Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
J Thromb Haemost. 2010 Aug;8(8):1702-9. doi: 10.1111/j.1538-7836.2010.03948.x. Epub 2010 Jun 14.
Venous thromboembolism(VTE) is a significant, common comorbidity of cancer patients associated with increased mortality. We evaluated the incidence and risk factors for developing a new VTE in ambulatory cancer patients while they were receiving therapy for advanced cancer. We also examined the affect of developing a new VTE on survival for patients with gastroesophageal malignancies.
All patients with non-hematologic malignancies who were treated using investigator-initiated therapeutic protocols at Memorial Sloan Kettering Cancer Center (MSKCC) from 2003 through to 2005 were identified for this cohort study. The occurrence of VTE was prospectively recorded in an actively managed clinical research database. Baseline laboratory parameters, treatment details and tumor type were correlated with VTE risk and patient survival.
115 out of 2120 patients being treated for advanced malignancy developed a new VTE (12.8 VTEs/100 person-years). In multivariate analysis, a diagnosis of gastroesophageal cancer (hazard ratio (HR), 2.76 (1.41-5.38); P=0.003), pancreatic cancer (HR, 2.26 (1.06-4.80); P=0.05), use of white cell growth factors (HR 1.69(1.09-2.64); P=0.02) and irinotecan therapy (HR, 1.89 (1.29-3.59); P=0.05) were independently associated with VTE development. Hemoglobin >10 g dL(-1) (HR, 0.52 (0.3-0.91); P=0.02) and albumin ≥ 4 g dL(-1) (HR, 0.61 (0.39-0.94); P=0.024) were associated with reduced VTE risk. The unadjusted HR for death among ambulatory gastroesophageal cancer patients with VTE is 0.89 (0.61-1.3), P=0.53. After adjusting for confounding risk factors associated with survival, the HR for death associated with VTE is 0.78 (0.5-1.2), P=0.25.
Upper gastrointestinal malignancies are independently associated with the development of a new VTE, implicating tumor biology in VTE development. Even after adjusting for prognostic factors, we were unable to demonstrate an adverse impact on survival due to the new development of VTE amongst patients with active gastroesophageal malignancy receiving therapy.
静脉血栓栓塞症（VTE）是癌症患者的一种严重且常见的合并症，与死亡率增加有关。我们评估了接受晚期癌症治疗的门诊癌症患者新发 VTE 的发生率和风险因素。我们还研究了新发 VTE 对胃肠道恶性肿瘤患者生存的影响。
从 2003 年到 2005 年，在纪念斯隆凯特琳癌症中心（MSKCC）接受研究者发起的治疗方案治疗的所有非血液恶性肿瘤患者均被纳入本队列研究。在一个积极管理的临床研究数据库中，前瞻性地记录 VTE 的发生情况。将基线实验室参数、治疗细节和肿瘤类型与 VTE 风险和患者生存相关联。
2120 名接受晚期恶性肿瘤治疗的患者中有 115 例（12.8 VTEs/100 人年）发生新发 VTE。多变量分析显示，诊断为胃肠道癌（危险比（HR），2.76（1.41-5.38）；P=0.003）、胰腺癌（HR，2.26（1.06-4.80）；P=0.05）、使用白细胞生长因子（HR 1.69（1.09-2.64）；P=0.02）和伊立替康治疗（HR，1.89（1.29-3.59）；P=0.05）与 VTE 发生独立相关。血红蛋白>10 g/dL（HR，0.52（0.3-0.91）；P=0.02）和白蛋白≥4 g/dL（HR，0.61（0.39-0.94）；P=0.024）与降低 VTE 风险相关。VTE 发生的门诊胃肠道癌患者死亡的未调整 HR 为 0.89（0.61-1.3），P=0.53。在调整与生存相关的混杂危险因素后，VTE 相关死亡的 HR 为 0.78（0.5-1.2），P=0.25。
上胃肠道恶性肿瘤与新发 VTE 的发生独立相关，提示肿瘤生物学在 VTE 发生中的作用。即使在调整了与预后相关的危险因素后，我们也未能证明在接受积极治疗的活动性胃肠道恶性肿瘤患者中，由于新发生 VTE，生存受到不利影响。
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