肺癌术后并发静脉血栓栓塞症的临床分析

Postoperative venous thromboembolism in patients with lung cancer

目的:分析肺癌术后发生静脉血栓栓塞(venous thromboembolism,VTE)的高危因素及其预后。方法:对1001例有完整临床随访资料的肺癌手术患者进行回顾性分析。应用螺旋CT、肺动脉造影和彩色多普勒超声诊断VTE。寿命表法绘制血栓发生曲线,COX多因素分析VTE高危因素。Kaplan-Meier法及log-rank检验绘制并比较高危因素血栓发生曲线及生存曲线。结果:术后1、3、5、11和30个月的VTE累积发生率分别为2.0%、3.0%、4.0%、5.0%和5.3%。COX多因素回归分析显示,接受不完全切除术患者发生VTE的风险比(hazard ratio,HR)为9.867(95%可信区间为5.275～18.459),P=0.000;术后接受化疗联合重组人血管内皮抑制素治疗患者的HR为3.472(95%可信区间为1.761～6.845),P=0.000;术后接受表皮生长因子受体酪氨酸激酶抑制剂治疗患者的HR为2.808(95%可信区间为1.439～5.479),P=0.002;术前基线血浆D-二聚体水平升高者的HR为7.520(95%可信区间为3.968～14.250),P=0.000。肺癌术后伴VTE患者的生存时间明显短于无VTE的患者(P=0.000)。结论:不完全切除术、术后化疗联合重组人血管内皮抑制素治疗、表皮生长因子受体酪氨酸激酶抑制剂治疗和术前基线血浆D-二聚体水平升高是肺癌手术患者术后并发VTE的高危因素。肺癌术后伴VTE患者的生存时间明显短于无VTE的患者。

Objective：This study aims to explore the clinical risk factors and prognosis for postoperative venous thromboembolism（VTE） in patients with lung cancer.Methods：A total of 1 001 lung cancer patients having confirmed pathological diagnosis and complete clinical and follow-up records were retrospectively analyzed.VTE was identified in a combination of spiral computed tomography（CT）,pulmonary angiography and color Doppler ultrasound.The life table method was used to create a frequency curve of thrombosis.The COX multivariate regression model was used to analyze the high risk factors for postoperative VTE.The thrombosis curves for risk factors and the survival curves were plotted by using Kaplan-Meier method and compared by log-rank test.Results：The cumulative frequencies of postoperative VTE among 1 001 patients undergoing lung resection for lung cancer were 2.0%,3.0%,4.0%,5.0% and 5.3% over one month,three months,five months,eleven months and thirty months,respectively.The COX multivariate regression analysis showed that the hazard ratios（HRs） of postoperative VTE in patients receiving incomplete resection,chemotherapy combined with recombinant human endostatin,and epidermal growth factor receptor-tyrosine kinase（EGFR-TKI） treatment were 9.867 [95% confidence interval（CI）：5.275-18.459;P=0.000],3.472（95% CI：1.761-6.845;P=0.000）,and 2.808（95% CI：1.439-5.479;P=0.002）,respectively.The HR of postoperative VTE for patients with increased level of plasma D-dimer relative to normal level of of plasma D-dimer was 7.520（95% CI：3.968-14.250;P=0.000）.The overall survival of lung cancer patients with postoperative VTE was remarkably shorter than that of the patients without postoperative VTE（P=0.000）.Conclusion：High-risk factors for postoperative VTE in patients with lung cancer include incomplete surgical resection,postoperative chemotherapy combined with recombinant human endostatin,EGFR-TKI treatment and an increase in preoperative plasma D-dimer level.The overall survival of patients with postoperative VTE is significantly shorter than that of patients without postoperative VTE.