Mitani Akihisa, Jo Taisuke, Yasunaga Hideo, Sakamoto Yukiyo, Hasegawa Wakae, Urushiyama Hirokazu, Yamauchi Yasuhiro, Matsui Hiroki, Fushimi Kiyohide, Nagase Takahide
Departments of Respiratory Medicine.
Health Services Research, Graduate School of Medicine.
Anticancer Drugs. 2018 Jul;29(6):560-564. doi: 10.1097/CAD.0000000000000625.
An association between chemotherapy and venous thromboembolic events (VTEs) in patients with cancer is well established, with cisplatin (CDDP) being one of the most well-studied risk factors. However, whether CDDP is more strongly associated with occurrence of VTEs than carboplatin (CBDCA) or nedaplatin (CDGP) is controversial. Our purposes were to characterize patients with lung cancer and in-hospital VTEs, identify risk factors associated with VTEs, and compare the risks associated with CDDP-based versus CBDCA/CDGP-based chemotherapy. We retrospectively identified patients with lung cancer who underwent platinum-based chemotherapy from April 2012 to March 2015 from a national inpatient database in Japan. We used multivariable logistic regression analysis to analyze associations between various factors, including chemotherapy regimens and VTE. Of 235 104 eligible patients, 675 (0.29%) had VTEs after receiving platinum-based chemotherapy while hospitalized. Multivariable analysis showed that age, activity of daily living index, and invasive medical procedures were significant risk factors for the occurrence of VTE. Furthermore, CDDP-based chemotherapy was associated with a higher rate of VTE than CBDCA/CDGP-based chemotherapy (adjusted odds ratio: 1.35; 95% confidence interval: 1.08-1.68; P<0.01). In conclusion, CDDP-based chemotherapy is a stronger risk factor for VTEs than CBDCA/CDGP-based chemotherapy in patients with lung cancer.
化疗与癌症患者静脉血栓栓塞事件（VTEs）之间的关联已得到充分证实，顺铂（CDDP）是研究最为深入的风险因素之一。然而，CDDP与VTEs发生的关联是否比卡铂（CBDCA）或奈达铂（CDGP）更强仍存在争议。我们的目的是对肺癌合并院内VTEs患者进行特征描述，确定与VTEs相关的风险因素，并比较基于CDDP的化疗与基于CBDCA/CDGP的化疗相关的风险。我们从日本全国住院患者数据库中回顾性地识别了2012年4月至2015年3月期间接受铂类化疗的肺癌患者。我们使用多变量逻辑回归分析来分析包括化疗方案和VTE在内的各种因素之间的关联。在235104例符合条件的患者中，675例（0.29%）在住院接受铂类化疗后发生了VTEs。多变量分析显示，年龄、日常生活活动指数和侵入性医疗操作是VTEs发生的重要风险因素。此外，与基于CBDCA/CDGP的化疗相比，基于CDDP的化疗与更高的VTE发生率相关（调整后的优势比：1.35；95%置信区间：1.08 - 1.68；P<0.01）。总之，在肺癌患者中，基于CDDP的化疗比基于CBDCA/CDGP的化疗是更强的VTEs风险因素。
