Diaz Quintero Luis A, Fuentes Harry E, Tafur Alfonso J, Majmudar Kaushal, Salazar Adum Juan P, Golemi Iva, Paz Luis H, Stocker Susan, Talamonti Mark
Division of Internal Medicine, Department of Medicine, NorthShore University HealthSystem, Evanston, IL, USA -
Division of Hematology and Oncology, Department of Medicine, Mayo Clinic Rochester, Rochester, MN, USA.
Int Angiol. 2019 Jun;38(3):194-200. doi: 10.23736/S0392-9590.19.04127-0. Epub 2019 May 16.
BACKGROUND: The aim of this study was to define the association of non-adenocarcinoma pancreatic cancer (NACPC) as a risk factor for postoperative cancer-associated thrombosis (CAT). METHODS: We conducted analysis of prospectively collected data of pancreatic cancer surgery. Randomly collected NACPC cases were matched 1:3 to adenocarcinoma cases (ACPC). Variables included comorbidities, demographics, cancer extension, and preoperative Khorana score (KRS). Primary outcome was CAT, which included deep vein thrombosis and pulmonary embolism confirmed by imaging. Categorical variables are presented as percentages, continuous variables as median and range. SPSS, χ2, Cochran-Armitage, and logistic regression were use for analysis. RESULTS: The study included 441 patients. Age 65.9±11.5, male 57% (N.=252), 8% (N.=36) had metastasis. IPMN and neuroendocrine were the most common NACPC. Median follow-up was 449 days in which 90 (20%) patients developed CAT. The odds (Odds Ratio [OR] 1.1, 95% Confidence Interval [CI] 0.6- 1.9, P=0.7) and time to venous thromboembolism were not different between NACPC and ACPC. We analyzed for trends of prophylactic strategies by year of surgery; there was no trend for NACPC (P=0.4) or ACPC (P=0.06). KRS was not associated with CAT. In the multivariate analysis, peripheral artery disease (Adjusted Odds Ratio [ORadj] 5.4, 95% CI: 1.7-17.3), ASA class ≥4 (ORadj 3.6; 95% CI: 1.3-10.4), length of stay >9 days (ORadj: 1.9; 1.2-3.2), and cancer vascular invasion (ORadj: 2.9; 95% CI: 1.6-5.3) were associated with CAT. CONCLUSIONS: The rate of VTE in NACPC after surgery was high and not different than ACPC. Histology type should not govern discrimination in thromboprophylaxis selection or extension.
背景:本研究的目的是确定非腺癌性胰腺癌(NACPC)作为术后癌症相关血栓形成(CAT)危险因素的相关性。 方法:我们对前瞻性收集的胰腺癌手术数据进行了分析。将随机收集的NACPC病例与腺癌病例(ACPC)按1:3进行匹配。变量包括合并症、人口统计学、癌症分期和术前Khorana评分(KRS)。主要结局是CAT,包括经影像学证实的深静脉血栓形成和肺栓塞。分类变量以百分比表示,连续变量以中位数和范围表示。使用SPSS、χ2检验、 Cochr an-Armitage检验和逻辑回归进行分析。 结果:该研究纳入了441例患者。年龄为65.9±11.5岁,男性占57%(n = 252),8%(n = 36)有转移。导管内乳头状黏液性肿瘤(IPMN)和神经内分泌肿瘤是最常见的NACPC。中位随访时间为449天,其中90例(20%)患者发生了CAT。NACPC和ACPC之间的发生几率(优势比[OR] 1.1,95%置信区间[CI] 0.6 - 1.9,P = 0.7)和静脉血栓栓塞发生时间无差异。我们分析了手术年份的预防策略趋势;NACPC(P = 0.4)或ACPC(P = 0.06)均无趋势。KRS与CAT无关。在多变量分析中,外周动脉疾病(调整后优势比[ORadj] 5.4,95% CI:1.7 - 17.3)、美国麻醉医师协会(ASA)分级≥4(ORadj 3.6;95% CI:1.3 - 10.4)、住院时间>9天(ORadj:1.9;1.2 - 3.2)和癌症血管侵犯(ORadj:2.9;95% CI:1.6 - 5.3)与CAT相关。 结论:NACPC术后静脉血栓栓塞(VTE)发生率较高,与ACPC无差异。组织学类型不应作为血栓预防选择或延长预防时间的判别依据。
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