Department of Obstetrics and Gynecology, Los Angeles County Medical Center, Division of Gynecologic Oncology, University of Southern California, Los Angeles, CA 90031, USA.
Am J Clin Oncol. 2013 Aug;36(4):362-7. doi: 10.1097/COC.0b013e318248da32.
Recent studies have suggested that inferior vena cava (IVC) filter placement in cancer patients is associated with decreased survival time after insertion. Causality, however, is yet to be understood. This study evaluates (i) the patterns of recurrence or progression of disease; and (ii) survival outcomes of ovarian cancer patients who underwent IVC filter placement.
A total of 274 patients who underwent primary cytoreductive surgery for epithelial ovarian, fallopian tube, and primary peritoneal cancers were identified for analysis. Anatomic location of the first recurrence or progression of disease, progression-free survival, and overall survival were correlated to IVC filter placement status inserted during the perioperative period.
Overall, 38 (13.9%) patients underwent perioperative IVC filter insertion, of which 37 (97.4%) were permanently placed. The most common indication was newly diagnosed venous thromboembolism (VTE) (52.6%). Patients with IVC filter placement for VTE were more likely to develop subsequent deep vein thrombosis (25% vs. 7.2%, odds ratio, 4.31, 95% confidence interval, 1.40-13.3, P = 0.019), have hematogenous distant metastasis as the site of first recurrence or progression of disease (12-mo hematogenous distant metastasis ratio, 45.2% vs. 13.6%, hazard ratio, 5.10, 95% confidence interval, 2.35-11.1, P < 0.001, multivariate analysis), and show decreased survival outcomes (median progression-free survival, 5.7 vs. 15.3 mo, P < 0.001: and median overall survival, 22.1 vs. 47.2 mo, P = 0.002, both multivariate analysis) when compared with patients without IVC filter placement.
Our results suggested that IVC filter placement for VTE in the perioperative period of primary cytoreductive surgery for ovarian cancer may be associated with increased risk of hematogenous distant metastasis and resulted in decreased survival.
最近的研究表明，下腔静脉（IVC）滤器置入与癌症患者置入后生存时间缩短有关。然而，因果关系尚不清楚。本研究评估了（i）疾病复发或进展的模式；以及（ii）接受 IVC 滤器置入的卵巢癌患者的生存结果。
共分析了 274 例接受原发性细胞减灭术治疗上皮性卵巢癌、输卵管癌和原发性腹膜癌的患者。将疾病首次复发或进展的解剖位置、无进展生存期和总生存期与围手术期置入的 IVC 滤器位置相关联。
总体而言，38 例（13.9%）患者在围手术期置入 IVC 滤器，其中 37 例（97.4%）为永久性置入。最常见的适应证是新诊断的静脉血栓栓塞症（VTE）（52.6%）。因 VTE 而置入 IVC 滤器的患者更有可能随后发生深静脉血栓形成（25%比 7.2%，比值比 4.31，95%置信区间 1.40-13.3，P=0.019），且疾病首次复发或进展的部位为血行远处转移（12 个月时血行远处转移率，45.2%比 13.6%，风险比 5.10，95%置信区间 2.35-11.1，P<0.001，多变量分析），并且与未置入 IVC 滤器的患者相比，生存结果较差（中位无进展生存期，5.7 比 15.3 个月，P<0.001；中位总生存期，22.1 比 47.2 个月，P=0.002，均为多变量分析）。
我们的结果表明，卵巢癌原发性细胞减灭术围手术期因 VTE 而置入 IVC 滤器可能与血行远处转移风险增加相关，并导致生存时间缩短。
