤器 + AC联合组（67例）。
治疗组在年龄、性别或白蛋白水平方面无差异。与接受IVC滤器治疗（2个月）或IVC + AC治疗（3.25个月）的患者相比，接受AC治疗的患者中位OS显著更长（13个月；P <.0002）。IVC滤器组患者的死亡风险是仅接受AC治疗患者的1.9倍（风险比 =.528；95%置信区间 =.374至.745）。多变量分析显示，体能状态和血栓类型不是混杂因素，对OS无影响。
置入IVC滤器预计会显著降低生存率。需要IVC滤器而非AC作为初始治疗的患者死亡风险增加2倍。这种治疗方法对癌症患者的预后是否有积极影响尚不确定。该队列中还分析了血栓形成导致的并发症。我们机构正在进行一项前瞻性随机试验来解决这个问题。
