Graul Ashley, Latif Nawar, Zhang Xiaochen, Dean Lorraine T, Morgan Mark, Giuntoli Robert, Burger Robert, Kim Sarah, Ko Emily
*Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia; and †Department of Public Health Sciences, Pennsylvania State University, Hershey, PA; and ‡Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Int J Gynecol Cancer. 2017 Mar;27(3):581-587. doi: 10.1097/IGC.0000000000000912.
Women with gynecologic cancer are at higher risk of venous thromboembolism (VTE) due to malignancy, pelvic surgery, increased age, and frequently comorbidities. The rate of VTE among different gynecologic cancers and relative to benign gynecologic surgeries has not been reported in a nationally representative cohort.
Using the American College of Surgeons National Surgical Quality Improvement Program database, gynecologic surgeries were identified retrospectively from 2006 to 2012. Clinical characteristics, surgical procedures, and 30-day postoperative complications were abstracted. Multivariable logistic regression models were performed.
Of all gynecologic surgeries (n = 104,368), 11,427 were performed for malignancy: 2.7% (n = 2800) for ovarian cancer, 6.8% (n = 7114) for uterine cancer, 1.0% (n = 1026) for cervical cancer, and 0.5%(n = 487) for vulvar cancer. 202 (1.8%) patients experienced a VTE. Ovarian cancer had a deep venous thrombosis and pulmonary embolism rates of 1.6% and 1.5% compared with uterine cancer, 0.8% and 0.8%, respectively. Ovarian cancer patients were 1.8 (95% confidence interval [CI], 1.19-2.65) times more likely to have a deep venous thrombosis and 1.7 (95% CI, 1.11-2.51) times more likely to have a pulmonary embolism than patients with uterine cancer. Compared with all gynecologic cancer surgeries, ovarian cancer patients were 1.5 times more likely to have a VTE (95% CI, 1.10-2.16). Patients undergoing minimally invasive surgery were 64% less likely to have a VTE regardless of malignancy site; however, if they had disseminated disease, they remained at higher risk of VTE (odds ratio, 5.96; P = 0.027).
Of gynecologic cancer surgeries, ovarian cancer patients had the highest rate of VTE. Venous thromboembolism rates were lower in those who had minimally invasive surgery but remained higher in those with disseminated disease.
由于恶性肿瘤、盆腔手术、年龄增长以及常见的合并症，妇科癌症患者发生静脉血栓栓塞（VTE）的风险更高。在全国代表性队列中，尚未报告不同妇科癌症之间以及与良性妇科手术相关的VTE发生率。
利用美国外科医师学会国家外科质量改进计划数据库，对2006年至2012年的妇科手术进行回顾性识别。提取临床特征、手术过程和术后30天并发症。进行多变量逻辑回归模型分析。
在所有妇科手术（n = 104,368）中，11,427例是因恶性肿瘤进行的手术：卵巢癌占2.7%（n = 2800），子宫癌占6.8%（n = 7114），宫颈癌占1.0%（n = 1026），外阴癌占0.5%（n = 487）。202例（1.8%）患者发生了VTE。卵巢癌的深静脉血栓形成率和肺栓塞率分别为1.6%和1.5%，而子宫癌分别为0.8%和0.8%。卵巢癌患者发生深静脉血栓形成的可能性是子宫癌患者的1.8倍（95%置信区间[CI]，1.19 - 2.65），发生肺栓塞的可能性是子宫癌患者的1.7倍（95%CI，1.11 - 2.51）。与所有妇科癌症手术相比，卵巢癌患者发生VTE的可能性高1.5倍（95%CI，1.10 - 2.16）。无论恶性肿瘤部位如何，接受微创手术的患者发生VTE的可能性降低64%；然而，如果他们患有播散性疾病，发生VTE的风险仍然较高（比值比，5.96；P = 0.027）。
在妇科癌症手术中，卵巢癌患者的VTE发生率最高。接受微创手术的患者VTE发生率较低，但患有播散性疾病的患者VTE发生率仍然较高。
