Liu Yan'e, Gu Yangchun, Yi Fumei, Cao Baoshan
Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China.
Zhongguo Fei Ai Za Zhi. 2019 Jul 20;22(7):419-426. doi: 10.3779/j.issn.1009-3419.2019.07.03.
Patients with lung cancer have high risk of developing venous thromboembolism (VTE), which has been shown to have a significant impact on mortality. This study was to identify the incidence of VTE in lung cancer patients during systemic therapy and to analyze the risk factors associated with it.
We retrospectively analyzed the cases of 283 patients with lung cancer who received systemic therapy in the Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, from January 2016 to December 2018. Chi-square test and multivariate analyses were used to assess the correlation between clinical features and VTE.
Of the patients we observed, 34 developed VTE, with an incidence of 12.01% (34/283). In patients with lower extremity varicose vein (LVV), there was an increase in the incidence of VTE (50.00% vs 9.89%, P=0.001). The incidence VTE in patients with distant metastasis was higher than that in patients without distant metastasis, and higher than that in patients with tumor-free (14.05% vs 14.00% vs 2.08%, P=0.024). The incidence of VTE in patients with active tumor was also significantly higher than that in patients without it (16.93% vs 8.18%, P=0.025). Patients with hypoalbuminemia (albumin <35 g/L) had more VTE events more than those without did (22.00% vs 9.87%, P=0.017), and patients with an elevated D-dimer level (>0.3 µg/mL) developed more VTE than those without did (17.93% vs 5.80%, P=0.006). There were no significant correlations between pathological types, blood cell count before systemic therapy including leukocyte, hemoglobin and platelet, or antiangiogenic drugs and VTE. Multivariate analysis showed that LVV, hypoalbuminemia and elevated level of D-dimer were independent risk factors of VTE.
LVV, serum albumin and D-dimer level may be potential and more effective predictors of VTE in lung cancer patients during systemic therapy. Basing on these factors, new predictive model can be built, and further study to validate its efficacy is required.
肺癌患者发生静脉血栓栓塞症（VTE）的风险较高，已证实VTE对死亡率有重大影响。本研究旨在确定肺癌患者在全身治疗期间VTE的发生率，并分析与之相关的危险因素。
我们回顾性分析了2016年1月至2018年12月在北京大学第三医院肿瘤内科和放射病科接受全身治疗的283例肺癌患者的病例。采用卡方检验和多因素分析来评估临床特征与VTE之间的相关性。
在我们观察的患者中，34例发生了VTE，发生率为12.01%（34/283）。下肢静脉曲张（LVV）患者的VTE发生率增加（50.00%对9.89%，P=0.001）。远处转移患者的VTE发生率高于无远处转移患者，且高于无肿瘤患者（14.05%对14.00%对2.08%，P=0.024）。有活动性肿瘤的患者VTE发生率也显著高于无活动性肿瘤的患者（16.93%对8.18%，P=0.025）。低白蛋白血症（白蛋白<35 g/L）患者的VTE事件比无低白蛋白血症的患者更多（22.00%对9.87%，P=0.017），D-二聚体水平升高（>0.3 µg/mL）的患者发生VTE的情况比未升高的患者更多（17.93%对5.80%，P=0.006）。病理类型、全身治疗前的血细胞计数（包括白细胞、血红蛋白和血小板）或抗血管生成药物与VTE之间无显著相关性。多因素分析显示，LVV、低白蛋白血症和D-二聚体水平升高是VTE的独立危险因素。
LVV、血清白蛋白和D-二聚体水平可能是肺癌患者全身治疗期间VTE的潜在且更有效的预测指标。基于这些因素，可以建立新的预测模型，需要进一步研究以验证其有效性。
