Rydell Harriet, Huge Ylva, Eriksson Victoria, Johansson Markus, Alamdari Farhood, Svensson Johan, Aljabery Firas, Sherif Amir
Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 90187 Umeå, Sweden.
Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, 58183 Linköping, Sweden.
Life (Basel). 2022 Aug 6;12(8):1198. doi: 10.3390/life12081198.
Thromboembolic events (TEE) are high-risk complications in patients undergoing neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for urothelial muscle-invasive bladder cancer (MIBC). The purpose of the study was to investigate any differences in TEE-incidence, comparing peripherally inserted central catheter (PICC) versus a totally implanted port (PORT) as CVA (central venous access) during NAC. We identified 947 cystectomized MIBC-patients from four Swedish medical centers in 2009-2021. Inclusion criteria were cT2-T4aN0M0 and 375 patients were finally eligible and evaluated, divided into: NAC-administered ( = 283) resp. NAC-naïve-NAC-eligible ( = 92), the latter as tentative control group. Data on TEEs and types of CVA were retrospectively collected and individually validated, from final transurethral resection of the bladder tumor (TUR-B) to 30 days post-RC. Adjusted logistic regression and log rank test were used for statistical analyses. Amongst NAC-administered, 83% ( = 235) received PICCs and 15% ( = 42) PORTs. Preoperative TEEs occurred in 38 PICC-patients (16.2%) and in one PORT-patient (2.4%), with 47 individual events registered. We found a significantly increased odds ratio of TEE in NAC-administered PICC-patients compared to in PORT-patients (OR: 8.140, -value: 0.042, 95% CI 1.078-61.455). Our findings indicate a greater risk for pre-RC TEEs with PICCs than with PORTs, suggesting favoring the usage of PORTs for MIBC-NAC-patients.
血栓栓塞事件（TEE）是接受新辅助化疗（NAC）和根治性膀胱切除术（RC）治疗肌层浸润性尿路上皮膀胱癌（MIBC）患者的高风险并发症。本研究的目的是调查在NAC期间，作为中心静脉通路（CVA）的外周静脉穿刺中心静脉导管（PICC）与完全植入式输液港（PORT）相比，TEE发生率是否存在差异。我们在2009年至2021年期间从瑞典四个医疗中心确定了947例接受膀胱切除术的MIBC患者。纳入标准为cT2-T4aN0M0，最终375例患者符合条件并接受评估，分为：接受NAC治疗组（n = 283）和未接受NAC但符合NAC条件组（n = 92），后者作为暂定对照组。从膀胱肿瘤最终经尿道切除术（TUR-B）到RC术后30天，回顾性收集并单独验证TEE和CVA类型的数据。采用校正逻辑回归和对数秩检验进行统计分析。在接受NAC治疗的患者中，83%（n = 235）接受了PICC，15%（n = 42）接受了PORT。术前TEE发生在38例PICC患者（16.2%）和1例PORT患者（2.4%）中，共记录到47例个体事件。我们发现，与PORT患者相比，接受NAC治疗的PICC患者发生TEE的优势比显著增加（OR：8.140，P值：0.042，95%CI 1.078 - 61.455）。我们的研究结果表明，RC术前使用PICC发生TEE的风险高于PORT，提示MIBC-NAC患者更适合使用PORT。
