老年肺癌合并静脉血栓栓塞症的临床研究

Clinical characteristics and outcomes of lung cancer in elderly patients with venous thromboembolism

目的探讨老年肺癌合并静脉血栓栓基症（VTE）的临床特点、危险因素及预后，提高防治意识，减少血栓事件发生。方法对北京医院2003年1月至2013年4月老年肺癌合并VTE的患者进行回顾性临床分析，记录年龄、性别、临床表现、病理类型、TNM分期、体力状态（PS）评分、化疗方案及预后等临床信息。结果老年肺癌组49例，年龄（72．8±5．56）岁，非老年组30例，年龄（54．2±8．29）岁。老年组基础疾病的发生率高于非老年组；近期卧床（24．49％对6．67％）和PS评分（2．32±1．38对1．37±1．10）亦高于非老年组（P值分别为0．048和0．02）。在两组患者中，以NSCLC为主，病理类型多为腺癌，TNM分期Ⅲ～Ⅳ期居多。老年组呼吸困难症状（36．74％对13．33％）及肺栓塞严重程度指数（PESI）评分（116．92±21．34对100．5±18．12）多于非老年组（P值分别为0．028和0．04）。老年肺癌组3、6、9和12个月VTE累积发生率分别为71．4％、77．6％、83．7％和87．8％；非老年组分别为76．7％、80．0％、83．3％和83．3％。生存分析显示，两组中位生存时间差异无统计学意义[（6．0±2．25）个月对（9±7．48）个月，P=0．657]。结论老年肺癌合并VTE患者具有较多的基础疾病，而且卧床患者较多；老年组PTE患者中呼吸困难症状多见，疾病危险程度高于非老年组，老年组患者预后较非老年组差。

Objective To identify the clinical features and outcomes of lung cancer in the elderly with venous thromboembo- lism（VTE）. Methods From January 2003 to April 2013,49 elderly lung cancer patients with VTE and 30 young patients were evaluated for clinical presentations and outcomes. The clinical data including age, gender, clinical manifestations, path- ological type, TNM stages, performance status, chemotherapeutic regimens and prognosis were collected. Results The mean age of the elderly was （ 72. 8 ± 5.56） years and that of the younger was （54. 2 ± 8.26 ） years. The incidence rate of comor- bidity in the elderly was higher than that of the younger patients;meanwhile, the scores for immobilization and performance status were significantly higher in the elderly （ P =0. 048 and 0. 02, respectively）. Most patients in both groups were with non-small cell lung cancer （NSCLC） with adenocarcimoma types and advanced stages. The elderly patients were more likely to present with dyspnea （36. 74% vs 13.33% ,P = 0. 028 ）. The pulmonary embolism severity index （PESI） was also higher in the elderly （ 116. 92 ±21.34 vs 100. 5 ± 18.12 ,P =0. 04）. The incidences of VTE were 71.4% ,77.6% ,83.7% and 87.8% in the elderly patients within 3,6,9 and 12 months, respectively, while those in the younger were 76. 7% , 80% ,83.3% and 83.3% , respectively. A total of 32 patients died in the elderly group while 20 patients passed away. There were no significant difference in the median survival time between the two groups （ [ 6. 0 ± 2.25 ] months vs [ 9 ± 7.48 ] months, P = 0. 657 ）. Conclusion Comorbidity may occur more in elderly lung cancer patients with VTE, and the immobilization rate is also higher. More elderly patients present with dyspnea in the elderly and the severity of disease is higher. Prognosis of the elderly is worse than that of the younger.