James P. Wilmot Cancer Center, Department of Medicine, University of Rochester, Rochester, N.Y., USA.
Thromb Res. 2010 Apr;125 Suppl 2:S1-7. doi: 10.1016/S0049-3848(10)00227-6.
Cancer patients are well-known to be at increased risk of venous thromboembolism (VTE). However, the risk varies widely between patients and over the natural history of malignancy. Recent data have identified multiple clinical risk factors as well as biomarkers predictive of VTE. Risk factors include patient-associated factors such as age, obesity and medical comorbidities, cancer-associated factors such as site and stage of cancer, and treatment-associated factors, particularly chemotherapy and anti-angiogenic therapy. Biomarkers associated with increased risk of cancer-associated VTE include leukocyte count, platelet count, and levels of tissue factor, P-selectin and D-dimer. This review focuses on the evidence for risk stratification of cancer patients, based on these risk factors and biomarkers, as well as a recently validated predictive model which can be used to identify patients at highest risk. Targeted thromboprophylaxis utilizing model-based and/or biomarker-based approaches may provide an optimal risk-benefit ratio and is currently the focus of ongoing clinical trials.
癌症患者众所周知存在静脉血栓栓塞（VTE）风险增加。然而，在恶性肿瘤的自然病程中，这种风险在患者之间差异很大。最近的数据已经确定了多个临床风险因素以及预测 VTE 的生物标志物。风险因素包括患者相关因素，如年龄、肥胖和合并症，癌症相关因素，如癌症部位和分期，以及治疗相关因素，特别是化疗和抗血管生成治疗。与癌症相关 VTE 风险增加相关的生物标志物包括白细胞计数、血小板计数以及组织因子、P 选择素和 D-二聚体水平。这篇综述重点介绍了基于这些风险因素和生物标志物对癌症患者进行风险分层的证据，以及最近验证的预测模型，该模型可用于识别风险最高的患者。基于模型和/或生物标志物的靶向血栓预防可能提供最佳的风险效益比，目前是正在进行的临床试验的重点。
