Adiamah Alfred, Ban Lu, West Joe, Humes David J
Department of Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Division of Epidemiology and Public Health, School of Medicine, University of Nottingham.
Dis Esophagus. 2020 Jun 15;33(6). doi: 10.1093/dote/doz079.
To define the incidence of postoperative venous thromboembolism (VTE) and effects of chemotherapy in a population undergoing surgery for esophagogastric cancer. This population-based cohort study used linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data from England to identify subjects undergoing esophageal or gastric cancer surgery between 1997 and 2014. Exposures included age, comorbidity, smoking, body mass index, and chemotherapy. Crude rates and adjusted hazard ratios (HRs) were calculated for rate of first postoperative VTE using Cox regression models. The cumulative incidence of VTE at 1 and 6 months was estimated accounting for the competing risk of death from any cause. Of the 2,452 patients identified, 1,012 underwent gastrectomy (41.3%) and 1,440 esophagectomy (58.7%). Risk of VTE was highest in the first month, with absolute VTE rates of 114 per 1,000 person-years (95% CI 59.32-219.10) following gastrectomy and 172.73 per 1,000 person-years (95% CI 111.44-267.74) following esophagectomy. Neoadjuvant and adjuvant chemotherapy was associated with a six-fold increased risk of VTE following gastrectomy, HR 6.19 (95% CI 2.49-15.38). Cumulative incidence estimates of VTE at 6 months following gastrectomy in patients receiving no chemotherapy was 1.90% and esophagectomy 2.21%. However, in those receiving both neoadjuvant and adjuvant chemotherapy, cumulative incidence following gastrectomy was 10.47% and esophagectomy, 3.9%. VTE rates are especially high in the first month following surgery for esophageal and gastric cancer. The cumulative incidence of VTE at 6 months is highest in patients treated with chemotherapy. In this category of patients, targeted VTE prophylaxis may prove beneficial during chemotherapy treatment.
确定接受食管癌和胃癌手术患者的术后静脉血栓栓塞（VTE）发生率及化疗的影响。这项基于人群的队列研究使用了来自英国的主要（临床实践研究数据链）和次要（医院事件统计）护理数据链接，以识别1997年至2014年间接受食管癌或胃癌手术的患者。暴露因素包括年龄、合并症、吸烟、体重指数和化疗。使用Cox回归模型计算首次术后VTE发生率的粗率和调整后的风险比（HRs）。估计1个月和6个月时VTE的累积发生率，并考虑任何原因导致死亡的竞争风险。在识别出的2452例患者中，1012例行胃切除术（41.3%），1440例行食管切除术（58.7%）。VTE风险在第一个月最高，胃切除术后每1000人年的绝对VTE发生率为114（95%CI 59.32 - 219.10），食管切除术后每1000人年为172.73（95%CI 111.44 - 267.74）。新辅助化疗和辅助化疗与胃切除术后VTE风险增加6倍相关，HR为6.19（95%CI 2.49 - 15.38）。未接受化疗的患者胃切除术后6个月VTE的累积发生率估计为1.90%，食管切除术后为2.21%。然而，在接受新辅助化疗和辅助化疗的患者中，胃切除术后的累积发生率为10.47%，食管切除术后为3.9%。食管癌和胃癌手术后第一个月的VTE发生率特别高。接受化疗的患者6个月时VTE的累积发生率最高。在这类患者中，针对性的VTE预防在化疗期间可能被证明是有益的。
