接受新辅助放化疗的食管癌患者发生血栓栓塞的风险增加。
Increased risk of thromboembolism in esophageal cancer patients treated with neoadjuvant chemoradiotherapy.
作者信息
Bosch Dirk J, Van Dalfsen Quirine A, Mul Véronique E M, Hospers Geke A P, Plukker John Th M
机构信息
Department of Surgery/Surgical Oncology, University of Groningen, University Medical Centre Groningen (UMCG), Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands.
Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen (UMCG), Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands.
出版信息
Am J Surg. 2014 Aug;208(2):215-21. doi: 10.1016/j.amjsurg.2013.10.031. Epub 2014 Jan 23.
BACKGROUND
Neoadjuvant chemoradiotherapy (CRT) in esophageal cancer (EC) patients may increase the formation of thromboembolic events (TEEs). We analyzed the incidence and impact of TEEs in EC patients treated with platinum-based CRT.
METHODS
A total of 336 patients with EC underwent an esophagectomy, of which 110 patients received neoadjuvant CRT (41.4 Gy with concurrent Carboplatin/Paclitaxel). Patients were matched based on pre- and perioperative characteristics.
RESULTS
Preoperatively, 9 (8.2%) patients with neoadjuvant CRT (P = .004) were diagnosed with TEEs. Despite delay until surgery (P = .021), the postoperative course did not differ. In multivariate analysis, a history of deep vein thrombosis (P = .005) and neoadjuvant CRT (P = .004) were identified as risk factors. Postoperatively, there were no differences in TEEs (P = .560) observed. In multivariate analysis, a history of pulmonary embolism (P = .012) was identified as a risk factor for postoperative TEEs.
CONCLUSIONS
Preoperatively, EC patients treated with neoadjuvant CRT have an increased risk to develop a TEE, especially those with a previous history of TEE. After surgery no increased incidence was observed. We recommend secondary prophylaxis during neoadjuvant treatment in this high-risk group.
背景
食管癌（EC）患者接受新辅助放化疗（CRT）可能会增加血栓栓塞事件（TEE）的形成。我们分析了接受铂类CRT治疗的EC患者中TEE的发生率及影响。
方法
共有336例EC患者接受了食管切除术，其中110例患者接受了新辅助CRT（41.4 Gy同步卡铂/紫杉醇）。根据术前和围手术期特征对患者进行匹配。
结果
术前，9例（8.2%）接受新辅助CRT的患者（P = .004）被诊断为TEE。尽管手术延迟（P = .021），但术后病程并无差异。多因素分析显示，深静脉血栓形成病史（P = .005）和新辅助CRT（P = .004）被确定为危险因素。术后，观察到的TEE并无差异（P = .560）。多因素分析显示，肺栓塞病史（P = .012）被确定为术后TEE的危险因素。
结论
术前，接受新辅助CRT治疗的EC患者发生TEE的风险增加，尤其是有TEE既往史的患者。术后未观察到发病率增加。我们建议对该高危组在新辅助治疗期间进行二级预防。
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