Rebouças Danilo, Costa Maria, Thuler Luiz, Garces Alvaro, Aquino Luciana, Bines José
Department of Medical Oncology, Instituto Nacional de Câncer, Rua Visconde de Santa Isabel 274, Rio de Janeiro 20560-120, Brazil.
Department of Radiology, Instituto Nacional de Câncer, Rua Visconde de Santa Isabel 274, Rio de Janeiro 20560-120, Rio de Janeiro, Brazil.
Breast. 2016 Aug;28:84-8. doi: 10.1016/j.breast.2016.04.015. Epub 2016 May 30.
Breast cancer is frequently associated with venous thromboembolism (VTE). VTE may result in significant morbidity, a substantial economic burden and even leads to patients' death. Risk factor identification and management of VTE in breast cancer patients remains poorly studied. We evaluated breast cancer patients' baseline and treatment characteristics in predicting VTE occurrence as well as its prognosis. We conducted a case-control study of all breast cancer patients with a VTE diagnosed between January 2007 and December 2011 at the Instituto Nacional de Câncer (INCA) in Brazil. Two hundred and twenty five patients developed VTE and were compared with 225 controls, in the 5-year study period. The bulk of the thrombotic events were unilateral (94.2%) VTEs of the lower extremity (78.7%), largely proximally located (78%). VTE occurred more often within the first 3 years after the diagnosis of cancer (66.2%), being more common in the first 6 months (21.8%). Significant predictors of developing VTE were age 50 years and over (OR 1.85, 95% CI: 1.16-2.95), PS equal to or above 3 (OR 2.01, 95% CI: 1.24-3.26), and the presence of a CVC (OR 2.56, 95% CI: 1.42-4.62). This large retrospective analysis of VTE in breast cancer patients confirms that most events occur early in the treatment course. The incidence of VTE was associated with patients' age, PS, and the presence of CVC. Prospective studies are needed to evaluate outpatient thromboprophylaxis for selected groups of patients.
乳腺癌常与静脉血栓栓塞症（VTE）相关。VTE可能导致严重的发病情况、巨大的经济负担，甚至导致患者死亡。乳腺癌患者VTE的危险因素识别与管理仍研究不足。我们评估了乳腺癌患者的基线和治疗特征对VTE发生及其预后的预测作用。我们对2007年1月至2011年12月期间在巴西国立癌症研究所（INCA）诊断为VTE的所有乳腺癌患者进行了一项病例对照研究。在5年的研究期间，225例患者发生了VTE，并与225例对照进行比较。大部分血栓形成事件为单侧（94.2%）下肢VTE（78.7%），主要位于近端（78%）。VTE在癌症诊断后的前3年内更常发生（66.2%），在前6个月更为常见（21.8%）。发生VTE的显著预测因素为年龄50岁及以上（OR 1.85，95%CI：1.16 - 2.95）、PS等于或高于3（OR 2.01，95%CI：1.24 - 3.26）以及存在中心静脉导管（CVC）（OR 2.56，95%CI：1.42 - 4.62）。这项对乳腺癌患者VTE的大型回顾性分析证实，大多数事件发生在治疗过程早期。VTE的发生率与患者年龄、PS以及CVC的存在有关。需要进行前瞻性研究以评估对特定患者群体的门诊血栓预防措施。
