Patel Apurva, Anraku Masaki, Darling Gail E, Shepherd Frances A, Pierre Andrew F, Waddell Thomas K, Keshavjee Shaf, de Perrot Marc
Toronto General Hospital and Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2009 Oct;138(4):843-8. doi: 10.1016/j.jtcvs.2009.02.028. Epub 2009 Apr 10.
The rate of venous thromboembolism in patients undergoing multimodality therapy for lung malignancy and the impact of preoperative venous thromboembolism on postoperative outcome have not been analyzed systematically.
We performed a retrospective review of all patients undergoing induction therapy before lung resection for non-small cell lung cancer and malignant pleural mesothelioma at the University Health Network between January 1996 and December 2007.
Venous thromboembolism developed in 23 (12.3%) of 186 patients undergoing induction therapy. The venous thromboembolism was diagnosed during induction therapy in 11 patients. The proportion of pulmonary embolism was higher during induction therapy (9/11 patients), whereas deep venous thromboses were observed predominantly postoperatively (7/12 patients) (P = .02). The risk of postoperative complications or death was not increased in patients undergoing surgery despite a preoperative diagnosis of venous thromboembolism. However, the risk of postoperative pulmonary embolism was higher in patients undergoing surgery without insertion of an inferior vena cava filter (1/2 patients vs 0/7 after insertion of an inferior vena cava filter, P = .047). The overall survival was similar between patients with or without venous thromboembolism complications.
This study demonstrates that venous thromboembolism events in patients undergoing multimodality therapy for lung malignancies is high and deserves careful consideration. Patients with a venous thromboembolism diagnosis during induction therapy may potentially benefit from a temporary inferior vena cava filter before surgery to limit the risk of recurrent pulmonary embolism. A preoperative diagnosis of venous thromboembolism, however, does not affect early and late outcomes after surgery and should not be viewed as a negative prognostic marker.
尚未对接受多模式治疗的肺癌患者的静脉血栓栓塞发生率以及术前静脉血栓栓塞对术后结局的影响进行系统分析。
我们对1996年1月至2007年12月在大学健康网络接受非小细胞肺癌和恶性胸膜间皮瘤肺切除术前诱导治疗的所有患者进行了回顾性研究。
186例接受诱导治疗的患者中有23例（12.3%）发生了静脉血栓栓塞。11例患者在诱导治疗期间被诊断出静脉血栓栓塞。诱导治疗期间肺栓塞的比例较高（9/11例患者），而深静脉血栓形成主要在术后观察到（7/12例患者）（P = 0.02）。尽管术前诊断为静脉血栓栓塞，但接受手术的患者术后并发症或死亡风险并未增加。然而，未插入下腔静脉滤器的手术患者术后发生肺栓塞的风险更高（1/2例患者 vs 插入下腔静脉滤器后0/7例患者，P = 0.047）。有或无静脉血栓栓塞并发症的患者总体生存率相似。
本研究表明，接受肺癌多模式治疗的患者发生静脉血栓栓塞事件的几率很高，值得仔细考虑。诱导治疗期间诊断为静脉血栓栓塞的患者可能在手术前从临时插入下腔静脉滤器中获益，以降低复发性肺栓塞的风险。然而，术前诊断为静脉血栓栓塞并不影响手术的早期和晚期结局，不应被视为不良预后指标。
