Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America.
Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States of America.
Gynecol Oncol. 2019 Feb;152(2):286-292. doi: 10.1016/j.ygyno.2018.11.021. Epub 2018 Nov 22.
To determine the incidence and risk factors for venous thromboembolism (VTE) within six months after primary debulking surgery (PDS) for epithelial ovarian cancer (EOC).
In a historical cohort, we estimated the cumulative incidence of clinically diagnosed VTE within 6 months among consecutive women who underwent PDS for EOC at a single institution from 1/1/2003 to 12/31/2011. We evaluated perioperative variables as potential risk factors of VTE within 6 months during the postoperative period using univariate and multivariable Cox proportional hazards models.
Among 860 women without an immediate history (past 30 days) of a VTE, the cumulative incidence of VTE was 7.5% (95% CI, 5.7-9.3) by 30 days and 13.8% (95% CI, 11.4-16.2) by 6 months following surgery. Macroscopic residual disease (adjusted HR 1.99 [95% CI 1.35-2.94] vs microscopic), increasing estimated blood loss (1.25 [1.05-1.49] per doubling), longer hospital length of stay (3.00 [1.57-5.75]), and experiencing a cardiac event within 30 postoperative days (2.72 [1.55-4.80]) were independently associated with subsequent VTE within 6 months. In-hospital VTE prophylaxis included heterogeneous approaches; dual prophylaxis did not impact 30-day or 6-month VTE rates.
VTE occurred in 1 in 7 women with EOC within 6 months of PDS-a substantial risk of VTE that extends into the adjuvant chemotherapy period. Novel prophylactic measures should be explored in these women at high risk for VTE.
确定上皮性卵巢癌（EOC）患者行初次肿瘤细胞减灭术后 6 个月内静脉血栓栓塞症（VTE）的发生率和相关风险因素。
在一项历史性队列研究中，我们评估了 2003 年 1 月 1 日至 2011 年 12 月 31 日期间于单中心行初次肿瘤细胞减灭术的 EOC 患者，术后 6 个月内临床诊断 VTE 的累积发生率。我们使用单变量和多变量 Cox 比例风险模型评估围手术期变量作为术后 6 个月内 VTE 的潜在风险因素。
在 860 例无近期（过去 30 天内）VTE 病史的患者中，术后 30 天和 6 个月时 VTE 的累积发生率分别为 7.5%（95%CI，5.7-9.3）和 13.8%（95%CI，11.4-16.2）。大体残留疾病（校正 HR 1.99[95%CI 1.35-2.94]vs 显微镜下）、估计失血量增加（每增加 1 倍，1.25[1.05-1.49]）、住院时间延长（3.00[1.57-5.75]）和术后 30 天内心脏事件（2.72[1.55-4.80]）与术后 6 个月内发生 VTE 独立相关。住院期间的 VTE 预防措施采用了不同的方法；双重预防并不能影响 30 天或 6 个月的 VTE 发生率。
初次肿瘤细胞减灭术后 6 个月内，EOC 患者中有 1/7 发生 VTE-这是 VTE 的一个很大风险，会延伸到辅助化疗期。应在这些 VTE 高危患者中探索新的预防措施。
