Saphner T, Tormey D C, Gray R
University of Wisconsin Clinical Cancer Center, Madison.
J Clin Oncol. 1991 Feb;9(2):286-94. doi: 10.1200/JCO.1991.9.2.286.
The records of 2,673 patients randomized according to seven consecutive Eastern Cooperative Oncology Group (ECOG) studies of adjuvant therapy for breast cancer were reviewed for the occurrence of vascular complications. All protocols opened and closed between June 1977 and July 1987. The objectives of the present study were (1) to compare the frequency of vascular complications among patients who received adjuvant therapy for breast cancer with patients on observation, and (2) to estimate the contribution of chemotherapy and hormonal therapy to the occurrence of venous and arterial thrombi. The frequency of thrombosis, both venous and arterial combined, was 5.4% among patients who received adjuvant therapy and was 1.6% among patients on observation (P = .0002). Premenopausal patients who received chemotherapy and tamoxifen had significantly more venous complications than those who received chemotherapy without tamoxifen (2.8% v 0.8%, P = .03). Postmenopausal patients who received tamoxifen and chemotherapy had significantly more venous thrombi than those who received tamoxifen alone (8.0% v 2.3%, P = .03) or those who were observed (8.0% v 0.4%, P less than .0001). Premenopausal patients who received tamoxifen and chemotherapy had a 1.6% frequency of arterial thrombosis, significantly more than patients who received chemotherapy alone (1.6% v 0.0%, P = .004). The frequency of arterial thrombosis among postmenopausal patients was not significantly correlated with adjuvant therapy. In conclusion, patients who received adjuvant therapy for breast cancer had a 5.4% frequency of thromboembolic complications, significantly more than those who were observed. The combination of chemotherapy and tamoxifen was associated with more venous and arterial thromboembolic complications than chemotherapy alone in premenopausal patients and with more venous thrombi than tamoxifen alone among postmenopausal patients.
回顾了根据东部肿瘤协作组（ECOG）连续七项乳腺癌辅助治疗研究随机分组的2673例患者的记录，以了解血管并发症的发生情况。所有方案于1977年6月至1987年7月期间开启和结束。本研究的目的是：（1）比较接受乳腺癌辅助治疗的患者与接受观察的患者中血管并发症的发生率；（2）评估化疗和激素治疗对静脉和动脉血栓形成的影响。接受辅助治疗的患者中，静脉和动脉血栓形成的总发生率为5.4%，接受观察的患者中为1.6%（P = 0.0002）。接受化疗和他莫昔芬的绝经前患者的静脉并发症明显多于仅接受化疗的患者（2.8%对0.8%，P = 0.03）。接受他莫昔芬和化疗的绝经后患者的静脉血栓明显多于仅接受他莫昔芬的患者（8.0%对2.3%，P = 0.03）或接受观察的患者（8.0%对0.4%，P＜0.0001）。接受他莫昔芬和化疗的绝经前患者的动脉血栓形成发生率为1.6%，明显高于仅接受化疗的患者（1.6%对0.0%，P = 0.004）。绝经后患者的动脉血栓形成发生率与辅助治疗无明显相关性。总之，接受乳腺癌辅助治疗的患者血栓栓塞并发症发生率为5.4%，明显高于接受观察的患者。在绝经前患者中，化疗与他莫昔芬联合使用比单纯化疗会导致更多的静脉和动脉血栓栓塞并发症；在绝经后患者中，化疗与他莫昔芬联合使用比单纯使用他莫昔芬会导致更多的静脉血栓。
