Leiva Orly, Connors Jean M, Al-Samkari Hanny
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02215, USA.
Harvard Medical School, Boston, MA 02215, USA.
Cancers (Basel). 2020 Jul 19;12(7):1958. doi: 10.3390/cancers12071958.
Venous thromboembolism (VTE) is common in patients with cancer and is an important contributor to morbidity and mortality in these patients. Early thromboprophylaxis initiated only in those cancer patients at highest risk for VTE would be optimal. Risk stratification scores incorporating tumor location, laboratory values and patient characteristics have attempted to identify those patients most likely to benefit from thromboprophylaxis but even well-validated scores are not able to reliably distinguish the highest-risk patients. Recognizing that tumor genetics affect the biology and behavior of malignancies, recent studies have explored the impact of specific molecular aberrations on the rate of VTE in cancer patients. The presence of certain molecular aberrations in a variety of different cancers, including lung, colon, brain and hematologic tumors, have been associated with an increased risk of VTE and arterial thrombotic events. This review examines the findings of these studies and discusses the implications of these findings on decisions relating to thromboprophylaxis use in the clinical setting. Ultimately, the integration of tumor molecular genomic information into clinical VTE risk stratification scores in cancer patients may prove to be a major advancement in the prevention of cancer-associated thrombosis.
静脉血栓栓塞症（VTE）在癌症患者中很常见，并且是这些患者发病和死亡的重要原因。仅对VTE风险最高的癌症患者进行早期血栓预防是最佳选择。纳入肿瘤位置、实验室检查值和患者特征的风险分层评分试图识别那些最有可能从血栓预防中获益的患者，但即使是经过充分验证的评分也无法可靠地区分最高风险患者。鉴于肿瘤遗传学影响恶性肿瘤的生物学特性和行为，最近的研究探讨了特定分子异常对癌症患者VTE发生率的影响。在包括肺癌、结肠癌、脑肿瘤和血液系统肿瘤在内的多种不同癌症中，某些分子异常的存在与VTE和动脉血栓形成事件风险增加相关。本综述审视了这些研究的结果，并讨论了这些结果对临床环境中血栓预防决策的影响。最终，将肿瘤分子基因组信息整合到癌症患者的临床VTE风险分层评分中可能会被证明是预防癌症相关血栓形成的一项重大进展。
