Division of Gynecologic Oncology and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, and the Department of Obstetrics and Gynecology, St. John Hospital, Detroit, Michigan; and the Division of Gynecologic Oncology, University of Wisconsin, Madison, Wisconsin.
Obstet Gynecol. 2017 Jun;129(6):979-985. doi: 10.1097/AOG.0000000000001980.
To identify the incidence and timing of venous thromboembolism as well as any associated risk factors in patients with ovarian, fallopian tube, or primary peritoneal cancer undergoing neoadjuvant chemotherapy.
We conducted a retrospective cohort study of patients diagnosed with ovarian, fallopian tube, and primary peritoneal cancer and receiving neoadjuvant chemotherapy from January 2009 to May 2014 at a single academic institution. The timing and number of venous thromboembolic events for the entire cohort were categorized as follows: presenting symptom, during neoadjuvant chemotherapy treatment, after debulking surgery, and during adjuvant chemotherapy.
Of the 125 total patients with ovarian cancer undergoing neoadjuvant chemotherapy, 13 of 125 patients (10.4%, 95% confidence interval [CI] 6.1-17.2%) had a venous thromboembolism as a presenting symptom and were excluded from further analysis. Of the 112 total patients at risk, 30 (26.8%, 95% CI 19.3-35.9%) experienced a venous thromboembolism. Based on the phase of care, 13 (11.6%, 95% CI 6.8-19.1%) experienced a venous thromboembolism during neoadjuvant chemotherapy, six (5.4%, 95% CI 2.4-11.5%) developed a postoperative venous thromboembolism, and 11 (9.9%, 95% CI 5.5-17%) developed a venous thromboembolism during adjuvant chemotherapy. Two of the four patients with clear cell histology developed a venous thromboembolism in this cohort.
Overall new diagnosis of venous thromboembolism was associated with one fourth of the patients undergoing neoadjuvant chemotherapy for ovarian cancer with nearly half of these diagnosed during chemotherapy cycles before interval debulking surgery. Efforts to reduce venous thromboembolism so far have largely focused on the postoperative period. Additional attention to venous thromboembolic prophylaxis during chemotherapy (neoadjuvant and adjuvant) in this patient population is warranted in an effort to decrease the rates of venous thromboembolism.
确定接受新辅助化疗的卵巢、输卵管或原发性腹膜癌患者发生静脉血栓栓塞症的发生率和时间，以及任何相关的危险因素。
我们对 2009 年 1 月至 2014 年 5 月在一家学术机构接受新辅助化疗的卵巢癌、输卵管癌和原发性腹膜癌患者进行了回顾性队列研究。整个队列的静脉血栓栓塞事件的时间和数量分为以下几类：首发症状、新辅助化疗期间、肿瘤细胞减灭术（debulking surgery）后和辅助化疗期间。
在 125 例接受新辅助化疗的卵巢癌患者中，有 13 例（10.4%，95%置信区间[CI]为 6.1-17.2%）以静脉血栓栓塞症为首发症状，故被排除在进一步分析之外。在 112 例有风险的患者中，有 30 例（26.8%，95%CI 为 19.3-35.9%）发生了静脉血栓栓塞症。根据治疗阶段，有 13 例（11.6%，95%CI 为 6.8-19.1%）在新辅助化疗期间发生静脉血栓栓塞症，6 例（5.4%，95%CI 为 2.4-11.5%）在肿瘤细胞减灭术后发生静脉血栓栓塞症，11 例（9.9%，95%CI 为 5.5-17%）在辅助化疗期间发生静脉血栓栓塞症。在该队列中，4 例透明细胞组织学患者中有 2 例发生静脉血栓栓塞症。
总体而言，新诊断的静脉血栓栓塞症与接受新辅助化疗的卵巢癌患者的四分之一有关，其中近一半是在间隔肿瘤细胞减灭术之前的化疗周期中诊断出来的。迄今为止，减少静脉血栓栓塞症的努力主要集中在术后阶段。在这一患者人群中，有必要额外关注化疗（新辅助和辅助）期间的静脉血栓栓塞症预防，以降低静脉血栓栓塞症的发生率。
