Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Chest. 2014 Sep;146(3):650-658. doi: 10.1378/chest.13-2379.
The risk of VTE before anticancer therapy in patients with lung cancer is not well defined.
A total of 673 hospitalized patients with newly diagnosed lung cancer were examined for VTE within 1 week after admission at five hospitals between January 2009 and January 2011. Additionally, VTE diagnoses within the last 3 months were reviewed. All VTE events were confirmed with imaging studies. Blood cell count and serum carcinoembryonic antigen (CEA) levels were measured before initial treatment.
VTE events occurred in 89 of the 673 patients (13.2%) enrolled in this study. Forty-two patients (6.2%) developed lower extremity DVT alone, 33 patients (4.9%) developed pulmonary embolism (PE) alone, and 14 patients (2.1%) developed both DVT and PE. By multivariate logistic regression analysis, distant metastasis (OR, 2.2; 95% CI, 1.2-3.9) and leukocytosis (OR, 2.8; 95% CI, 1.5-5.4) were significantly associated with DVT, adenocarcinoma (OR, 2.1; 95% CI, 1.1-4.4) and anemia (OR, 4.6; 95% CI, 1.4-14.5) were significantly associated with PE, and an elevated CEA level in tertiles was linearly associated with PE (P for trend = .06). The area under the receiver operating characteristic curve for the prognostic or diagnostic CEA values was 0.68 (95% CI, 0.59-0.76; P < .001).
The prevalence of VTE was high in patients with newly diagnosed lung cancer. In patients with lung cancer, the factors associated with DVT might be different from those associated with PE. An elevated CEA level might facilitate the identification of patients at a higher risk of developing PE.
在接受抗癌治疗之前，肺癌患者的静脉血栓栓塞（VTE）风险尚未明确。
2009 年 1 月至 2011 年 1 月期间，我们在五家医院共检查了 673 例新诊断为肺癌且住院的患者，在入院后 1 周内检查 VTE，同时回顾过去 3 个月内的 VTE 诊断。所有 VTE 事件均通过影像学研究进行确认。在初始治疗前测量血细胞计数和血清癌胚抗原（CEA）水平。
本研究共纳入 673 例患者，其中 89 例（13.2%）发生 VTE 事件。42 例（6.2%）患者仅发生下肢深静脉血栓形成，33 例（4.9%）患者仅发生肺栓塞（PE），14 例（2.1%）患者同时发生下肢深静脉血栓形成和 PE。多变量 logistic 回归分析显示，远处转移（OR，2.2；95%CI，1.2-3.9）和白细胞增多症（OR，2.8；95%CI，1.5-5.4）与 DVT 显著相关，腺癌（OR，2.1；95%CI，1.1-4.4）和贫血（OR，4.6；95%CI，1.4-14.5）与 PE 显著相关，CEA 水平的三分位与 PE 呈线性相关（趋势 P=.06）。预测或诊断 CEA 值的受试者工作特征曲线下面积为 0.68（95%CI，0.59-0.76；P<0.001）。
新发肺癌患者的 VTE 患病率较高。在肺癌患者中，与 DVT 相关的因素可能与与 PE 相关的因素不同。CEA 水平升高可能有助于识别发生 PE 风险较高的患者。
