淋巴瘤患者静脉血栓栓塞症的研究进展

血液恶性肿瘤患者易发生出凝血障碍,以急性白血病为代表,其中淋巴瘤出凝血障碍发生率也较高,凝血异常所致静脉血栓栓塞(VTE)是其死亡主要原因之一。淋巴瘤血栓栓塞症在非霍奇金淋巴瘤中发生率明显高于霍奇金淋巴瘤,VTE的发生可形成凝血瀑布从而促进肿瘤生长,提示患者疾病进展及病情恶化。淋巴瘤VTE发生的危险因素及相关特点可作为临床早期用药干预的依据从而改善患者预后,极大提高患者的生活质量。     

导致肺癌化疗患者发生静脉血栓栓塞症的相关因素及其治疗

目的探讨导致肺癌化疗患者发生静脉血栓栓塞症的相关因素及其治疗。方法回顾性分析106例伴有静脉血栓栓塞症的肺癌化疗患者(观察组)和120例未伴有静脉血栓栓塞症肺癌化疗患者(对照组)的临床症状。对可能导致2组患者发生不同病症的相关影响因素,如:性别、年龄、既往病史(高脂血症、肥胖、高血压、吸烟史、糖尿病)、病理类型与分期、血小板计数、血黏稠度、D-二聚体进行统计分析。对106例患者中5例实施了尿激酶溶栓治疗,其余101例患者采用低分子肝素-华法林序贯抗凝治疗方法。结果单因素方差分析结果显示2组患者的年龄、吸烟史、病理分期、血黏稠度和D-二聚体之间的差异具有统计学意义(P<0.05),性别、高脂血症、肥胖、高血压、糖尿病、病理分型、血小板计数之间的差异无统计学意义(P>0.05)。对筛选出的影响因素进行多因素Logistic回归分析,结果显示年龄≥60岁、有吸烟史、晚期、血黏稠度上升(男士>4.66 c P/女士>3.93 c P)、D-二聚体上升(>500μg/L)是肺癌化疗患者发生静脉血栓栓塞症的危险因素。经积极治疗后58例治愈,11例好转,有效率为65.09%。结论年龄≥60岁、有吸烟史、晚期、血黏稠度上升、D-二聚体上升是肺癌化疗患者发生静脉血栓栓塞症的危险因素,在治疗时应及时评估其致病的相关危险因素,尽早实施抗凝治疗,提高疗效,减少并发症的发生。     

恶性肿瘤合并静脉血栓栓塞症患者的临床特点分析CSCD

目的分析恶性肿瘤合并静脉血栓栓塞症(VTE)患者的临床特点并探寻相关危险因素。方法采用回顾性病例对照研究,调查恶性肿瘤合并VTE患者的临床及生存结局信息。采用卡方检验、Log rank检验和比例风险回归模型(Cox模型)等方法进行统计分析,采用GraphPad Prism8.0绘制生存曲线,分析VTE相关影响因素。结果5年间共收治新发恶性肿瘤患者11620例,其中合并VTE患者385例(3.31%)。恶性淋巴瘤患者合并VTE的比例最大,达到4.78%,其次是结直肠癌和乳腺癌,分别为4.40%和4.08%;联合治疗的患者比单一治疗方式发生VTE的比例高;分期越晚的患者合并VTE的比例越高;随访结果显示合并VTE患者中位生存时间为17.90月(95%CI:10.21~25.59),1、3、5年生存率分别为51.89%、37.76%、18.88%;多因素分析结果显示年龄、性别、TNM分期是影响VTE患者预后的独立危险因素。结论恶性肿瘤患者容易并发VTE,临床上应对高危患者密切观察、提早预防。     

82例血液恶性肿瘤合并静脉血栓栓塞症患者的临床特点分析

目的:探讨血液系统肿瘤患者合并静脉血栓栓塞症(venous thromboembolism,VTE)的临床特点.方法:回顾性分析2012年1月至2020年12月宁夏医科大学总医院收治的82例血液肿瘤合并VTE患者的住院资料并作为病例组,以同期100例未合并VTE的血液肿瘤患者为对照组.结果:血液肿瘤并发VTE以急性白血...     

