消化系统恶性肿瘤合并静脉血栓栓塞症的临床特点

Clinical features of patients with digestive malignancy complicated with venous thromboembolism

目的:分析消化系统恶性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12月—2019年12月收治的143例消化系统恶性肿瘤合并VTE患者的临床资料。结果:143例患者中,141例(98.7%)的VTE发生于肿瘤确诊之后,中位时间为105.0 d(四分位距:23.0~373.0 d;范围:-86~3645 d);112例(78.3%)接受抗凝治疗,其中64例(57.1%)接受影像学复查以评价疗效,结果显示45例(70.3%)治疗显效或有效,19例(29.7%)治疗无效或恶化。143例患者中,98例(68.5%)在抗肿瘤治疗过程中发生VTE,其中66例(67.3%)继续接受标准抗肿瘤治疗,30例(30.6%)因VTE推迟或停止化疗,2例(2.1%)推迟靶向治疗。应用Khorana评分、Caprini评分和Padua评分评估VTE风险,结果显示中至高危患者分别占38.5%、96.5%和30.1%,提示现有评分工具对于消化系统恶性肿瘤患者合并VTE风险的预测能力有限。结论:VTE是消化系统恶性肿瘤患者的常见并发症,给抗肿瘤治疗计划的顺利完成带来不利影响。

Objective:To evaluate the clinical characteristics of patients with malignancy of digestive system complicated with venous thromboembolism(VTE).Methods:Clinical data of 143 patients with malignancy of digestive system complicated with VTE admitted from December 2012 to December 2019 were collected and analyzed.Results:Of the 143 patients,141(98.7%)were diagnosed with VTE after cancer diagnosis,with a median time gap of 105.0 d(interquartile range:23.0-373.0 d;range:-86-3645 d).After the diagnosis of VTE,112(78.3%)patients received anticoagulant therapy,of them 64(57.1%)patients received imaging examination for evaluation of response to treatment.The treatment for VTE was markedly effective or effective in 45(70.3%)patients,while VTE remained unchanged or worsen in 19(29.7%)patients,despite of anticoagulant therapy.VTE occurred during antitumor therapy in 98(68.5%)patients,of whom 66(67.3%)continued to receive standard anti-tumor treatment,30(30.6%)had the chemotherapy delayed or termianted,while 2(2.1%)postponed targeted therapy.Using Khorana score,Caprini score and Padua score to retrospectively evaluate the VTE risk,patients with medium to high risk taken up 38.5%,96.5%and 30.1%,respectively,indicating poor sensitivity of Padua score and Khorana score.Conclusion:VTE is one of the common complications of digestive system malignancy and affects the implementation of antitumor therapy.