Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Division of Surgical Oncology, Department of Surgery, West Virginia University, Morgantown, WV, USA.
Ann Surg Oncol. 2019 May;26(5):1503-1511. doi: 10.1245/s10434-018-07148-z. Epub 2019 Jan 16.
Pancreatic ductal adenocarcinoma (PDA) is associated with a hypercoagulable state, resulting in a high risk of venous thromboembolism (VTE). Risk of VTE is well established for patients receiving chemotherapy for advanced disease and during the perioperative period for patients undergoing surgical resection. However, data are lacking for patients undergoing neoadjuvant treatment followed by resection, who may have a unique risk of VTE because of exposure to both chemotherapy and surgery.
The study included patients with PDA who underwent neoadjuvant therapy followed by surgery from 2007 to June 2017. Development of VTE was evaluated from the start of treatment through the 90-day postoperative period. Risk factors including demographic, treatment, and laboratory variables were evaluated.
The study investigated 426 patients receiving neoadjuvant therapy before surgical resection. Of these patients, 20% had a VTE within 90 days postoperatively (n = 87), and 70% of the VTE occurred during the postoperative period. The VTE included pulmonary embolism (30%), deep vein thrombosis (33%), and thrombosis of the portal vein (PV)/superior mesenteric vein (SMV) (40%). A pretreatment hemoglobin level lower than 10 g/dL and a platelet count higher than 443 were independently associated with VTE during neoadjuvant treatment. The independent predictors of postoperative VTE were a body mass index higher than 35 kg/m, a preoperative platelet-to-lymphocyte ratio higher than 260, resection with distal pancreatectomy with celiac axis resection/total pancreatectomy, PV/SMV resection, and longer operative times. Development of VTE was associated with worse overall and disease-free survival and an independent predictor of survival and decreased likelihood of receiving adjuvant chemotherapy.
Venous thromboembolism during neoadjuvant therapy and the subsequent perioperative period is common and has a significant impact on outcome. Further study into novel thromboprophylaxis measures or protocols during neoadjuvant treatment and the perioperative period is warranted.
胰腺导管腺癌（PDA）与高凝状态相关，导致静脉血栓栓塞（VTE）的风险增加。接受晚期疾病化疗的患者和接受手术切除的围手术期患者的 VTE 风险已得到充分证实。然而，对于接受新辅助治疗后再行切除术的患者，缺乏相关数据，这些患者由于接受化疗和手术的双重暴露，可能具有独特的 VTE 风险。
本研究纳入了 2007 年至 2017 年 6 月期间接受新辅助治疗后行手术的 PDA 患者。从治疗开始到术后 90 天评估 VTE 的发生情况。评估了包括人口统计学、治疗和实验室变量在内的危险因素。
本研究共纳入 426 例接受新辅助治疗后行手术切除的患者。这些患者中，20%（n=87）在术后 90 天内发生 VTE，70%的 VTE 发生在术后。VTE 包括肺栓塞（30%）、深静脉血栓形成（33%）和门静脉（PV）/肠系膜上静脉（SMV）血栓形成（40%）。术前血红蛋白水平低于 10g/dL 和血小板计数高于 443 与新辅助治疗期间的 VTE 独立相关。术后 VTE 的独立预测因素为 BMI 高于 35kg/m2、术前血小板与淋巴细胞比值高于 260、行远端胰腺切除术伴腹腔干切除/全胰腺切除术、PV/SMV 切除术以及手术时间延长。VTE 的发生与总生存期和无病生存期的降低相关，是生存的独立预测因素，并且降低了接受辅助化疗的可能性。
新辅助治疗期间及随后的围手术期发生静脉血栓栓塞较为常见，对结局有显著影响。需要进一步研究新辅助治疗和围手术期的新型血栓预防措施或方案。
