Qiao L S, Xu X M, Yang H, Fang B M, Tan Z, Jin J
Division of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, National Center of Respiratory Disease, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2018 May 15;98(18):1403-1407. doi: 10.3760/cma.j.issn.0376-2491.2018.18.007.
To compare the clinical characteristics and outcomes of patients with lung cancer, gastrointestinal (GI) cancer and urologic cancer with venous thromboembolism (VTE). From January 2003 to January 2013, 192 lung cancer, GI cancer and urologic cancer patients with VTE were retrospectively evaluated for the clinical characteristics and outcomes. Among 192 patients, 82 cases of lung cancer, 78 cases of GI cancer, 32 cases of urologic cancer were involved. The Eastern Cooperative oncology Group Performance Status score of GI cancer group was significantly higher than those of the lung cancer and urologic cancer groups[(2.4±1.1) vs (2.0±1.4), (1.8±1.0), both <0.05]. The proportion of smoking patients in lung cancer group was significantly higher than that in GI cancer and urologic cancer groups (79.3% vs 30.8%, 53.1%, both <0.05), while the proportion of operation was significantly lower than that in the latter two groups (35.4% vs 53.8%, 68.8%, both <0.05). Pathological types of cancer were mostly adenocarcinoma, and the proportion of adenocarcinoma in lung cancer and GI cancer groups was significantly higher than that in urologic cancer group (76.9%, 73.8% vs 37.9%, both <0.001). The proportion of moderately and/or poorly differentiated histodifferentiation in the first two groups was significantly higher than that of urologic cancer group (90.0%, 95.7% vs 40.0%, both <0.001). The proportion of patients with TNM stage Ⅲ-Ⅳ in lung cancer group was significantly higher than that of the urological cancer group (87.0% vs 64.3%, <0.05). The incidence of VTE in lung cancer group was significantly higher than those of GI cancer and urologic cancer groups within 6 months after tumor diagnosis, chemotherapy and operation (79.3% vs 60.3%, 46.9%; 76.5% vs 48.6%, 36.4%; 92.3% vs 57.9%, 59.1%; all <0.05). The case fatality rate within one year in lung cancer and GI cancer groups was significantly higher than that in urologic cancer group (51.2%, 52.6% vs 18.8%, both <0.01). The median survival time of the lung cancer and GI cancer groups was significantly shorter than that of the urological cancer group (=0.001, 0.010, respectively). Adenocarcinoma, advanced cancer, and poor histodifferentiation are risk factors of VTE in cancer patients. Most events of VTE occur within 6 months after a diagnosis of cancer. The prognosis of lung cancer and GI cancer complicated with VTE is worse than that of urologic cancer with VTE.
比较肺癌、胃肠道（GI）癌和泌尿系统癌患者发生静脉血栓栓塞（VTE）的临床特征及预后。回顾性评估2003年1月至2013年1月期间192例发生VTE的肺癌、胃肠道癌和泌尿系统癌患者的临床特征及预后。192例患者中，肺癌82例，胃肠道癌78例，泌尿系统癌32例。胃肠道癌组的东部肿瘤协作组体能状态评分显著高于肺癌组和泌尿系统癌组[（2.4±1.1） vs （2.0±1.4），（1.8±1.0），均P<0.05]。肺癌组吸烟患者比例显著高于胃肠道癌组和泌尿系统癌组（79.3% vs 30.8%，53.1%，均P<0.05），而手术比例显著低于后两组（35.4% vs 53.8%，68.8%，均P<0.05）。癌症病理类型大多为腺癌，肺癌组和胃肠道癌组腺癌比例显著高于泌尿系统癌组（76.9%，73.8% vs 37.9%，均P<0.001）。前两组中、高分化组织学分化比例显著高于泌尿系统癌组（90.0%，95.7% vs 40.0%，均P<0.001）。肺癌组TNMⅢ-Ⅳ期患者比例显著高于泌尿系统癌组（87.0% vs 64.3%，P<0.05）。肺癌组在肿瘤诊断、化疗及手术后6个月内VTE发生率显著高于胃肠道癌组和泌尿系统癌组（79.3% vs 60.3%，46.9%；76.5% vs 48.6%，36.4%；92.3% vs 57.9%，59.1%；均P<0.05）。肺癌组和胃肠道癌组1年内病死率显著高于泌尿系统癌组（51.2%，52.6% vs 18.8%，均P<0.01）。肺癌组和胃肠道癌组的中位生存时间显著短于泌尿系统癌组（分别为P=0.001，P=0.010）。腺癌、晚期癌症及低组织学分化是癌症患者发生VTE的危险因素。大多数VTE事件发生在癌症诊断后6个月内。肺癌和胃肠道癌合并VTE的预后比泌尿系统癌合并VTE的预后差。
