Wolfson Institute of Population Health, Queen Mary University of London, London, UK
Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK.
Int J Gynecol Cancer. 2024 Nov 4;34(11):1768-1774. doi: 10.1136/ijgc-2024-005742.
To determine the incidence of venous thromboembolism in patients with advanced epithelial ovarian cancer undergoing neoadjuvant chemotherapy in UK gynecological cancer centers. Secondary outcomes included incidence and timing of venous thromboembolism since cancer presentation, impact on cancer treatment, and mortality.
All UK gynecological cancer centers were invited to participate in this multi-center retrospective audit through the British Gynecological Cancer Society. Data were captured on all patients undergoing neoadjuvant chemotherapy for International Federation of Gynecology and Obstetrics (FIGO) stage III/IV epithelial ovarian cancer within a 12-month period during 2021-2022. Patients on anticoagulation prior to cancer presentation were excluded. Patients who were diagnosed with venous thromboembolism between cancer presentation and commencing neoadjuvant chemotherapy were also excluded from our analysis of venous thromboembolism rates from neoadjuvant chemotherapy.
Fourteen UK gynecological cancer centers returned data on 660 eligible patients. The median age was 67 years (range 34-96). In total, 131/660 (19.8%) patients were diagnosed with venous thromboembolism from cancer presentation until discharge following cytoreductive surgery. Between commencing neoadjuvant chemotherapy and post-operative discharge, 65/594 (10.9%) patients developed venous thromboembolism (median 11.3%, IQR 5.9-11.3); 55/594 (9.3%) during neoadjuvant chemotherapy, 10/594 (1.7%) during post-operative admission. There was no significant difference across centers (p=0.47). Of these 65 patients, 44 (68%) were diagnosed with pulmonary embolism and 30 (46%) with deep-vein thrombosis (nine had both), including in major abdominal/pelvic vessels, with 36 (55%) presenting symptomatically and 29 (45%) diagnosed incidentally on imaging. Venous thromboembolism resulted in mortality (n=3/65, 5%), and delays/changes/cancelation of treatment (n=18/65, 28%).
Across a large, representative sample of UK gynecological cancer centers, one in five patients undergoing neoadjuvant chemotherapy were diagnosed with a potentially preventable venous thromboembolism, including one in nine diagnosed after commencing chemotherapy. This led to adverse clinical consequences for one third, including delay to oncological treatment and mortality. This high venous thromboembolism rate justifies the consideration of thromboprophylaxis in this patient group.
确定在英国妇科癌症中心接受新辅助化疗的晚期上皮性卵巢癌患者中静脉血栓栓塞症的发生率。次要结局包括自癌症发病以来静脉血栓栓塞症的发生率和时间、对癌症治疗的影响以及死亡率。
通过英国妇科癌症学会邀请所有英国妇科癌症中心参与这项多中心回顾性审计。在 2021-2022 年的 12 个月期间，对所有接受国际妇产科联合会（FIGO）III/IV 期上皮性卵巢癌新辅助化疗的患者进行了数据采集。在癌症发病前接受抗凝治疗的患者被排除在外。在癌症发病至开始新辅助化疗期间被诊断患有静脉血栓栓塞症的患者也被排除在我们对新辅助化疗期间静脉血栓栓塞症发生率的分析之外。
14 家英国妇科癌症中心提供了 660 名符合条件患者的数据。中位年龄为 67 岁（范围 34-96 岁）。共有 131/660（19.8%）名患者在接受细胞减灭术后出院前被诊断患有静脉血栓栓塞症。在开始新辅助化疗和术后出院期间，65/594（10.9%）名患者发生静脉血栓栓塞症（中位值为 11.3%，IQR 为 5.9-11.3%）；55/594（9.3%）在新辅助化疗期间，10/594（1.7%）在术后住院期间。各中心之间无显著差异（p=0.47）。在这 65 名患者中，44 名（68%）被诊断为肺栓塞，30 名（46%）为深静脉血栓形成（9 名患者同时患有两种疾病），其中 36 名（55%）有症状，29 名（45%）在影像学检查中偶然发现。静脉血栓栓塞症导致 3 名患者死亡（65 例患者中的 3 名，5%），并导致 18 名患者（65 例患者中的 18 名，28%）的治疗延迟/改变/取消。
在英国大型代表性妇科癌症中心的样本中，每五个接受新辅助化疗的患者中就有一个被诊断患有潜在可预防的静脉血栓栓塞症，其中九个中有一个在开始化疗后被诊断。这给三分之一的患者带来了不良的临床后果，包括延迟肿瘤治疗和死亡。如此高的静脉血栓栓塞症发生率证明了在该患者群体中考虑使用血栓预防措施的合理性。
