Ward Alistair, Dampali Roxani, Wang Wanxin, Bertoni Sclavi Sofia, Khalil Habib R, Touloumis Anestis, Devaja Omer, Papadopoulos Andreas J, Attard Montalto Stephen
Department of Gynaecological Oncology, West Kent Cancer Centre, Maidstone and Tunbridge Wells NHS Trust, Hermitage Lane, Maidstone, Kent ME16 9QQ, United Kingdom; Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Southwick Hill Road, Cosham, Hampshire PO6 3LY, United Kingdom.
Department of Gynaecological Oncology, West Kent Cancer Centre, Maidstone and Tunbridge Wells NHS Trust, Hermitage Lane, Maidstone, Kent ME16 9QQ, United Kingdom.
Eur J Obstet Gynecol Reprod Biol. 2025 Feb;305:292-297. doi: 10.1016/j.ejogrb.2024.12.027. Epub 2024 Dec 19.
During the treatment of ovarian cancer, the risk of venous thromboembolism (VTE) post operatively is well established, however, patients may be at even greater risk during neoadjuvant chemotherapy (NACT). This study aimed to determine the incidence and timing of VTE amongst patients undergoing NACT, whether there was an association with survival, and examine risk factors associated with the development of VTE.
This was a retrospective cohort study of patients diagnosed with ovarian, fallopian tube and primary peritoneal cancer receiving neoadjuvant chemotherapy betweenApril 2011 and April 2022 at a gynaecological cancer centre in England. Clinical factors examined included: age at diagnosis, Body Mass Index (BMI), presence of inflammatory co-morbidity, tumour morphology, stage of disease, pelvic mass,ascites,retroperitoneal lymphadenopathy, Khorana score, serum albumin levels, chemotherapy regime, bevacizumab administration and Ca 125 levels.
Of 304 patients analysed, 73 (24%) patients developed venous thromboembolism. Of the patients who developed VTE, fifty-five patients developed pulmonary embolism (75%) and the stage of treatment at which most VTEs were diagnosed was neoadjuvant chemotherapy (32%). There was no correlation observed, between the incidence of VTE and any risk factors, including Khorana score, with the exception of low albumin (<35 g/L)(odds ratio (OR):2.1(95%CI 1.1-3.9; p = 0.06) and patients who did not receive paclitaxel chemotherapy (OR:2.04(95%CI 1.02-4.05; p = 0.08). There was no difference in survival rates between the VTE group and the non-VTE group.
This study demonstrates high rates of VTE, especially pulmonary embolism, in ovarian cancer patients undergoing NACT. The present study, amongst others in the literature also suggest that the risk of VTE in ovarian cancer patients undergoing NACT is underestimated by current risk stratification models. Therefore, prospective trials dedicated to ovarian cancer patients specifically, and a development of a risk model that takes into account factors established by higher levels of evidence, are strongly recommended.
在卵巢癌治疗过程中，术后静脉血栓栓塞（VTE）的风险已得到充分证实，然而，新辅助化疗（NACT）期间患者的风险可能更高。本研究旨在确定接受NACT的患者中VTE的发生率和发生时间，是否与生存率相关，并研究与VTE发生相关的危险因素。
这是一项对2011年4月至2022年4月期间在英国一家妇科癌症中心接受新辅助化疗的卵巢癌、输卵管癌和原发性腹膜癌患者进行的回顾性队列研究。检查的临床因素包括：诊断时的年龄、体重指数（BMI）、炎症合并症的存在、肿瘤形态、疾病分期、盆腔肿块、腹水、腹膜后淋巴结病、Khorana评分、血清白蛋白水平、化疗方案、贝伐单抗的使用以及Ca 125水平。
在分析的304例患者中，73例（24%）发生了静脉血栓栓塞。在发生VTE的患者中，55例发生了肺栓塞（75%），大多数VTE被诊断时的治疗阶段是新辅助化疗（32%）。除低白蛋白（<35g/L）（比值比（OR）：2.1（95%CI 1.1 - 3.9；p = 0.06））和未接受紫杉醇化疗的患者（OR：2.04（95%CI 1.02 - 4.05；p = 0.08））外，未观察到VTE发生率与任何危险因素（包括Khorana评分）之间存在相关性。VTE组和非VTE组的生存率没有差异。
本研究表明，接受NACT的卵巢癌患者中VTE发生率很高，尤其是肺栓塞。本研究以及文献中的其他研究还表明，目前的风险分层模型低估了接受NACT的卵巢癌患者发生VTE的风险。因此，强烈建议专门针对卵巢癌患者进行前瞻性试验，并开发一种考虑更高证据水平所确定因素的风险模型。
