Tetzlaff E D, Correa A M, Komaki R, Swisher S G, Maru D, Ross W A, Ajani J A
Department of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77005-4341, USA.
Dis Esophagus. 2008;21(7):575-81. doi: 10.1111/j.1442-2050.2008.00829.x. Epub 2008 May 2.
Thromboembolic event (TEE) is the most common complication and a second cause of mortality in cancer patients. Multiple hypotheses for occurrence of TEE have been proposed. There are no reports on the frequency/impact of TEE in localized gastroesophageal cancer patients. We hypothesized that TEE at baseline and during chemoradiotherapy (CTRT) in gastroesophageal cancer patients would have an impact on overall survival (OS) of these patients. All consecutive patients with gastroesophageal cancer undergoing CTRT from 2001 to 2004 were eligible for this analysis. Baseline and subsequent TEEs were documented and correlated with patient characteristics and OS. One hundred ninety-eight patients were analyzed. TEEs were documented in 9.6% of the patients. At baseline, TEEs were documented in 4.0% of the patients. During CTRT, TEEs were documented in 6.1% of the patients. Pulmonary embolism (43.5%) and lower extremity venous thromboses (39%) were the most frequent TEEs. Median OS for patients with a TEE occurring at anytime was 17.7 versus 32.0 months for patients who never developed a TEE (P = 0.014). TEEs at baseline correlated with poor median survival: 13.1 versus 30.7 months for those without a TEE (P = 0.029). In a multivariable analysis, TEE at baseline and/or during CTRT was an independent predictor of OS (hazard ratio, 1.818; P = 0.040). Our data are the first to document the frequency of TEE in gastroesophageal cancer patients undergoing CTRT, and that TEE is an independent prognosticator of OS. Active research to prevent and treat TEEs is needed to improve survival of patients with localized gastroesophageal cancer.
血栓栓塞事件（TEE）是癌症患者中最常见的并发症及第二大死亡原因。关于TEE发生的多种假说已被提出。目前尚无关于局限性胃食管癌患者中TEE发生频率/影响的报道。我们推测，胃食管癌患者基线期及放化疗（CTRT）期间的TEE会对这些患者的总生存期（OS）产生影响。对2001年至2004年期间所有接受CTRT的连续性胃食管癌患者进行此项分析。记录基线期及后续的TEE，并将其与患者特征及OS进行关联分析。共分析了198例患者。9.6%的患者记录到TEE。基线期，4.0%的患者记录到TEE。CTRT期间，6.1%的患者记录到TEE。肺栓塞（43.5%）和下肢静脉血栓形成（39%）是最常见的TEE。任何时候发生TEE的患者中位OS为17.7个月，而从未发生TEE的患者为32.0个月（P = 0.014）。基线期的TEE与较差的中位生存期相关：未发生TEE者为30.7个月，发生TEE者为13.1个月（P = 0.029）。在多变量分析中，基线期和/或CTRT期间的TEE是OS的独立预测因素（风险比，1.818；P = 0.040）。我们的数据首次记录了接受CTRT的胃食管癌患者中TEE的发生频率，且TEE是OS的独立预后因素。需要积极开展预防和治疗TEE的研究，以提高局限性胃食管癌患者的生存率。
