Children's Hospital Los Angeles, Los Angeles, California, USA.
Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Pediatr Blood Cancer. 2021 May;68(5):e28957. doi: 10.1002/pbc.28957. Epub 2021 Feb 24.
Venous thromboembolism (VTE) is a known complication among pediatric and adult cancer patients. Adolescent and young adult oncology (AYAO) patients have unique biological and physiological characteristics that make them distinct from other populations. Our objective was to study the VTE incidence, risk factors, and outcomes, which have been understudied in this population.
A retrospective case-control study was conducted on AYAO participants with new or relapsed cancer and an imaging confirmed VTE from January 2011 to November 2016 at our institution. Eligible AYAO participants without a history of VTE were designated as controls and were randomly selected from our institution's tumor registry. Demographics, medical history, surgeries, central venous catheter (CVC) data, VTE diagnosis and treatment, relapses, and deaths were abstracted.
Thirty-five VTE cases and 70 controls were included in this analysis. Eighty percent of cases had leukemia or lymphoma (vs. a solid tumor) compared to 58% of controls. The majority of VTEs (57%) were CVC associated, and more than 70% of cases had more than one CVC placed during their cancer treatment versus 34% of controls. Infection was associated with increased VTE risk (OR = 6.35, 95% CI = 2.30, 17.55, p < .0001). VTE cases had increased cancer relapse (23% vs. 10%) and mortality rates (29% vs. 16%) than controls.
AYAO participants with a VTE were more likely to have leukemia or lymphoma, more than one CVC or infection. Further studies are needed to identify patients who would benefit from modifiable prevention measures, such as limiting to one CVC, preventing infections, or considering prophylactic anticoagulation for those with a liquid tumor.
静脉血栓栓塞症（VTE）是儿科和成人癌症患者的已知并发症。青少年和年轻成人肿瘤学（AYAO）患者具有独特的生物学和生理学特征，使他们与其他人群不同。我们的目的是研究 VTE 的发病率、危险因素和结局，这在该人群中研究较少。
对 2011 年 1 月至 2016 年 11 月在我院新诊断或复发癌症且影像学证实 VTE 的 AYAO 患者进行回顾性病例对照研究。无 VTE 病史的合格 AYAO 患者被指定为对照组，并从我院肿瘤登记处随机选择。提取人口统计学、病史、手术、中心静脉导管（CVC）数据、VTE 诊断和治疗、复发和死亡等数据。
本分析纳入 35 例 VTE 病例和 70 例对照。80%的病例为白血病或淋巴瘤（与实体瘤相比为 58%）。大多数 VTE（57%）与 CVC 相关，超过 70%的病例在癌症治疗期间放置了一个以上的 CVC，而对照组为 34%。感染与 VTE 风险增加相关（OR=6.35，95%CI=2.30，17.55，p<0.0001）。VTE 病例的癌症复发率（23%比 10%）和死亡率（29%比 16%）高于对照组。
患有 VTE 的 AYAO 患者更有可能患有白血病或淋巴瘤、一个以上的 CVC 或感染。需要进一步研究以确定哪些患者受益于可修改的预防措施，例如限制使用一个 CVC、预防感染或对液体肿瘤患者考虑预防性抗凝。
