Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Peter MacCallum Cancer Centre, Melbourne, Australia.
Lung Cancer. 2014 Jun;84(3):275-80. doi: 10.1016/j.lungcan.2014.02.009. Epub 2014 Feb 28.
Thromboembolism is common in lung cancer. Current thromboprophylaxis guidelines lack specific recommendations for appropriate strategies in this high thrombotic risk patient cohort. We profiled lung cancer patients receiving anti-cancer therapy. Thromboembolism incidence and thromboembolism-related mortality rates are reported and we explored patient, disease, and treatment-related risk factors associated with higher thrombotic rates.
Retrospective review of lung cancer patients referred to a Comprehensive Cancer Centre between 01/07/2011 and 30/06/2012 for anti-cancer therapy. Data were collected from medical, pharmacy, pathology and diagnostic imaging electronic records.
After a median follow up of 10 months (range: 0.03-32 months), 24/222 patients (10.8%) had developed radiologically confirmed thromboembolism; 131 events per 1000 person-years (95%CI 87-195). Thromboembolism occurred equally in patients with non-small cell and small cell lung cancer (10.8% and 10.5% respectively), and more frequently among patients with adenocarcinoma compared to squamous cell carcinoma (14.7% and 5.3% respectively). Chemotherapy-treated patients experienced thromboembolism more often than patients who did not receive chemotherapy (HR 5.7 95%CI 2.2-14.8). Radiotherapy was also associated with more frequent thromboembolism (HR 5.2 95%CI 2.0-13.2). New lung cancer diagnosis, presence of metastatic disease, second primary malignancy and Charlson Index ≥ 5 were also associated with higher rates of thromboembolism. Importantly, pharmacological thromboprophylaxis (P-TP) was not routinely or systematically prescribed for ambulant lung cancer patients during any treatment phase, at this institution. The majority (83%) of thromboembolic events occurred in the ambulatory care setting.
Morbidity and mortality from thromboembolism occurs frequently in lung cancer. Thromboprophylaxis guidelines should be developed for the ambulatory care setting.
血栓栓塞在肺癌中很常见。目前的血栓预防指南缺乏针对这一高血栓风险患者群体的具体建议。我们对接受抗癌治疗的肺癌患者进行了分析。报告了血栓栓塞的发生率和与血栓栓塞相关的死亡率，并探讨了与更高血栓形成率相关的患者、疾病和治疗相关的危险因素。
回顾性分析 2011 年 7 月 1 日至 2012 年 6 月 30 日期间在综合癌症中心接受抗癌治疗的肺癌患者。数据来自医疗、药房、病理和诊断影像学电子记录。
中位随访 10 个月（范围：0.03-32 个月）后，222 例患者中有 24 例（10.8%）经影像学证实发生血栓栓塞；每 1000 人年发生 131 例（95%CI 87-195）。非小细胞肺癌和小细胞肺癌患者的血栓栓塞发生率相同（分别为 10.8%和 10.5%），腺癌患者比鳞状细胞癌患者更常发生血栓栓塞（分别为 14.7%和 5.3%）。接受化疗的患者发生血栓栓塞的频率高于未接受化疗的患者（HR 5.7，95%CI 2.2-14.8）。放疗也与更频繁的血栓栓塞相关（HR 5.2，95%CI 2.0-13.2）。新发肺癌诊断、转移性疾病、第二原发恶性肿瘤和 Charlson 指数≥5 也与更高的血栓栓塞率相关。重要的是，在该机构，在任何治疗阶段，常规或系统地为门诊肺癌患者开具药物性血栓预防（P-TP）。大多数（83%）血栓栓塞事件发生在门诊护理环境中。
肺癌患者血栓栓塞的发病率和死亡率很高。应制定针对门诊护理环境的血栓预防指南。
