癌症相关性血栓形成：肺栓塞反应团队随访的肿瘤患者和非肿瘤患者的特征、治疗和结局比较。

Cancer-associated thrombosis: comparison of characteristics, treatment, and outcomes in oncologic and nononcologic patients followed by a pulmonary embolism response team.

机构信息

First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.

First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland

出版信息

Pol Arch Intern Med. 2023 Aug 30;133(7-8). doi: 10.20452/pamw.16421. Epub 2023 Feb 3.

DOI:10.20452/pamw.16421

PMID:36734981

Abstract

INTRODUCTION

The risk of venous thromboembolism (VTE) in patients with cancer is currently 12 times higher than in the general population, and even 23 times higher when they receive chemotherapy. The main goal of the pulmonary embolism response team at the Center for the Management of Pulmonary Embolism (PERT‑CELZAT) is to improve prognosis through interdisciplinary care, with a particular focus on patients with contraindications to standard pharmacologic treatment, requiring individual decision‑making, including a wider use of interventional therapeutic methods.

OBJECTIVES

The objectives of the study were to report and compare the characteristics and outcomes of pulmonary embolism (PE) in patients with and without cancer treated by the PERT‑CELZAT.

PATIENTS AND METHODS

The analysis included 235 patients diagnosed with VTE who were consulted by local PERT between September 2017 and December 2021. The study group was divided into 2 cohorts: oncologic patients (OP) and nononcologic patients (NOP). There were 81 patients in the OP group (mean [SD] age, 66.2 [14.1] years) and 154 patients in the NOP group (mean age, 57.4 [17.4] years).

RESULTS

The OPs were older and more frequently diagnosed with incidental PE. In‑hospital mortality for all patients reached 6.4% (15/235), 3.7% in the OP and 7.8% in the NOP group (P = 0.27). In‑hospital events, such as major bleeding, minor bleeding, recurrent PE, and deep venous thrombosis occurred with similar frequency in both groups. Posthospital mortality up to 12 months after the PE diagnosis was 12.8% (10/78) in the OP and 4.2% (6/142) in the NOP group (P = 0.03). In a long‑term survival analysis, cancer was associated with increased risk of mortality (hazard ratio, 2.44 [95% CI, 1.51-3.95]; P <0.001) when adjusted for age.

CONCLUSIONS

The multidisciplinary therapeutic approach may provide the OPs with VTE an in‑hospital survival rate noninferior to that of the NOPs. The OPs died more often in the following months, because of their underlying neoplastic disease.

摘要

简介

癌症患者发生静脉血栓栓塞症（VTE）的风险目前比普通人群高 12 倍，而在接受化疗时甚至高达 23 倍。管理肺栓塞中心的肺栓塞反应团队（PERT-CELZAT）的主要目标是通过跨学科护理改善预后，特别关注有标准药物治疗禁忌、需要个体化决策的患者，包括更广泛地使用介入治疗方法。

目的

本研究旨在报告并比较经 PERT-CELZAT 治疗的伴有和不伴有癌症的肺栓塞（PE）患者的特征和结局。

患者和方法

该分析纳入了 2017 年 9 月至 2021 年 12 月期间由当地 PERT 咨询的 235 例 VTE 确诊患者。研究组分为两组：肿瘤患者（OP）和非肿瘤患者（NOP）。OP 组有 81 例患者（平均[SD]年龄，66.2[14.1]岁），NOP 组有 154 例患者（平均年龄，57.4[17.4]岁）。

结果

OP 组患者年龄较大，且更常被诊断为偶然性 PE。所有患者的院内死亡率为 6.4%（15/235），OP 组为 3.7%，NOP 组为 7.8%（P=0.27）。两组患者的院内事件（如大出血、小出血、复发性 PE 和深静脉血栓形成）发生频率相似。PE 诊断后 12 个月的院内死亡率，OP 组为 12.8%（10/78），NOP 组为 4.2%（6/142）（P=0.03）。在长期生存分析中，在校正年龄后，癌症与死亡率升高相关（风险比，2.44[95%CI，1.51-3.95]；P<0.001）。