Cohen Abigail, Lim Chung Sim, Davies Alun Huw
Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom.
Int J Gynecol Cancer. 2017 Nov;27(9):1970-1978. doi: 10.1097/IGC.0000000000001111.
Venous thromboembolism (VTE) is a recognized complication of gynecological malignancy and represents a leading cause of morbidity and mortality in these patients. The review aimed to discuss the incidence, risk factors, and clinical presentation of VTE before examining the literature on the diagnosis, prevention, and management in the context of uterine, cervical, ovarian, and vulval cancers.
METHODS/MATERIALS: A literature search was performed using Ovid Medline and Embase with the following words: "gynecological malignancy," "pelvic tumor," "venous thromboembolism," "deep vein thrombosis" and "pulmonary embolism."
The incidence of VTE in patients with gynecological malignancy ranged between 3% and 25% and was affected by several patient and tumor factors. Duplex ultrasonography is currently the first-line imaging modality for deep venous thrombosis with sensitivity and specificity of up to 95% and 100%, respectively. Low-molecular-weight heparin is currently the VTE prophylaxis and treatment of choice for patients with gynecological malignancy, although warfarin and unfractionated heparin play a role in selected circumstances. The relatively new direct oral anticoagulants including factor Xa inhibitors and direct thrombin inhibitors are increasingly being used, although further evaluations are required, particularly in cancer patients. Catheter-directed thrombolysis and percutaneous mechanical and surgical thrombectomy may have a role in treating patients with severe symptomatic iliocaval or iliofemoral deep venous thrombosis. Overall, VTE is a poor prognosis marker in patients with gynecological malignancy.
Gynecological malignancy-associated VTE is associated with significant morbidity, contributing to a large number of life years lost. Although promising new therapies are emerging, a 2-pronged approach is required to simultaneously target cancer-specific management and predict early on those who are likely to be affected. In the meantime, clinicians should continue to combine current guidelines with a multidisciplinary team approach to ensure that these complex patients receive the best evidence-based and compassionate care.
静脉血栓栓塞症（VTE）是妇科恶性肿瘤公认的一种并发症，是这些患者发病和死亡的主要原因。本综述旨在讨论VTE的发病率、危险因素和临床表现，然后再审视关于子宫癌、宫颈癌、卵巢癌和外阴癌的诊断、预防及管理方面的文献。
方法/材料：使用Ovid Medline和Embase进行文献检索，检索词如下：“妇科恶性肿瘤”、“盆腔肿瘤”、“静脉血栓栓塞症”、“深静脉血栓形成”和“肺栓塞”。
妇科恶性肿瘤患者中VTE的发病率在3%至25%之间，受多种患者和肿瘤因素影响。目前，双功超声检查是诊断深静脉血栓形成的一线影像学检查方法，其敏感性和特异性分别高达95%和100%。低分子量肝素是目前妇科恶性肿瘤患者VTE预防和治疗的首选药物，尽管华法林和普通肝素在特定情况下也发挥作用。包括Xa因子抑制剂和直接凝血酶抑制剂在内的相对较新的直接口服抗凝剂的使用越来越多，不过还需要进一步评估，尤其是在癌症患者中。导管定向溶栓以及经皮机械性和外科血栓切除术可能在治疗有严重症状的髂总静脉或髂股深静脉血栓形成患者中发挥作用。总体而言，VTE是妇科恶性肿瘤患者预后不良的指标。
妇科恶性肿瘤相关的VTE与显著的发病率相关，导致大量生命年损失。尽管有前景的新疗法不断涌现，但仍需要采取双管齐下的方法，同时针对癌症的特异性管理并尽早预测哪些患者可能受到影响。与此同时，临床医生应继续将当前指南与多学科团队方法相结合，以确保这些复杂患者获得最佳的循证且充满关爱的治疗。
