Department of Gynecology and Obstetrics, Aalborg University Hospital, Denmark; Department of Surgical Gastroenterology, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Denmark.
Department of Gynecology and Obstetrics, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark.
Gynecol Oncol. 2019 Oct;155(1):112-118. doi: 10.1016/j.ygyno.2019.07.022. Epub 2019 Aug 1.
We aimed to clarify if endometrial cancer patients are at higher risk of venous thromboembolism (VTE) following hysterectomy, compared to patients undergoing hysterectomy for benign gynecological disease.
In a nationwide registry-based cohort study, patients undergoing hysterectomy for endometrial cancer or benign disease were followed 30 days after surgery. The Danish Gynecological Cancer Database (DGCD) and the Danish National Patient Register (DNPR) were linked with four other administrative registries to describe the population and retrieve data on venous thromboembolism and mortality. Multivariable logistic regression models were used to estimate odds ratios (ORs) for 30-day postoperative VTE.
We identified 5513 patients with endometrial cancer, and 45,825 patients with benign disease undergoing hysterectomy in the period 2005-2014. The overall incidence of 30-day VTE following hysterectomy was 0.2% (103/51,338). Thirty (0.5%) patients with endometrial cancer and 73 (0.16%) patients with benign disease developed VTE. In a multivariable logistic regression analysis, significant predictors of 30-day OR for VTE were open surgery (minimally invasive surgery vs. open: OR = 0.46; 95% CI, 0.30-0.71; p < 0.001), lymphadenectomy (OR = 4.00; 95% CI, 1.89-8.46; p < 0.001), BMI > 40 (OR = 2.34;95% CI, 1.10-5.01; p = 0.03) and previous VTE (OR = 34; 95% CI, 22.7-51.3; p < 0.001). There was no statistically significant difference in the 30-day OR for VTE in endometrial cancer compared to benign disease (OR = 1.47; 95% CI, 0.74-2.91; p = 0.27).
This study did not identify endometrial cancer to be an independent risk factor for VTE following hysterectomy compared to benign disease. We identified open surgery, lymphadenectomy, BMI above 40 and previous VTE as independent risk factors for 30-day postoperative VTE.
本研究旨在明确与因良性妇科疾病行子宫切除术的患者相比，子宫内膜癌患者在子宫切除术后发生静脉血栓栓塞症（VTE）的风险是否更高。
本项全国范围内基于登记的队列研究纳入了 2005 年至 2014 年期间因子宫内膜癌或良性疾病行子宫切除术的患者，在术后 30 天内对其进行随访。丹麦妇科癌症数据库（DGCD）和丹麦国家患者登记处（DNPR）与另外四个行政登记处相链接，以描述人群并获取静脉血栓栓塞症和死亡率数据。多变量逻辑回归模型用于估计术后 30 天内 VTE 的比值比（OR）。
我们共确定了 5513 例子宫内膜癌患者和 45825 例因良性疾病行子宫切除术的患者。术后 30 天内 VTE 的总体发生率为 0.2%（51338 例中有 103 例）。30 例（0.5%）子宫内膜癌患者和 73 例（0.16%）良性疾病患者发生了 VTE。在多变量逻辑回归分析中，VTE 的 30 天 OR 的显著预测因素包括开腹手术（微创手术与开腹手术：OR=0.46；95%CI，0.30-0.71；p<0.001）、淋巴结切除术（OR=4.00；95%CI，1.89-8.46；p<0.001）、BMI>40（OR=2.34；95%CI，1.10-5.01；p=0.03）和既往 VTE（OR=34；95%CI，22.7-51.3；p<0.001）。与良性疾病相比，子宫内膜癌患者术后 30 天 VTE 的 OR 无统计学显著差异（OR=1.47；95%CI，0.74-2.91；p=0.27）。
与良性疾病相比，本研究未发现子宫内膜癌是子宫切除术后 VTE 的独立危险因素。我们发现开腹手术、淋巴结切除术、BMI 超过 40 和既往 VTE 是术后 30 天内发生 VTE 的独立危险因素。