肺癌合并静脉血栓栓塞症89例临床分析

目的:本研究旨在探讨肺癌合并静脉血栓栓塞症(venous thromboembolism,VTE)患者的临床相关因素,为肺癌合并VTE的预防及治疗提供依据。方法:对2008年7月-2010年6月收治的经细胞学或病理学确诊的2053例肺癌病例进行回顾性分析。采用螺旋CT、肺动脉造影及彩色多普勒超声检查明确VTE诊断。将年龄、性别、病理类型、肺癌分期、手术、体质量指数、基础疾病、治疗前血小板计数、D-二聚体、白细胞介素1和肿瘤坏死因子作为临床相关因素。结果:2053例肺癌患者中,89例(4.34%)患者合并VTE。腺癌患者的VTE发生率为5.65%(58/1027),非腺癌患者为3.02%(31/1026),差异有统计学意义(P=0.003);Ⅰ～ⅢA期患者的VTE发生率为1.48%(10/677),ⅢB～Ⅳ期患者的VTE发生率为5.74%(79/1376),差异有统计学意义(P<0.001);Ⅰ～ⅢA期接受手术治疗患者的VTE发生率为1.55%(10/645),未行手术治疗患者的VTE发生率为0%(0/32),差异有统计学意义(P=0.044);无基础疾病患者的VTE发生率为2.70%(33/1221),伴随基础疾病患者的VTE发生率为6.73%(56/832),差异有统计学意义(P<0.001)。治疗前,血小板计数、D-二聚体、白细胞介素1和肿瘤坏死因子水平正常者的VTE发生率分别为3.72%、0.31%、2.44%和3.27%,而水平升高者的VTE发生率分别为6.26%、19.91%、10.26%和7.74%,差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示,腺癌、手术、基础疾病以及D-二聚体、白细胞介素1和肿瘤坏死因子水平升高是肺癌患者发生VTE的相关临床因素(P<0.05)。结论:肺癌合并VTE患者中,腺癌是最常见的病理类型。手术、基础疾病以及D-二聚体、白细胞介素1和肿瘤坏死因子水平升高是肺癌患者发生VTE的危险因素。     

胸腺恶性肿瘤术后静脉血栓栓塞症的影响因素分析

背景与目的 胸外科术后静脉血栓栓塞症(venous thromboembolism,VTE)的发生率高,本研究旨在分析胸腺恶性肿瘤术后VTE的发生率及相关危险因素.方法 本研究为单中心研究.收集2017年12月-2021年2月在首都医科大学附属北京同仁医院胸外科接受胸腺恶性肿瘤切除手术治疗的患者资料.除术前常规检查以外...     

卵巢恶性肿瘤患者发生静脉血栓栓塞症的相关因素分析

目的 探讨卵巢恶性肿瘤患者发生静脉血栓栓塞症(VTE)的相关因素.方法 收集65例发生VTE的卵巢恶性肿瘤患者的病历资料,采用修改后的Caprini风险评估量表评估患者的VTE发生风险,并分析卵巢恶性肿瘤患者发生VTE的危险因素.结果 根据修改后的Caprini风险评估量表进行评分,65例患者中,高危16例(24.62...     

晚期肺癌化疗患者伴静脉血栓栓塞症的相关因素分析

目的：分析晚期肺癌化疗患者伴静脉血栓栓塞症的相关因素。方法回顾性分析晚期肺癌化疗伴静脉血栓栓塞症的53例患者（栓塞组）和晚期肺癌化疗未伴有静脉血栓栓塞症的60例患者（对照组）的临床资料,并对晚期肺癌化疗患者伴静脉血栓栓塞症发生的影响因素进行Logistic回归分析。结果单因素分析表明两组患者的性别、病理分型、高脂血症、高血压、肥胖、糖尿病及血小板计数上升比较,差异均无统计学意义（P﹥0.05）;两组患者的年龄、临床分期、吸烟史、D-二聚体上升及血黏稠度升高比较,差异均有统计学意义（P﹤0.05）。通过对筛选出的影响因素予以多因素Logistic回归分析发现,年龄≥60岁、吸烟史、临床分期为Ⅳ期、D-二聚体上升及血黏稠度升高属于晚期肺癌化疗患者伴有静脉血栓栓塞症的危险因素。结论年龄≥60岁、吸烟史、临床分期为Ⅳ期、D-二聚体上升及血黏稠度升高作为晚期肺癌化疗患者伴有静脉血栓栓塞症的危险因素,在临床中,应加以重视。     

