Department of Oncology, Aga Khan University Hospital, Stadium Road, PO BOX: 3500, Karachi, 74800, Pakistan.
Department of Medicine, Aga Khan University Hospital, Stadium Road, PO BOX: 3500, Karachi, 74800, Pakistan.
BMC Cancer. 2017 Jan 16;17(1):57. doi: 10.1186/s12885-016-3032-4.
Cancer related thrombosis not only increases morbidity and mortality but also poses a significant financial burden on health care system. Risk of venous thromboembolism (VTE) in these patients substantially increases with the addition of chemotherapy. Lately, cisplatin has been implicated as an independent factor. There is little data estimating the risk of venous thromboembolism in patients receiving cisplatin based chemotherapy when compared to other chemotherapeutic agents.
Patients who had received chemotherapy between November 2010 and October 2012 were retrospectively identified from a single institute cancer registry. 200 patients who had received cisplatin based chemotherapy were identified as the exposed group while 200 patients who had received non-Cisplatin based regimens were identified as the non-exposed group. Patients were followed for development of VTE throughout the entire duration of therapy and one month thereafter. Cox proportional hazard model was used to compute relative risks with 95% confidence intervals.
The baseline characteristics were similar in the two groups. Mean age for the entire cohort was 55.4 ± 10.7 years and male to female ratio was almost 1:1. On univariate analysis, cisplatin based chemotherapy, presence of central venous catheter, female gender, poor performance status, high risk stratification according to the Khorana model and use of granulocyte colony stimulating factor were all significantly associated with the development of VTE. The crude relative risk for the incidence of VTE in cisplatin group was 2.8 (95% CI, 1.4 - 4.2) times compared to the non-Cisplatin group. When the relative risk was adjusted for the above variables in multivariable analysis, it increased to 3.3 (95% CI, 1.6 - 6.8) compared to the control group.
A high incidence of VTE in patients receiving cisplatin based chemotherapy was demonstrated in this study. Prospective studies are warranted to establish this observation with certainty and to explore the possible use of thromboprophylaxis in patients receiving cisplatin based chemotherapeutic regimens.
癌症相关的血栓不仅增加了发病率和死亡率，而且对医疗保健系统造成了重大的经济负担。这些患者发生静脉血栓栓塞（VTE）的风险随着化疗的加入而大大增加。最近，顺铂被认为是一个独立的因素。与其他化疗药物相比，关于接受顺铂为基础的化疗的患者发生静脉血栓栓塞的风险的数据很少。
从一个单机构癌症登记处回顾性地确定了 2010 年 11 月至 2012 年 10 月期间接受化疗的患者。将 200 名接受顺铂为基础的化疗的患者确定为暴露组，同时将 200 名接受非顺铂为基础方案的患者确定为非暴露组。在整个治疗期间和之后的一个月内，对患者进行 VTE 的发展情况进行随访。使用 Cox 比例风险模型计算相对风险和 95%置信区间。
两组的基线特征相似。整个队列的平均年龄为 55.4±10.7 岁，男女比例几乎为 1:1。在单变量分析中，顺铂为基础的化疗、中央静脉导管的存在、女性、较差的表现状态、根据 Khorana 模型的高风险分层以及使用粒细胞集落刺激因子与 VTE 的发展均显著相关。与非顺铂组相比，顺铂组 VTE 发生率的粗相对风险为 2.8（95%CI，1.4-4.2）。当多变量分析中调整上述变量的相对风险时，与对照组相比，该风险增加到 3.3（95%CI，1.6-6.8）。
本研究表明，接受顺铂为基础的化疗的患者 VTE 的发生率较高。需要进行前瞻性研究以确定这一观察结果的确定性，并探讨在接受顺铂为基础的化疗方案的患者中使用血栓预防的可能性。
