Abufarhaneh Mohammed, Pandya Rudra Kashyap, Alkhaja Ahmed, Iansavichene Alla, Welch Stephen, Lazo-Langner Alejandro
Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Library Services, London Health Sciences Centre, London, Ontario, Canada.
Thromb Res. 2022 May;213:47-56. doi: 10.1016/j.thromres.2022.02.022. Epub 2022 Mar 4.
Venous thromboembolism (VTE) is a frequent complication in cancer patients and is associated with significant morbidity, mortality, and burden on the health care system [1]. Previous studies have suggested an association between genetic mutations in solid tumors and VTE risk.
MEDLINE and EMBASE databases were searched from inception to February 2021. We aimed to include studies presenting data on VTE and genetic mutations with >5% frequency in patients with melanoma, small cell lung cancer (SCLC), non-small cell lung cancer (NSCLC), and colon, gastric and ovarian cancers. Meta-analyses of proportions and size effects were conducted if possible.
Of 682 eligible articles, we included 33 articles, of which 26 papers reporting on a total of 13,844 patients were included in the meta-analysis. The estimated proportions of VTE in lung cancer patients with EGFR, KRAS, and ALK mutations were 7.3, 18.2, and 30.6%, respectively, whereas for colon cancer with KRAS mutations was 13%. In NSCLC patients with EGFR, KRAS and ALK mutations the relative risk (RR) of VTE was 0.98 (0.81-1.18, P = 0.818), 1.24 (0.78-1.97 P = 0.358) and 1.70 (1.46-1.97, P < 0.001), respectively using a fixed-effects model. In patients with colon cancer and KRAS mutation, no significant increase in the VTE risk was observed according to the random-effects model, RR 1.31 (0.79-2.19, P = 0.285).
In patients with NSCLC, the presence of ALK mutations was associated with a high proportion and RR of developing VTE. There was no significant increase in the risk of VTE in patients with colon cancer and KRAS mutations.
静脉血栓栓塞症（VTE）是癌症患者常见的并发症，与显著的发病率、死亡率及医疗系统负担相关[1]。既往研究提示实体瘤中的基因突变与VTE风险之间存在关联。
检索MEDLINE和EMBASE数据库自建库至2021年2月的数据。我们旨在纳入有关黑色素瘤、小细胞肺癌（SCLC）、非小细胞肺癌（NSCLC）以及结直肠癌、胃癌和卵巢癌患者中VTE和基因突变频率>5%的数据的研究。若可行，进行比例和效应量的荟萃分析。
在682篇符合条件的文章中，我们纳入了33篇文章，其中26篇报告了总共13844例患者的数据并纳入荟萃分析。肺癌患者中表皮生长因子受体（EGFR）、 Kirsten大鼠肉瘤病毒癌基因（KRAS）和间变性淋巴瘤激酶（ALK）突变患者发生VTE的估计比例分别为7.3%、18.2%和30.6%，而结直肠癌KRAS突变患者为13%。在NSCLC患者中，使用固定效应模型，EGFR、KRAS和ALK突变患者发生VTE的相对风险（RR）分别为0.98（0.81 - 1.18，P = 0.818）、1.24（0.78 - 1.97，P = 0.358）和1.70（1.46 - 1.97，P < 0.001）。在结直肠癌KRAS突变患者中，根据随机效应模型，未观察到VTE风险显著增加，RR为1.31（0.79 - 2.19，P = 0.285）。
在NSCLC患者中，ALK突变的存在与发生VTE的高比例和RR相关。结直肠癌KRAS突变患者的VTE风险未显著增加。
