Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand; Department of Gastrointestinal Medical Oncology, UT MD Anderson Cancer Center, Houston, Texas.
Department of Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, Texas.
Thromb Res. 2014 Feb;133(2):154-7. doi: 10.1016/j.thromres.2013.10.027. Epub 2013 Oct 24.
Cancer patients are a high-risk population for venous thromboembolism (VTE); the natural history of gonadal vein thrombosis (GVT) occurring in cancer patients is not well described in the medical literature.
Utilizing a software program the computerized tomographic scan reports of patients at a single cancer center from January 1, 2004 to June 30, 2011 were searched for the term GVT. Patients included in this analysis had a diagnosis of cancer, an isolated GVT (i.e. no evidence of thrombosis at another site), no symptoms referable to the GVT, and at least six months of follow-up information. All subsequent recurrent VTE events were confirmed by imaging studies.
196 cancer patients with GVT were identified. The majority of patients in this analysis had metastatic disease (118, 61.2%) as well as active cancer (167, 85.2%). Twenty patients (10.8%) developed recurrent VTE (median follow-up 14.5 months); median time to recurrent VTEs was 5.5 months (range 0-19 months). When considering only patients with without a recent history of gynecologic surgery, VTE recurrence rates were 14.3%. Active cancer was the only risk factor significantly associated with recurrent VTE (P=0.047).
Based upon the patient's risk factors for VTE, treatment of an incidentally detected GVT in cancer patients with anticoagulation, as per guidelines for other VTE sites, may be indicated in certain high risk subgroups, especially those patients with active cancer who have not had prior pelvic surgery.
癌症患者是静脉血栓栓塞症（VTE）的高危人群；癌症患者发生的性腺静脉血栓形成（GVT）的自然史在医学文献中描述得并不充分。
利用软件程序，检索了 2004 年 1 月 1 日至 2011 年 6 月 30 日期间一家癌症中心的计算机断层扫描报告中出现的“GVT”一词。本分析纳入的患者有癌症诊断、孤立性 GVT（即无其他部位血栓形成的证据）、无 GVT 相关症状且至少有 6 个月的随访信息。所有随后的复发性 VTE 事件均通过影像学研究证实。
共发现 196 例有 GVT 的癌症患者。本分析中大多数患者患有转移性疾病（118 例，61.2%）和活动性癌症（167 例，85.2%）。20 例（10.8%）患者出现复发性 VTE（中位随访时间 14.5 个月）；复发性 VTE 的中位时间为 5.5 个月（范围 0-19 个月）。当仅考虑无近期妇科手术史的患者时，VTE 复发率为 14.3%。活动性癌症是唯一与复发性 VTE 显著相关的危险因素（P=0.047）。
根据患者 VTE 的风险因素，对于偶然发现的癌症患者伴抗凝治疗的 GVT，可能需要按照其他 VTE 部位的指南进行治疗，尤其是那些无既往盆腔手术且有活动性癌症的患者。
