Department of Medicine, University at Buffalo, Buffalo, NY.
Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY.
Clin Colorectal Cancer. 2018 Jun;17(2):e207-e216. doi: 10.1016/j.clcc.2017.12.001. Epub 2017 Dec 12.
Within gastrointestinal malignancies, primary hepatocellular carcinoma and pancreatic ductal adenocarcinoma (PDAC) are frequently associated with visceral thromboses (VT). Thrombus formation in the portal (PVT), mesenteric (MVT), or splenic vein (SVT) system leads to portal hypertension and intestinal ischemia. VT in PDAC may convey a risk of increased distal thrombosis and poses therapeutic uncertainty regarding the role of anticoagulation. An increasing number of reports describe VT associated with PDAC. It is possible that early diagnosis of these events may help reduce morbidity and speculatively improve oncologic outcomes. To perform a systematic review to study PVT, MVT, and SVT associated with PDAC, and to provide a comprehensive review. Medline/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library. Data Extraction and Assessment: Two blinded independent observers extracted and assessed the studies for diagnosis of PVT, MVT, and SVT in PDAC. Studies were restricted to English-language literature published between 2007 and 2016. Eleven articles were identified. Five case reports and 7 retrospective studies were found, with a total of 127 patients meeting the inclusion criteria. The mean age at diagnosis was 64 years. PVT was found in 35% (n = 46), SVT in 52% (n = 65), and MVT in 13% (n = 15). Mean follow-up time was 26 months. Only 3 of the selected articles studied the impact of anticoagulation in VT. All patients with nonvisceral thrombosis (eg, deep-vein thrombosis, pulmonary emboli) were therapeutically treated; in contrast, patients with VT only rarely received treatment. VT in PDAC is a frequent finding at diagnosis or during disease progression. Evidence to guide treatment choices is limited, and current management is based on inferred experience from nononcologic settings. Anticoagulation appears to be safe in VT, with most of the large studies recommending a careful assessment for patients at a high risk of bleeding.
在胃肠道恶性肿瘤中，原发性肝细胞癌和胰腺导管腺癌（PDAC）常伴有内脏血栓形成（VT）。门静脉（PVT）、肠系膜（MVT）或脾静脉（SVT）系统的血栓形成导致门静脉高压和肠缺血。PDAC 中的血栓可能增加远端血栓形成的风险，并对抗凝治疗的作用提出治疗上的不确定性。越来越多的报告描述了与 PDAC 相关的 VT。早期诊断这些事件可能有助于降低发病率，并推测改善肿瘤学结果。进行系统综述，以研究与 PDAC 相关的 PVT、MVT 和 SVT，并提供全面的综述。Medline/PubMed、Embase、Web of Science、Scopus 和 Cochrane 图书馆。数据提取和评估：两名盲法独立观察者提取并评估了诊断 PDAC 中 PVT、MVT 和 SVT 的研究。研究仅限于 2007 年至 2016 年期间发表的英语文献。共确定了 11 篇文章。发现 5 篇病例报告和 7 篇回顾性研究，共有 127 名符合纳入标准的患者。诊断时的平均年龄为 64 岁。35%（n=46）发现 PVT，52%（n=65）发现 SVT，13%（n=15）发现 MVT。平均随访时间为 26 个月。只有 3 篇选定的文章研究了 VT 中抗凝的影响。所有非内脏血栓形成（如深静脉血栓形成、肺栓塞）患者均接受治疗性治疗；相比之下，只有极少数 VT 患者接受治疗。PDAC 中的 VT 在诊断时或疾病进展过程中经常发现。指导治疗选择的证据有限，目前的治疗方法基于非肿瘤学环境中推断的经验。抗凝在 VT 中似乎是安全的，大多数大型研究建议对高出血风险的患者进行仔细评估。
