Lv Yajuan, Hou Yong, Pan Bo, Ma Yuwan, Li Paiyun, Yu Lili, Xu Deguo, Song Juanjuan, Shang Heli, Wang Hongyan, Tian Yuan
Department of Radiation Oncology, Shandong Provincial Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong, 250014, P.R. China.
Key Laboratory of Translational Research, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
Oncotarget. 2018 Jan 12;9(15):12376-12388. doi: 10.18632/oncotarget.24212. eCollection 2018 Feb 23.
The risk of venous thrombosis and mortality associated with central catheter (PICC/CICC) for malignant tumor patients is not definite. So, we carried out a systematic review and meta-analysis to evaluate it. Among patients with comparing PICC with CICC, odds ratio (OR) or risk ratio (RR) was calculated with a random effect model meta-analysis. The result of the stratification analysis of 7 studies (PICC vs CICC) supported the theory that CICCs were associated with a decrease in the odds ratio of thrombosis compared with PICCs. 7 of 15 studies provided the information about the compared mortality rate of the patients. The result showed that CICCs were associated with a decrease in the odds ratio of thrombosis compared with PICCs (OR = 0.45, 95% CI:0.32-0.62, < 0.0001, I = 0%,Tau = 0.00). Meta-analysis of 8 studies of 2639 patients showed that pharmacological deep vein thrombosis prophylaxis drugs could decrease the risk of mortality of malignant tumor patients with CICCs (RR = 0.58, 95% CI:0.48-0.71, = 5.32, < 0.0001, I = 71%). We found that PICCs are associated with a raised risk of deep vein thrombosis, and pharmacological deep vein thrombosis prophylaxis drugs is a beneficial factor in decreasing the incidence of thrombosis, while warfarin may decrease the risk of mortality of malignant tumor patients with CICCs.
恶性肿瘤患者中心静脉导管(经外周静脉穿刺中心静脉置管/中心静脉导管)相关的静脉血栓形成风险和死亡率尚不明确。因此,我们进行了一项系统评价和荟萃分析以评估其风险。在比较经外周静脉穿刺中心静脉置管与中心静脉导管的患者中,采用随机效应模型荟萃分析计算比值比(OR)或风险比(RR)。7项研究(经外周静脉穿刺中心静脉置管与中心静脉导管对比)的分层分析结果支持以下理论:与经外周静脉穿刺中心静脉置管相比,中心静脉导管与血栓形成比值比降低相关。15项研究中的7项提供了患者对比死亡率的信息。结果显示,与经外周静脉穿刺中心静脉置管相比,中心静脉导管与血栓形成比值比降低相关(OR = 0.45,95%CI:0.32 - 0.62,P < 0.0001,I² = 0%,Tau² = 0.00)。对2639例患者的8项研究进行的荟萃分析表明,药物性深静脉血栓形成预防药物可降低中心静脉导管置管的恶性肿瘤患者的死亡风险(RR = 0.58,95%CI:0.48 - 0.71,χ² = 5.32,P < 0.0001,I² = 71%)。我们发现,经外周静脉穿刺中心静脉置管与深静脉血栓形成风险增加相关,药物性深静脉血栓形成预防药物是降低血栓形成发生率的有益因素,而华法林可能降低中心静脉导管置管的恶性肿瘤患者的死亡风险。