Cornuz J, Pearson S D, Creager M A, Cook E F, Goldman L
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Ann Intern Med. 1996 Nov 15;125(10):785-93. doi: 10.7326/0003-4819-125-10-199611150-00001.
The relation between thrombosis and cancer is well documented, but the clinical evaluation appropriate for detecting underlying cancer in patients with deep venous thrombosis remains unknown.
To 1) determine the appropriate initial evaluation for cancer in patients with idiopathic deep venous thrombosis and 2) estimate the incidence of subsequently diagnosed cancer in patients who were not found to have cancer when deep venous thrombosis was diagnosed.
Retrospective cohort study.
Urban, tertiary care teaching hospital.
986 consecutive patients (637 women and 349 men; mean age +/- SD, 53 +/- 17 years) who had no risk factors for venous disease and had venous ultrasonography because idiopathic deep venous thrombosis was suspected.
Initial clinical evaluation was assessed by using chart review. The incidence of cancer at a median of 34 months after diagnosis of deep venous thrombosis was obtained through hospital chart review (38%), computerized record extraction (54%), mailed questionnaires (6%), telephone interviews (1%), or a death registry (1%).
Deep venous thrombosis was diagnosed in 142 patients (14%); 136 of the 142 were hospitalized. Cancer was diagnosed in 16 of these 136 patients (12%) during the index hospitalization. All 16 of these patients had one or more abnormalities on at least one of the four components of the clinical examination: history, physical examination, basic laboratory testing, or chest radiography. The probability of detecting cancer increased as the number of findings suggestive of cancer on the four components of the clinical evaluation increased. Cancer was diagnosed in none of the 56 patients with deep venous thrombosis who did not have findings on the clinical evaluation. The probability of cancer-free survival during follow-up (median, 34 months) was similar in patients with (3 of 122 [2.5%]) and without (23 of 844 [2.7%]) deep venous thrombosis and in the age- and sex-matched U.S. population.
A clinical evaluation that includes a comprehensive medical history, physical examination, routine laboratory testing, and chest radiography seems to be appropriate for detecting cancer in these patients. Additional testing should be guided by any abnormalities detected by this clinical evaluation.
血栓形成与癌症之间的关系已有充分记载，但对于检测深静脉血栓形成患者潜在癌症的恰当临床评估仍不清楚。
1）确定特发性深静脉血栓形成患者癌症的恰当初始评估方法；2）估计深静脉血栓形成诊断时未发现癌症的患者随后被诊断为癌症的发生率。
回顾性队列研究。
城市三级护理教学医院。
986例连续患者（637例女性和349例男性；平均年龄±标准差，53±17岁），他们无静脉疾病危险因素，因疑似特发性深静脉血栓形成接受了静脉超声检查。
通过查阅病历评估初始临床评估。通过医院病历查阅（38%）、计算机化记录提取（54%）、邮寄问卷（6%）、电话访谈（1%）或死亡登记（1%）获取深静脉血栓形成诊断后中位34个月时的癌症发生率。
142例患者（14%）诊断为深静脉血栓形成；其中136例住院。这136例患者中有16例（12%）在本次住院期间诊断为癌症。这16例患者在临床检查的四个组成部分（病史、体格检查、基础实验室检查或胸部X线检查）中至少一项有一个或多个异常。随着临床评估四个组成部分中提示癌症的发现数量增加，检测到癌症的可能性增加。临床评估未发现异常的56例深静脉血栓形成患者中无一人诊断为癌症。随访期间（中位时间34个月）无癌生存率在有深静脉血栓形成的患者（122例中的3例[2.5%]）和无深静脉血栓形成的患者（844例中的23例[2.7%]）以及年龄和性别匹配的美国人群中相似。
包括全面病史、体格检查、常规实验室检查和胸部X线检查的临床评估似乎适合检测这些患者中的癌症。应根据该临床评估发现的任何异常来指导进一步检查。
