根据卵巢癌女性的主要治疗方法，静脉血栓栓塞症的发生率和风险：一项回顾性队列研究。
Incidence and risk of venous thromboembolism according to primary treatment in women with ovarian cancer: A retrospective cohort study.
机构信息
Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea.
Department of Obstetrics and Gynecology, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea.
出版信息
PLoS One. 2021 Apr 28;16(4):e0250723. doi: 10.1371/journal.pone.0250723. eCollection 2021.
OBJECTIVE
This study aimed to investigate incidence and risk for venous thromboembolism (VTE) according to primary treatment in women with ovarian cancer.
METHODS
We selected 26,863 women newly diagnosed with ovarian cancer between 2009 and 2018 from the Korean Health Insurance Review and Assessment Service databases. During the total follow-up period and the first six months after initiation of primary treatments, incidence and risk of VTE were evaluated according to primary treatment as no treatment, surgery, radiotherapy, or chemotherapy.
RESULTS
The mean follow-up period was 1285.5±6 days. The VTE incidence was highest in women who underwent chemotherapy (306 per 10,000 women). Among women who underwent surgery, VTE was highest in surgery with neoadjuvant chemotherapy (536 per 10,000 women), followed by surgery with adjuvant chemotherapy (360 per 10,000 women) and surgery alone (132 per 10,000 women). During the first 12 months, monthly incidence of VTE decreased. Compared with women with no treatment, risk of VTE significantly increased in women undergoing chemotherapy (HR 1.297; 95% CI, 1.08-1.557; P = 0.005) during the total follow-up period and decreased in women undergoing surgery (HR 0.557; 95% CI, 0.401-0.775; P<0.001) and radiotherapy (HR 0.289; 95% CI, 0.119-0.701; P = 0.006) during the first six months. Among women who underwent surgery, VTE risk significantly increased in surgery with neoadjuvant chemotherapy (HR 4.848; 95% CI, 1.86-12.632; P = 0.001) followed by surgery with adjuvant chemotherapy (HR 2.807; 95% CI, 1.757-4.485; P<0.001) compared with surgery alone during the total follow-up period and in surgery with neoadjuvant chemotherapy (HR 4.223; 95% CI, 1.37-13.022; P = 0.012) during the first six months.
CONCLUSIONS
In this large Korean cohort study, incidence and risk of VTE were highest in women with ovarian cancer who underwent chemotherapy and surgery with neoadjuvant chemotherapy as a primary cancer treatment. Incidence of VTE decreased over time.
目的
本研究旨在根据卵巢癌女性的主要治疗方法，调查静脉血栓栓塞症（VTE）的发病和风险。
方法
我们从韩国健康保险审查和评估服务数据库中选择了 2009 年至 2018 年间新诊断为卵巢癌的 26863 名女性。在总随访期和主要治疗开始后的前 6 个月内，根据无治疗、手术、放疗或化疗评估 VTE 的发病和风险。
结果
平均随访时间为 1285.5±6 天。接受化疗的女性 VTE 发生率最高（每 10000 名女性中有 306 例）。在接受手术的女性中，接受新辅助化疗的手术中 VTE 发生率最高（每 10000 名女性中有 536 例），其次是接受辅助化疗的手术（每 10000 名女性中有 360 例）和单纯手术（每 10000 名女性中有 132 例）。在最初的 12 个月内，VTE 的每月发病率下降。与未接受治疗的女性相比，接受化疗的女性 VTE 风险显著增加（HR 1.297；95%CI，1.08-1.557；P=0.005），而接受手术的女性（HR 0.557；95%CI，0.401-0.775；P<0.001）和放疗（HR 0.289；95%CI，0.119-0.701；P=0.006）的风险则降低。在接受手术的女性中，接受新辅助化疗的手术（HR 4.848；95%CI，1.86-12.632；P=0.001）和辅助化疗的手术（HR 2.807；95%CI，1.757-4.485；P<0.001）的 VTE 风险显著高于单纯手术，而接受新辅助化疗的手术的 VTE 风险（HR 4.223；95%CI，1.37-13.022；P=0.012）在总随访期内和新辅助化疗的手术（HR 4.223；95%CI，1.37-13.022；P=0.012）在最初的 6 个月内均显著增加。
结论
在这项来自韩国的大型队列研究中，接受化疗和新辅助化疗作为主要癌症治疗的卵巢癌女性 VTE 的发病和风险最高。VTE 的发病率随时间而下降。
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