University Hospital of Saint-Etienne, Saint-Priest en Jarez, France.
J Cancer Res Clin Oncol. 2021 Nov;147(11):3447-3454. doi: 10.1007/s00432-021-03590-x. Epub 2021 Mar 14.
There are still controversial data regarding the prognostic value of Venous ThromboEmbolism (VTE) in advanced Pancreatic Ductal AdenoCarcinoma (PDAC) and thromboprophylaxis is poorly prescribed despite international recommendations.
Medical charts of patients consecutively treated for advanced PDAC from 2010 to 2019 were retrospectively reviewed. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier method. Prognostic Factors were identified using a multivariate Cox's proportional hazard model. Early VTE was defined as VTE occurring within the three months following the PDAC diagnosis.
A total of 174 patients were included (median age: 67 years; males: 55.2%; performance status (PS) 0-1: 88.5%) with metastatic disease in 74.7%. At baseline, Khorana score was high (≥ 3) in the vast majority of cases (93.7%). The cumulative incidences of VTE were 12.4% (95% CI 7.3-17.2) at 3 months, 20.4% (95% CI 13.9-26.4) at 6 months and 28.1% (95% CI 20.0-35.3) at 12 months. Patients who experienced early VTE had shorter PFS (3.8 months vs. 7.1 months; HR = 2.02; 95% CI 1.21-3.37; p = 0.006) and shorter OS (8.0 months vs. 14.1 months; HR = 2.42; 95% CI 1.37-4.30; p = 0.002) compared to the others, independently of prognostic factors such as PS, liver metastases, carcinomatosis, and chemotherapy regimen.
early VTE is a strong prognostic factor in advanced PDAC and occurs in about one in 10 patients.
尽管有国际指南，但在晚期胰腺导管腺癌（PDAC）中，静脉血栓栓塞（VTE）的预后价值仍存在争议，而且血栓预防措施的应用也很差。
回顾性分析了 2010 年至 2019 年连续治疗晚期 PDAC 的患者的病历。使用 Kaplan-Meier 法估计无进展生存期（PFS）和总生存期（OS）。使用多变量 Cox 比例风险模型确定预后因素。早期 VTE 定义为 PDAC 诊断后三个月内发生的 VTE。
共纳入 174 例患者（中位年龄：67 岁；男性：55.2%；体能状态（PS）0-1：88.5%），74.7%的患者有转移性疾病。基线时，绝大多数患者（93.7%）的 Khorana 评分较高（≥3）。VTE 的累积发生率在 3 个月时为 12.4%（95%CI7.3-17.2），在 6 个月时为 20.4%（95%CI13.9-26.4），在 12 个月时为 28.1%（95%CI20.0-35.3）。发生早期 VTE 的患者 PFS 更短（3.8 个月 vs. 7.1 个月；HR=2.02；95%CI1.21-3.37；p=0.006），OS 更短（8.0 个月 vs. 14.1 个月；HR=2.42；95%CI1.37-4.30；p=0.002），与 PS、肝转移、癌性播散和化疗方案等预后因素无关。
早期 VTE 是晚期 PDAC 的一个强烈预后因素，约每 10 例患者中就有 1 例发生。
