Department of Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo; CPC Clinical Research, University of Colorado, Anschutz Medical Center, Aurora, Colo.
Department of Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo; Division of Vascular Surgery and Endovascular Surgery, University of Colorado, Anschutz Medical Center, Aurora, Colo.
J Vasc Surg. 2021 Sep;74(3):1033-1040.e1. doi: 10.1016/j.jvs.2021.03.058. Epub 2021 Apr 24.
Cancer results in a hypercoagulable state that is associated with both venous and arterial thromboses. However, little is known about the effects of acute limb ischemia (ALI) in this cohort of patients. In the present systematic review and meta-analysis, we analyzed the available clinical data on cancer and its association with ALI and evaluated the outcomes in these patients after a diagnosis of ALI.
Three databases, including PubMed, EMBASE, and the Cochrane Library, were queried. Studies that met the inclusion criteria were included regardless of the publication year, language, sample size, or follow-up length. All the steps of the meta-analysis were conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) and MOOSE (meta-analysis of observational studies in epidemiology) guidelines.
Seven studies from 6222 references with a total of 2899 patients were included. Of the 2899 patients, 1195 (41%) had had a diagnosis of ALI before their cancer diagnosis, and 1704 (59%) had presented with ALI after a cancer diagnosis. Nearly three quarters of ALI events were among patients with cancer of the skin and soft tissue (19%), genitourinary (18%), lung (17%), and gastrointestinal (16%) systems. ALI recurrence was similar between the two groups, and major amputation was more likely in patients with a diagnosis of ALI after a cancer diagnosis (7.4% vs 4.6%; P < .01). The incidence of mortality at 1 year was significantly greater for patients with established cancer who had presented with ALI compared with the patients who had presented with ALI before a cancer diagnosis (50.6% vs 29.9%; P < .01). After adjusting for study variability using the random effects model, the mortality at 1 year for all patients was 52.3% (95% confidence interval, 37.7%-66.5%). No significant heterogeneity (P = .73) was found between the two groups of patients, which varied by the timing of the ALI diagnosis in relation to the cancer diagnosis.
The 1-year mortality after the development of ALI in patients with cancer was >50%. For patients presenting with ALI of unclear etiology, the presence of an underlying cancer should be considered.
癌症导致高凝状态，与静脉和动脉血栓形成有关。然而，对于癌症患者的急性肢体缺血（ALI），我们知之甚少。在本系统评价和荟萃分析中，我们分析了癌症及其与 ALI 相关的现有临床数据，并评估了这些患者在诊断为 ALI 后的结局。
检索了三个数据库，包括 PubMed、EMBASE 和 Cochrane 图书馆。无论研究的发表年份、语言、样本量或随访时间如何，只要符合纳入标准，我们都将其纳入研究。荟萃分析的所有步骤均符合 PRISMA（系统评价和荟萃分析的首选报告项目）和 MOOSE（流行病学观察性研究的荟萃分析）指南。
从 6222 篇参考文献中检索到 7 项研究，共纳入 2899 例患者。在 2899 例患者中，有 1195 例（41%）在癌症诊断前就已确诊为 ALI，1704 例（59%）在癌症诊断后出现 ALI。近四分之三的 ALI 事件发生在皮肤和软组织（19%）、泌尿生殖系统（18%）、肺部（17%）和胃肠道（16%）癌症患者中。两组的 ALI 复发率相似，在癌症诊断后出现 ALI 的患者中，主要截肢的可能性更高（7.4%对 4.6%；P<.01）。与癌症诊断前出现 ALI 的患者相比，已经确诊癌症并出现 ALI 的患者在 1 年内的死亡率明显更高（50.6%对 29.9%；P<.01）。使用随机效应模型调整研究变异性后，所有患者在 1 年内的死亡率为 52.3%（95%置信区间，37.7%-66.5%）。未发现两组患者之间存在显著异质性（P=.73），这与 ALI 诊断与癌症诊断的时间关系有关。
癌症患者出现 ALI 后的 1 年死亡率>50%。对于病因不明的 ALI 患者，应考虑是否存在潜在的癌症。
