术前化疗的食管胃腺癌患者发生血栓栓塞并发症的预测因素。

Predictive factors of thromboembolic complications in patients with esophagogatric adenocarcinoma undergoing preoperative chemotherapy.

机构信息

a Department of Medical Oncology , The Christie NHS Foundation Trust , Manchester , UK.

b Department of Medical Oncology , The Mid Yorkshire Hospitals NHS Trust , Wakefield , UK.

出版信息

Acta Oncol. 2018 Jun;57(6):790-798. doi: 10.1080/0284186X.2017.1423375. Epub 2018 Jan 8.

DOI:10.1080/0284186X.2017.1423375

PMID:29308947

Abstract

BACKGROUND

Thromboembolic events (TEEs) represent a significant treatment and disease complication for cancer patients. In the present study we assessed the incidence of TEEs in patients receiving preoperative chemotherapy for esophagogastric adenocarcinoma. The risk factors for TEE development and their impact on prognosis were further analyzed.

MATERIAL AND METHODS

Data from 590 patients with esophagogastric adenocarcinoma, who received preoperative epirubicin-cisplatin with capecitabine (ECX) or 5-fluorouracil (ECF) between 2009 and 2016 in three UK hospitals were retrospectively collected.

RESULTS

Twenty-one percent had stomach primary and 98% received ECX chemotherapy. In total, 52 patients (9%) had a venous and 22 (4%) an arterial event. Of those patients with venous TEEs (vTTEs), 39 had pulmonary embolism and 13 deep vein thrombosis, whereas in patients with arterial TEEs (arTTEs), 7 developed a myocardial infarct, 8 developed limb ischemia, 4 developed cerebrovascular accidents and 3 developed superior mesenteric artery thrombosis. ArTEEs were associated with a much higher inoperability rate compared to cases without TEE or with vTEE (77% vs. 20% vs. 31%, respectively, p < .001). Independent risk factors of vTEEs were primary site being the stomach (Odds ratio [OR] 3.24, 95%CI 1.72-6.12, p < .001), being overweight (OR 3.11, 95%CI 1.33-7.26, p = .009) or obese (OR 4.52, 95%CI 1.85-11.09, p = .001) and the presence of central venous access device (OR 3.40, 95%CI 1.00-11.55, p = .050). In contrast, anticoagulant treatment was independently associated with a lower risk of vTEE (OR 0.22, 95%CI 0.06-0.83, p = .026). Khorana score of 4-5 was an independent risk factor of arTEE (OR 6.38, 95%CI 1.85-22.04, p = .003). Finally, arTEEs were an independent poor prognostic factor for OS, when adjusted for baseline patient, tumor and treatment characteristics (Hazard ratio 3.02, 95%CI 1.85-4.95, p < .001).

CONCLUSION

Preoperative ECX/ECF chemotherapy for patients with resectable esophagogastric adenocarcinoma was associated with relatively high incidence of TEEs. However, only arTEEs affected patient survival outcomes.

摘要

背景

血栓栓塞事件（TEEs）是癌症患者治疗和疾病的严重并发症。本研究评估了接受术前化疗的胃食管腺癌患者 TEE 的发生率。进一步分析了 TEE 发生的危险因素及其对预后的影响。

材料与方法

回顾性收集了 2009 年至 2016 年期间，3 家英国医院的 590 名胃食管腺癌患者接受表柔比星联合顺铂加卡培他滨（ECX）或氟尿嘧啶（ECF）术前化疗的数据。

结果

21%的患者为胃原发癌，98%接受 ECX 化疗。共有 52 例（9%）患者发生静脉 TEEs（vTTEs），22 例（4%）发生动脉 TEEs（arTTEs）。vTTEs 患者中，39 例发生肺栓塞，13 例发生深静脉血栓形成，而 arTTEs 患者中，7 例发生心肌梗死，8 例发生肢体缺血，4 例发生脑血管意外，3 例发生肠系膜上动脉血栓形成。与无 TEE 或 vTTE 的患者相比，arTTEs 患者的手术切除率明显更高（分别为 77%、20%和 31%，p < .001）。vTTEs 的独立危险因素包括原发部位为胃（比值比 [OR] 3.24，95%CI 1.72-6.12，p < .001）、超重（OR 3.11，95%CI 1.33-7.26，p = .009）或肥胖（OR 4.52，95%CI 1.85-11.09，p = .001）和中央静脉置管（OR 3.40，95%CI 1.00-11.55，p = .050）。相比之下，抗凝治疗与 vTTE 风险降低独立相关（OR 0.22，95%CI 0.06-0.83，p = .026）。Khorana 评分 4-5 是 arTTEs 的独立危险因素（OR 6.38，95%CI 1.85-22.04，p = .003）。最后，在调整基线患者、肿瘤和治疗特征后，arTTEs 是 OS 的独立不良预后因素（危险比 3.02，95%CI 1.85-4.95，p < .001）。