Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.
Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland.
Eur J Neurol. 2022 Aug;29(8):2386-2397. doi: 10.1111/ene.15404. Epub 2022 May 31.
Venous thromboembolic events (VTEs) are a major complication in cancer patients, and therefore, also in brain cancer patients, anticoagulants are considered appropriate in the treatment of VTEs.
Frequency, risk factors, and treatment of VTEs, as well as associated complications, were assessed in a population-based cohort of glioblastoma patients in the Canton of Zurich, Switzerland. Correlations between clinical data and survival were retrospectively analyzed using the log-rank test and Cox regression models.
Four hundred fourteen glioblastoma patients with isocitrate dehydrogenase wild-type status were identified. VTEs were documented in 65 patients (15.7%). Median time from tumor diagnosis to the occurrence of a VTE was 1.8 months, and 27 patients were diagnosed with VTEs postoperatively (within 35 days; 42.2%). History of a prior VTE was more common in patients who developed VTEs than in those who did not (p = 0.004). Bevacizumab treatment at any time during the disease course was not associated with occurrence of VTEs (p = 0.593). Most patients with VTEs (n = 61, 93.8%) were treated with therapeutic anticoagulation. Complications occurred in 14 patients (23.0%), mainly intracranial hemorrhages (n = 7, 11.5%). Overall survival did not differ between patients diagnosed with VTEs and those who had no VTE (p = 0.139). Tumor progression was the major cause of death (n = 283, 90.7%), and only three patients (1.0%) died in association with acute VTEs.
Venous thromboembolic events occurred early in the disease course, suggesting that the implementation of primary venous thromboembolism prophylaxis during first-line chemoradiotherapy could be explored in a randomized setting.
静脉血栓栓塞事件（VTE）是癌症患者的主要并发症，因此，在脑癌患者中，抗凝剂被认为是治疗 VTE 的合适选择。
在瑞士苏黎世州的一个基于人群的胶质母细胞瘤患者队列中，评估了 VTE 的频率、危险因素和治疗方法，以及相关并发症。使用对数秩检验和 Cox 回归模型对临床数据与生存之间的相关性进行了回顾性分析。
确定了 414 例异柠檬酸脱氢酶野生型的胶质母细胞瘤患者。65 例患者（15.7%）记录到 VTE。从肿瘤诊断到 VTE 发生的中位时间为 1.8 个月，27 例患者在术后（35 天内；42.2%）诊断为 VTE。发生 VTE 的患者比未发生 VTE 的患者有更常见的 VTE 病史（p=0.004）。在疾病过程中的任何时间接受贝伐单抗治疗与 VTE 的发生无关（p=0.593）。大多数 VTE 患者（n=61，93.8%）接受了治疗性抗凝治疗。14 例患者（23.0%）发生了并发症，主要为颅内出血（n=7，11.5%）。诊断为 VTE 的患者与无 VTE 的患者之间的总生存率无差异（p=0.139）。肿瘤进展是死亡的主要原因（n=283，90.7%），只有 3 例患者（1.0%）死于急性 VTE。
VTE 发生在疾病早期，提示在一线放化疗中可以探索预防性使用抗凝药物来预防静脉血栓栓塞症。