骨肉瘤继发静脉血栓栓塞的相关危险因素及药物治疗进展

骨肉瘤是最常见的骨原发恶性肿瘤之一,好发于青少年及60岁以上老年人,尽管近年来骨肉瘤的综合治疗已有了长足进步,但晚期患者的5年生存率仍较低。静脉血栓栓塞（VTE）包括深静脉血栓形成（DVT）和肺栓塞（PE）,是一种十分普遍和隐匿的致命性疾病。目前VTE已成为恶性肿瘤患者的第二大死亡原因,仅次于肿瘤本身,VTE可发生于各个年龄段的骨肉瘤患者,且以上肢DVT为主要发病类型。本文总结近年来国内外针对骨肉瘤继发VTE的各项研究,对骨肉瘤患者继发VTE的相关危险因素及其预防、治疗的研究进展进行综述,旨在为进一步的研究及临床诊治提供有力证据。     

肺癌合并静脉血栓栓塞症患者的诊疗特点

目的探讨静脉血栓栓塞症(VTE)对肺癌患者原发疾病诊疗方案的影响。方法回顾性分析北京大学肿瘤医院收治的肺癌患者中,发生VTE患者的临床资料。计算肺癌患者VTE的发生率,分析VTE对原发疾病肺癌的影响。结果 1766例肺癌患者中有115例(6.5%)发生VTE,其中男性78例(67.8%)。深静脉血栓82例(71.3%)、肺栓塞21例(18.3%)、肺栓塞合并深静脉血栓12例(10.4%)。症状性VTE?74例(64.3%)。102例(88.7%)患者进行抗血栓治疗。在抗血栓治疗的患者中,97例(95.1%)患者使用药物治疗,其中65例(67.0%)患者使用了足量或标准剂量。52例(45.2%)患者VTE治疗后显效或者有效,32例(27.8%)经治疗后无效或者恶化,31例(27.0%)未复查或者情况不详。11例(9.6%)患者在抗血栓治疗中发生出血等不良反应。30例(26.1%)患者因为VTE导致抗肿瘤治疗方案改变。结论 VTE是肺癌患者的常见并发症。肺癌合并VTE患者的抗血栓治疗情况复杂,治疗效果不理想,出血等不良反应风险较高。VTE严重影响原定抗肿瘤治疗方案的实施。     

Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients

BACKGROUND: Venous thromboembolism (VTE) contributes to morbidity and mortality in cancer patients and is a frequent complication of anticancer therapy. In the current study, the frequency, risk factors, and trends associated with VTE were examined among hospitalized cancer patients. METHODS: A retrospective cohort study was conducted using the discharge database of the University HealthSystem Consortium. This included 1,824,316 hospitalizations between 1995 and 2003 at 133 U.S. medical centers. RESULTS: Among 1,015,598 cancer patients, 34,357 (3.4%) were diagnosed with deep venous thrombosis and 11,515 with pulmonary embolism (PE) (1.1%) for an overall VTE rate of 4.1%. Subgroups of cancer patients with the highest rates included black ethnicity (5.1% per hospitalization) and those receiving chemotherapy (4.9%). Sites of cancer with the highest rates of VTE included pancreas (8.1%), kidney (5.6%), ovary (5.6%), lung (5.1%), and stomach (4.9%). Among hematologic malignancies, myeloma (5%), non-Hodgkin lymphoma (4.8%), and Hodgkin disease (4.6%) had the highest rates of VTE. The rate of VTE increased by 28%, secondary to a near-doubling of PE rates from 0.8% to 1.5% (P < .0001). Among patients receiving chemotherapy, the rates of VTE rose from 3.9% to 5.7%, an increase of 47% (P < .0001). In multivariate analysis, risk factors associated with VTE included age >or=65 years, female sex, black ethnicity, use of chemotherapy, primary site of cancer, presence of comorbidities, and year of admission. CONCLUSIONS: VTE, particularly PE, is an increasingly frequent complication of hospitalization in cancer patients. Patients with black ethnicity, specific sites of cancer, or those receiving chemotherapy are disproportionately at risk.     

