Wang Yuchen, Attar B M, Hinami K, Fuentes H E, Jaiswal P, Zhang H, Simons-Linares C S, Tafur A J
Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, 1900 West Polk Street, Chicago, IL, 60612, USA.
Division of Gastroenterology and Hepatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
J Gastrointest Cancer. 2018 Sep;49(3):275-282. doi: 10.1007/s12029-017-9945-6.
Venous thromboembolism (VTE) is a common complication in cancer patients, and is associated with worse prognosis in such population. Hepatocellular carcinoma (HCC) poses high risk for VTE; however, data is scarce regarding the characteristics and consequences of VTE in HCC patients.
We retrospectively reviewed the electronic medical records (EMR) of 270 patients diagnosed with HCC from 2000 to 2015 in Cook County Health and Hospitals System. We report the cumulative incidence of VTE in the present cohort, and identified through multivariate logistic regression the independent risk factors of the development of VTE. Overall prognosis of patients with and without VTE were presented and compared.
Sixteen cases (5.93%) of VTE were documented in the present study. In multivariate analysis, obesity, Child B cirrhosis, intra-hepatic lesions more than 3, and multi-organ extrahepatic metastasis were significantly associated with VTE development (p < 0.05). The presence of VTE was an independent risk factor for mortality in multivariate analysis (HR = 3.62, p = 0.021), together with male gender, Child C cirrhosis, and extrahepatic metastasis.
Obesity, Child B cirrhosis, more intra-hepatic lesions, and multi-organ extrahepatic metastasis are associated with cancer-associated VTE. VTE will adversely affect the prognosis of patients with HCC; therefore, primary thromboprophylaxis may be warranted in such population.
静脉血栓栓塞症（VTE）是癌症患者常见的并发症，且与该人群的不良预后相关。肝细胞癌（HCC）患者发生VTE的风险较高；然而，关于HCC患者VTE的特征和后果的数据却很匮乏。
我们回顾性分析了2000年至2015年在库克县卫生和医院系统诊断为HCC的270例患者的电子病历（EMR）。我们报告了本队列中VTE的累积发病率，并通过多因素逻辑回归确定了VTE发生的独立危险因素。呈现并比较了有和没有VTE的患者的总体预后。
本研究记录了16例（5.93%）VTE病例。在多因素分析中，肥胖、Child B级肝硬化、肝内病变超过3个以及多器官肝外转移与VTE的发生显著相关（p<0.05）。在多因素分析中，VTE的存在是死亡率的独立危险因素（HR=3.62，p=0.021），此外还有男性、Child C级肝硬化和肝外转移。
肥胖、Child B级肝硬化、更多的肝内病变以及多器官肝外转移与癌症相关的VTE有关。VTE会对HCC患者的预后产生不利影响；因此，在此类人群中可能有必要进行一级血栓预防。
