子宫浆液性癌患者静脉血栓栓塞症的危险因素和发生时间特征。

Characterization of Risk Factors and Timing of Venous Thromboembolism in Patients With Uterine Serous Carcinoma.

机构信息

Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, and the Department of Epidemiology & Population Health and the Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York.

出版信息

Obstet Gynecol. 2018 Nov;132(5):1130-1136. doi: 10.1097/AOG.0000000000002932.

DOI:10.1097/AOG.0000000000002932

PMID:30303906

Abstract

OBJECTIVE

To characterize risk factors and timing of venous thromboembolism in women with uterine serous carcinoma.

METHODS

A retrospective cohort study was performed including all women diagnosed with uterine serous carcinoma from 1999 to 2016 at our institution. Clinicopathologic data and information regarding timing of venous thromboembolism were abstracted from the medical record. Logistic regression and Cox proportional hazards modeling were used to examine the association between covariates and risk and timing of venous thromboembolism.

RESULTS

Seventy of the 413 included patients (17%) developed venous thromboembolism, with a median time from presentation to venous thromboembolism of 7.2 months (interquartile range 1.0-24.8) and from surgery to venous thromboembolism of 13.2 months (interquartile range 3.5-33.6). Fifty-nine of the 70 patients (84%) who developed venous thromboembolism were diagnosed either before surgery or greater than 6 weeks postoperatively. Twenty-two of the 70 patients (31%) who developed clots were on chemotherapy at the time of diagnosis. Venous thromboembolism was highly associated with cancer stage and presence of hypertension (P<.01). Cox proportional hazards modeling revealed that only cancer stages III and IV (hazard ratio [HR] 3.20, 95% CI 1.54-6.64 and HR 8.68, 95% CI 4.50-16.73, respectively) and hypertensive or cardiovascular diseases (HR 2.29, 95% CI 1.08-4.85 and HR 1.82, 95% CI 1.05-3.13) were associated with time to venous thromboembolism.

CONCLUSION

Patients with uterine serous carcinoma are at high risk of developing venous thromboembolism even many months after their cancer diagnosis. This study generates the hypothesis that venous thromboembolism prophylaxis may be beneficial in patients with uterine serous carcinoma during other time points along the continuum of disease rather than only in the postoperative period, especially for those with advanced cancer.

摘要

目的

描述患有子宫浆液性癌的女性静脉血栓栓塞的风险因素和时间。

方法

本研究对我院 1999 年至 2016 年间所有诊断为子宫浆液性癌的女性进行了回顾性队列研究。从病历中提取临床病理数据和静脉血栓栓塞发生时间的信息。采用逻辑回归和 Cox 比例风险模型来检验协变量与静脉血栓栓塞风险和时间之间的关系。

结果

413 例患者中，70 例（17%）发生静脉血栓栓塞，从就诊到静脉血栓栓塞的中位时间为 7.2 个月（四分位距 1.0-24.8），从手术到静脉血栓栓塞的中位时间为 13.2 个月（四分位距 3.5-33.6）。70 例发生静脉血栓栓塞的患者中，59 例（84%）在手术前或术后 6 周以上被诊断。70 例发生血栓的患者中，22 例（31%）在诊断时正在接受化疗。静脉血栓栓塞与癌症分期和高血压高度相关（P<.01）。Cox 比例风险模型显示，只有癌症分期 III 期和 IV 期（风险比 [HR] 3.20，95%CI 1.54-6.64 和 HR 8.68，95%CI 4.50-16.73）和高血压或心血管疾病（HR 2.29，95%CI 1.08-4.85 和 HR 1.82，95%CI 1.05-3.13）与静脉血栓栓塞的时间相关。