恶性肿瘤合并静脉血栓形成相关危险因素及风险评估

静脉血栓(VTE)是恶性肿瘤的常见并发症,静脉血栓可发生于肿瘤形成的任何阶段并有较高的死亡率和致残率.本文就恶性肿瘤合并静脉血栓形成的相关危险因素及风险评估等方面做一综述,利于早期识别恶性肿瘤合并静脉血栓,并作早期治疗.     

Excess risk of cancer in patients with primary venous thromboembolism: a national, population-based cohort study

We conducted a nationwide, retrospective cohort study assessing the risk of cancer in VTE patients diagnosed in Scotland in 1982-2000. Significantly elevated risks of cancer were sustained for 2 years after VTE diagnosis, most notably for ovarian tumours and lymphomas. Younger patients were at an increased relative risk from this association.     

Risk assessment models for cancer-associated venous thromboembolism

Venous thromboembolism (VTE) is common in cancer patients, and is associated with significant morbidity and mortality. Several factors, including procoagulant agents secreted by tumor cells, immobilization, surgery, indwelling catheters, and systemic treatment (including chemotherapy), contribute to an increased risk of VTE in cancer patients. There is growing interest in instituting primary prophylaxis in high-risk patients to prevent incident (first-time) VTE events. The identification of patients at sufficiently high risk of VTE to warrant primary thromboprophylaxis is essential, as anticoagulation may be associated with a higher risk of bleeding. Current guidelines recommend the use of pharmacological thromboprophylaxis in postoperative and hospitalized cancer patients, as well as ambulatory cancer patients receiving thalidomide or lenalidomide in combination with high-dose dexamethasone or chemotherapy, in the absence of contraindications to anticoagulation. However, the majority of cancer patients are ambulatory, and currently primary thromboprophylaxis is not recommended for these patients, even those considered at very high risk. In this concise review, the authors discuss risk stratification models that have been specifically developed to identify cancer patients at high risk for VTE, and thus might be useful in future studies designed to determine the potential benefit of primary thromboprophylaxis.     

The risk of a second cancer after hospitalisation for venous thromboembolism

Although venous thromboembolism (VTE) is common in patients with cancer, it is not known if it is associated with risk of a second malignancy. Using the Danish Cancer Registry and National Registry of Patients, we studied a population-based cohort of 6285 patients with cancer who had an episode of VTE. The risk of a second cancer was compared with that among 30 713 cancer patients without VTE, matched for age, sex, cancer site and year of diagnosis. Overall, the relative risk for a second cancer diagnosis was 1.3 (95% confidence interval (CI) 1.1-1.4). However, the excess risk varied with the time from the initial cancer diagnosis to the thrombotic event. If the thrombotic episode occurred within the first year, the relative risk for a second cancer was 1.0 (95% CI 0.9-1.3), but if the VTE occurred more than 1 year after the initial cancer, the overall relative risk for a second cancer was 1.4 (95% CI 1.2-1.7), with strong associations for cancers of the digestive organs, ovary and prostate. The association between VTE and subsequent incident cancer extends to patients who already have had a cancer diagnosis.     

Circulating tumour cells are associated with increased risk of venous thromboembolism in metastatic breast cancer patients

Background:

Cancer is a risk factor for venous thromboembolism (VTE). Circulating tumour cells (CTCs) are an independent predictor of survival in metastatic breast cancer (MBC) patients. The aim of this study was to test the hypothesis that CTCs are associated with the risk of VTE in MBC patients.

Methods:

This retrospective study included 290 MBC patients treated in the MD Anderson Cancer Center from January 2004 to December 2007. Circulating tumour cells were detected and enumerated using the CellSearch system before starting new lines of therapy.

