Department of Medicine, University at Buffalo, Buffalo, NY.
Department of Diagnostic Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Clin Colorectal Cancer. 2018 Jun;17(2):121-128. doi: 10.1016/j.clcc.2018.01.008. Epub 2018 Jan 31.
Visceral or splanchnic thrombosis is defined as thrombi within the hepatoportal venous system, including portal (PV), mesenteric (MV), and splenic vein (SV), as well as thrombi in renal or gonadal veins. There are limited data to evaluate the prognostic significance, incidence, and clinical management of visceral thromboses in patients with pancreatic ductal adenocarcinoma (PDAC).
We conducted an analysis of 95 patients treated at Memorial Sloan Kettering Cancer Center with PDAC who had a visceral thrombosis.
A total of 153 visceral thromboses (VsT) were identified in 95 patients (n = 51, 54% woman). A total of 36 patients (37%) had locally advanced disease, and n = 59 (62%) had metastatic disease. Systemic therapies received included FOLFIRINOX (n = 57, 60%) and GC/PTX (n = 27, 28%). All VsT events were incidentally detected. Overall survival of cohort was 12.3 months (range, 10.2-14.4 months). Visceral thrombosis incidence in the cohort was as follows: portal vein (PV) (45%), MV (26%), SV (17%), and gonadal veins (8%). Time to develop first VsT was 4.3 months (range, 3-5.6 months), and time to death from VsT development was 1.87 months (range, 0.8-2.8 months). Forty-five patients (47%) developed a second VsT. Sixty percent had a Khorana risk score of > 3. Thirty-nine patients (41%) were treated with short-term anticoagulation (AC) (< 1 month) (low-molecular-weight heparin, n = 34). Forty-five patients (47%) were treated with long-term AC (> 1 month) (low-molecular-weight heparin, n = 32; 23 were transitioned to an oral anticoagulant). Twenty-two patients (23%) were not treated with AC. Eight patients (8%) had a bleeding complication from AC. Portal vein thrombosis had the shortest overall survival at 3.6 months (range, 2.3-4.8 months).
In PDAC, VsT can frequently present as an incidental finding on routine abdominal imaging. The most common location is PV, followed by MV and SV. We observed that AC is underutilized in this setting despite a low bleeding complication rate. PV was associated with the least overall survival of the VsT. Future large prospective studies should explore the role of AC and value in this setting.
内脏或内脏血栓形成定义为肝门静脉系统内的血栓，包括门静脉 (PV)、肠系膜 (MV) 和脾静脉 (SV)，以及肾或性腺静脉内的血栓。目前评估胰腺导管腺癌 (PDAC) 患者内脏血栓形成的预后意义、发生率和临床处理的数据有限。
我们对在纪念斯隆凯特琳癌症中心接受治疗的 95 例 PDAC 患者进行了分析，这些患者存在内脏血栓形成。
95 例患者共发现 153 例内脏血栓形成（VsT）（n=51，54%为女性）。36 例患者（37%）患有局部晚期疾病，59 例患者（62%）患有转移性疾病。接受的系统治疗包括 FOLFIRINOX（n=57，60%）和 GC/PTX（n=27，28%）。所有 VsT 事件均为偶然发现。该队列的总生存时间为 12.3 个月（范围，10.2-14.4 个月）。该队列中内脏血栓形成的发生率如下：门静脉（PV）（45%）、MV（26%）、SV（17%）和性腺静脉（8%）。首次出现 VsT 的时间为 4.3 个月（范围，3-5.6 个月），因 VsT 发展而死亡的时间为 1.87 个月（范围，0.8-2.8 个月）。45 例患者（47%）发生第二次 VsT。60%的患者 Khorana 风险评分>3。39 例患者（41%）接受短期抗凝治疗（<1 个月）（低分子量肝素，n=34）。45 例患者（47%）接受长期抗凝治疗（>1 个月）（低分子量肝素，n=32；23 例转为口服抗凝剂）。22 例患者（23%）未接受 AC 治疗。8 例患者（8%）因 AC 发生出血并发症。门静脉血栓形成的总生存时间最短，为 3.6 个月（范围，2.3-4.8 个月）。
在 PDAC 中，VsT 通常在常规腹部成像时偶然发现。最常见的部位是 PV，其次是 MV 和 SV。尽管出血并发症发生率较低，但我们观察到在此情况下 AC 的应用不足。PV 与 VsT 中总体生存率最低相关。未来的大型前瞻性研究应探讨该情况下 AC 的作用和价值。
