University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Oklahoma City, OK, United States.
University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Oklahoma City, OK, United States.
Gynecol Oncol. 2014 Jul;134(1):73-7. doi: 10.1016/j.ygyno.2014.04.046. Epub 2014 May 1.
The aim of this study is to evaluate the effect of venous thromboembolism (VTE) chronology with respect to surgery on survival with epithelial ovarian cancer (EOC).
An IRB approved, retrospective review was performed of patients treated for Stage I-IV EOC from 1996 to 2011. Cox proportional hazards model was used to assess associations between VTE and the primary outcomes of progression free survival (PFS) and overall survival (OS). SAS 9.3 was used for statistical analyses.
586 patients met study criteria. Median age was 63 years (range, 17-94); median BMI was 27.1 kg/m(2) (range, 13.7-67.0). Most tumors were high grade serous (68.3%) and advanced stage (III/IV, 75.4%). 3.7% had a preoperative VTE; 13.2% had a postoperative VTE. Upon multivariate analysis adjusting for age, stage, histology, performance status, and residual disease, preoperative VTE was predictive of OS (HR 3.1, 95% CI: 1.6-6.1, p=0.001) but not PFS (p=0.55). Postoperative VTE was associated with shorter PFS (HR 1.45, 95% CI: 1.04-2.02, p=0.03) and OS (HR 1.8, 95% CI: 1.3-2.6, p=0.001). When VTE timing was modeled, preoperative VTE (HR 3.5, 95% CI: 1.8-6.9, p<0.001) and postoperative VTE after primary therapy (HR 2.3, 95% CI: 1.4-3.6, p=0.001) were predictive of OS.
Preoperative and postoperative VTE appear to have a detrimental effect on OS with EOC. When modeled as a binary variable, postoperative VTE attenuated PFS; however, when VTE timing was modeled, postoperative VTE was not associated with PFS. It is unclear whether VTE is an inherent poor prognostic marker or if improved VTE prophylaxis and treatment may enable similar survival to patients without these events.
本研究旨在评估静脉血栓栓塞症（VTE）与手术时间的关系对上皮性卵巢癌（EOC）患者生存的影响。
对 1996 年至 2011 年期间接受 I-IV 期 EOC 治疗的患者进行了经机构审查委员会批准的回顾性分析。采用 Cox 比例风险模型评估 VTE 与无进展生存期（PFS）和总生存期（OS）的主要结局之间的关联。SAS 9.3 用于统计分析。
586 名患者符合研究标准。中位年龄为 63 岁（范围 17-94 岁）；中位 BMI 为 27.1kg/m²（范围 13.7-67.0）。大多数肿瘤为高级别浆液性（68.3%）和晚期（III/IV 期，75.4%）。术前 VTE 发生率为 3.7%；术后 VTE 发生率为 13.2%。经多变量分析调整年龄、分期、组织学、表现状态和残留疾病后，术前 VTE 与 OS 相关（HR 3.1，95%CI：1.6-6.1，p=0.001），但与 PFS 无关（p=0.55）。术后 VTE 与较短的 PFS（HR 1.45，95%CI：1.04-2.02，p=0.03）和 OS（HR 1.8，95%CI：1.3-2.6，p=0.001）相关。当 VTE 时间模型化时，术前 VTE（HR 3.5，95%CI：1.8-6.9，p<0.001）和原发性治疗后术后 VTE（HR 2.3，95%CI：1.4-3.6，p=0.001）与 OS 相关。
术前和术后 VTE 似乎对上皮性卵巢癌患者的 OS 有不利影响。当作为二分类变量建模时，术后 VTE 降低了 PFS；然而，当 VTE 时间模型化时，术后 VTE 与 PFS 无关。目前尚不清楚 VTE 是一种固有的预后不良标志物，还是改善 VTE 预防和治疗可能使具有这些事件的患者获得类似的生存。
