Obstetrics and Gynecology, Duke University Health System, Durham, North Carolina, USA.
West Virginia University, Morgantown, West Virginia, USA.
Int J Gynecol Cancer. 2020 Apr;30(4):491-497. doi: 10.1136/ijgc-2019-000980. Epub 2020 Feb 12.
Neoadjuvant chemotherapy may be considered for women with epithelial ovarian cancer who have poor performance status or a disease burden not amenable to primary cytoreductive surgery. Overlap exists between indications for neoadjuvant chemotherapy and known risk factors for venous thromboembolism, including impaired mobility, increasing age, and advanced malignancy. The objective of this study was to determine the rate of venous thromboembolism among women receiving neoadjuvant chemotherapy for epithelial ovarian cancer.
A multi-institutional, observational study of patients receiving neoadjuvant chemotherapy for primary epithelial ovarian, fallopian tube, or peritoneal cancer was conducted. Primary outcome was rate of venous thromboembolism during neoadjuvant chemotherapy. Secondary outcomes included rates of venous thromboembolism at other stages of treatment (diagnosis, following interval debulking surgery, during adjuvant chemotherapy, or during treatment for recurrence) and associations between occurrence of venous thromboembolism during neoadjuvant chemotherapy, subject characteristics, and interval debulking outcomes. Venous thromboembolism was defined as deep vein thrombosis in the upper or lower extremities or in association with peripherally inserted central catheters or ports, pulmonary embolism, or concurrent deep vein thrombosis and pulmonary embolism. Both symptomatic and asymptomatic venous thromboembolism were reported.
A total of 230 patients receiving neoadjuvant chemotherapy were included; 63 (27%) patients overall experienced a venous thromboembolism. The primary outcome of venous thromboembolism during neoadjuvant chemotherapy occurred in 16 (7.7%) patients. Of the remaining venous thromboembolism events, 22 were at diagnosis (9.6%), six post-operatively (3%), five during adjuvant chemotherapy (3%), and 14 during treatment for recurrence (12%). Patients experiencing a venous thromboembolism during neoadjuvant chemotherapy had a longer mean time to interval debulking and were less likely to undergo optimal cytoreduction (50% vs 80.2%, p=0.02).
Patients with advanced ovarian cancer are at high risk for venous thromboembolism while receiving neoadjuvant chemotherapy. Consideration of thromboprophylaxis may be warranted.
对于体力状况不佳或肿瘤负荷较大无法进行初始细胞减灭术的上皮性卵巢癌患者，可考虑采用新辅助化疗。新辅助化疗的适应证与静脉血栓栓塞的已知危险因素（包括活动受限、年龄增长和晚期恶性肿瘤）存在重叠。本研究旨在确定接受上皮性卵巢癌新辅助化疗的患者发生静脉血栓栓塞的比例。
对接受新辅助化疗治疗原发性上皮性卵巢癌、输卵管癌或腹膜癌的患者进行了一项多机构、观察性研究。主要结局为新辅助化疗期间静脉血栓栓塞的发生率。次要结局包括治疗其他阶段（诊断时、间隔性肿瘤细胞减灭术后、辅助化疗期间或复发治疗期间）的静脉血栓栓塞发生率，以及新辅助化疗期间发生静脉血栓栓塞与患者特征和间隔性肿瘤细胞减灭术结局之间的关系。静脉血栓栓塞定义为四肢或与外周插入中心导管或端口相关的深静脉血栓形成、肺栓塞或同时发生的深静脉血栓形成和肺栓塞。报告了有症状和无症状的静脉血栓栓塞。
共纳入 230 例接受新辅助化疗的患者；27%（63 例）的患者发生了静脉血栓栓塞。新辅助化疗期间静脉血栓栓塞的主要结局在 16 例（7.7%）患者中发生。其余静脉血栓栓塞事件中，22 例发生在诊断时（9.6%），6 例发生在手术后（3%），5 例发生在辅助化疗期间（3%），14 例发生在复发治疗期间（12%）。新辅助化疗期间发生静脉血栓栓塞的患者间隔性肿瘤细胞减灭术的平均时间更长，更不可能进行最佳肿瘤细胞减灭术（50%比 80.2%，p=0.02）。
接受新辅助化疗的晚期卵巢癌患者发生静脉血栓栓塞的风险较高。可能需要考虑使用血栓预防措施。