Results:

At a median follow-up of 12.5 months, 25 patients experienced VTE and 53 patients died without experiencing thrombosis. Cumulative incidence of thrombosis at 12 months was 8.5% (95% confidence interval (CI)=5.5%, 12.4%). Patients with CTCs ⩾1 and ⩾5 had a higher incidence of VTE compared with patients with 0 and <5 CTCs (12-month estimate, 11.7 and 11.6% vs 3 and 6.6%; P=0.006 and P=0.076, respectively). In the multivariate model, patients with CTCs⩾1 had a hazard ratio of VTE of 5.29 (95% CI=1.58, 17.7, P=0.007) compared with patients with no CTCs.

Conclusion:

These results suggest that CTCs in MBC patients are associated with increased risk of VTE. These patients should be followed up more closely for the risk of VTE.     

Risk of venous thromboembolism in patients receiving adjuvant chemotherapy with 5-fluorouracil, epirubicin and cyclophosphamide for early breast cancer

Aim:   Previous studies have shown that adjuvant chemotherapy in early breast cancer (EBC) may increase the risk of venous thromboembolism (VTE). Clinical experience suggests the combination of 5-fluorouracil, epirubicin and cyclophosphamide (FEC) may be associated with a higher frequency of VTE than other regimens. This study aims to investigate the use of adjuvant FEC compared with other adjuvant regimens in the development of VTE in patients with EBC.
Methods:   A retrospective audit was conducted examining all eligible patients who received adjuvant chemotherapy for EBC in the Australian Capital Territory from 1 January 2005 to 30 June 2007. Data were collected from patients' notes, including risk factors for VTE, tumor pathology, chemotherapy details and incidence of VTE. Comparisons using χ² tests and independent samples t -tests were made between patients who received FEC and those who received another regimen. Multivariate logistic regression was used to investigate prognostic factors for the development of VTE.
Results:   A total of 325 patients were included in the study, of whom 176 received FEC and 149 received other adjuvant chemotherapy regimens. The incidence of VTE in patients who received FEC was 47/176 (27%), which was significantly higher than for patients who received other regimens (7/149, 5%, P  < 0.001). FEC was the only significant prognostic factor for the development of VTE (OR 7.9, 95% CI 3.3–19.2, P  < 0.001).
Conclusion:   The use of adjuvant FEC chemotherapy is associated with an increased incidence of VTE in patients with EBC compared with other commonly used chemotherapy regimens.     

Biomarkers predictive of venous thromboembolism in patients with newly diagnosed high-grade gliomas

Background

High-grade gliomas (HGGs) are among the most prothrombotic of malignancies.

Methods

We performed a prospective study to investigate 11 potential biomarkers for prediction of venous thromboembolism (VTE) in newly diagnosed HGG patients who had undergone a neurosurgical intervention. In addition, we tested 2 VTE risk assessment models (RAMs). The strongest predictors of VTE, which were identified by statistical forward selection, were used for the first RAM. The parameters used for the second RAM were both predictive of VTE and available in routine clinical practice.

Results

One hundred forty-one HGG patients were included in this study, and 24 (17%) of them developed VTE during follow-up. An association with the risk of future VTE was found for the following parameters: leukocyte count, platelet count, sP-selectin, prothrombin-fragment 1 + 2, FVIII activity, and D-dimer. The first RAM included low platelet count (<25th percentile of the study population) and elevated sP-selectin (≥75th percentile). The cumulative VTE probability after 12 months was 9.7% for score 0 (n = 76), 18.9% for score 1 (n = 59), and 83.3% for score 2 (n = 6). The second RAM included low platelet count (<25th percentile), elevated leukocyte count, and elevated D-dimer (≥75th percentile). The probability of VTE was 3.3% for score 0 (n = 63), 23.0% for score 1 (n = 53), and 37.7% for score 2 (n = 22) or score 3 (n = 3).

Conclusions

We identified biomarkers suitable for assessing the VTE risk in newly diagnosed HGG patients. The application of 2 RAMs allowed identification of patients at high risk of developing VTE. We could also define patients at low risk of VTE, who would most probably not benefit from extended primary thromboprophylaxis.