Kang Jun Ren, Long Li Hai, Yan Sun Wen, Wei Wang Wei, Jun Han Zhi, Chen Wei
1 Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
2 Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy Of Medical Sciences and Peking Union Medical College, Beijing, China.
Clin Appl Thromb Hemost. 2017 Mar;23(2):181-186. doi: 10.1177/1076029615595880. Epub 2016 Jul 9.
Peripherally inserted central venous catheters (PICCs) are widely used in patients with cancer. Catheter usage is one of the risk factors for venous thromboembolism. We aimed to scrutinize the incidence and risk factors for PICC-related upper extremity venous thrombosis (UEVT) in patients with lung cancer receiving chemotherapy.
We performed a retrospective cohort study of patients with lung cancer with PICC insertion undergoing chemotherapy. Symptomatic PICC-UEVT was diagnosed by ultrasound. The relationship between chemotherapeutic agent exposure and PICC-UEVT was evaluated. Patient-, catheter-, and insertion-related factors were analyzed in univariable and multivariable logistic regression to identify significant independent risk factors for PICC-UEVT in patients with lung cancer.
A total of 328 patients with lung cancer having PICC undergoing chemotherapy were included, for a total of 34 895 catheter days. Seventeen (5.2%) patients developed PICC-related UEVT, with an incidence of 0.49 per 1000 catheter days. In multivariable logistic analysis, advanced disease was shown to be a significant risk factor for PICC-UEVT (odds ratio [OR]: 4.9; 95% confidence interval [CI]: 1.4-16.7; P = .011). Patients treated with etoposide had a higher risk of PICC-related UEVT (OR: 3.6; 95% CI: 1.1-12.1; P = .042). Patients were followed up after PICC removal for a median duration of 246 days. None of the patients developed pulmonary embolism.
Patients with lung cancer harboring an advanced disease or treating with etoposide were at higher risk of PICC-UEVT.
经外周静脉穿刺中心静脉导管（PICC）在癌症患者中广泛应用。导管使用是静脉血栓栓塞的危险因素之一。我们旨在仔细研究接受化疗的肺癌患者中PICC相关上肢静脉血栓形成（UEVT）的发生率及危险因素。
我们对接受化疗且已插入PICC的肺癌患者进行了一项回顾性队列研究。有症状的PICC-UEVT通过超声诊断。评估化疗药物暴露与PICC-UEVT之间的关系。在单变量和多变量逻辑回归中分析患者、导管及插入相关因素，以确定肺癌患者发生PICC-UEVT的显著独立危险因素。
共纳入328例接受化疗且已插入PICC的肺癌患者，导管总使用天数为34895天。17例（5.2%）患者发生了PICC相关的UEVT，发生率为每1000导管日0.49例。在多变量逻辑分析中，疾病进展被证明是PICC-UEVT的一个显著危险因素（比值比[OR]：4.9；95%置信区间[CI]：1.4-16.7；P = 0.011）。接受依托泊苷治疗的患者发生PICC相关UEVT的风险更高（OR：3.6；95% CI：1.1-12.1；P = 0.042）。PICC拔除后对患者进行了中位时长为246天的随访。无一例患者发生肺栓塞。
患有进展期疾病或接受依托泊苷治疗的肺癌患者发生PICC-UEVT的风险更高。
