Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
J Thromb Haemost. 2010 Mar;8(3):540-7. doi: 10.1111/j.1538-7836.2009.03731.x. Epub 2009 Dec 21.
Data on venous thromboembolism (VTE) in gastric cancer (GC) are very scarce.
To investigate the incidence, risk factors and prognostic implications of VTE in Asian GC patients.
Prospective databases containing clinical information on GC patients (n = 2,085) were used.
The 2-year cumulative incidences of all VTE events were 0.5%, 3.5% and 24.4% in stages I, II-IV(M0) and IV(M1), respectively. Advanced stage, older age and no major surgery were independent risk factors for developing VTE. When the VTE cases were classified into extremity venous thrombosis (EVT), pulmonary thromboembolism (PTE) or intra-abdominal venous thrombosis (IVT), IVTs (62%) were more common than EVTs (21%) or PTEs (17%). Although peri-operative pharmacologic thromboprophylaxis was not routinely administered, the VTE incidence after major surgery was only 0.2%. During chemotherapy, EVT/PTE developed more frequently than IVT (54% vs. 19%); however, during untreated or treatment-refractory periods, IVT developed more frequently than EVT/PTE (69% vs. 36%). In multivariate models, the development of EVT/PTE was a significant predictor of early death when compared with no occurrence of VTE (P < 0.05). However, IVT did not affect survival.
This is the largest study that specially focused on VTE in GC and the VTE incidence in Asian GC patients was first demonstrated. Considering the low incidence of post-operative VTE development, the necessity of peri-operative pharmacologic thromboprophylaxis should be evaluated separately in Asian patients. The clinical situation of the development of EVT/PTE and IVT differed. Only EVT/PTE had an adverse effect on survival and IVT had no prognostic significance.
关于胃癌（GC）患者静脉血栓栓塞症（VTE）的数据非常有限。
研究亚洲 GC 患者 VTE 的发生率、危险因素和预后意义。
使用包含 GC 患者临床信息的前瞻性数据库（n=2085）。
所有 VTE 事件的 2 年累积发生率分别为 I 期、II-IV（M0）和 IV（M1）期的 0.5%、3.5%和 24.4%。晚期、年龄较大和无主要手术是发生 VTE 的独立危险因素。当 VTE 病例分为肢体静脉血栓形成（EVT）、肺血栓栓塞症（PTE）或腹腔内静脉血栓形成（IVT）时，IVTs（62%）比 EVTs（21%）或 PTEs（17%）更常见。尽管未常规给予围手术期药物预防血栓形成，但主要手术后 VTE 的发生率仅为 0.2%。在化疗期间，EVT/PTE 比 IVT 更常见（54%比 19%）；然而，在未治疗或治疗抵抗期间，IVT 比 EVT/PTE 更常见（69%比 36%）。在多变量模型中，与未发生 VTE 相比，EVT/PTE 的发生是早期死亡的显著预测因素（P<0.05）。然而，IVT 并不影响生存。
这是专门针对 GC 中 VTE 进行的最大研究，首次展示了亚洲 GC 患者的 VTE 发生率。考虑到术后 VTE 发展的发生率较低，应单独评估亚洲患者围手术期药物预防血栓形成的必要性。EVT/PTE 和 IVT 的发展临床情况不同。只有 EVT/PTE 对生存有不利影响，而 IVT 对预后无意义。
