卵巢癌与宫颈癌合并血栓栓塞性疾病临床特点分析

Clinical features of venous thrombus embolism diseases developed in ovarian cancer and cervical cancer patients

目的:对比分析上皮性卵巢癌患者与宫颈鳞状细胞癌患者发生静脉血栓栓塞(VTE)的临床特征,分析其高危因素,为其临床预防及诊治提供参考。方法:回顾性分析我院收治的上皮性卵巢癌患者(n=147例)及宫颈鳞状细胞癌患者(n=149例)的临床资料,对比分析两组患者VTE发生临床特点的差异,尤其是化疗及围手术期对VTE发生的影响,单因素回归分析VTE发生的高危因素。结果:卵巢癌患者的VTE发生率高于宫颈癌患者(13.6%vs 7.4%,P=0.08),但无统计学意义。卵巢癌患者与宫颈癌患者VTE的发生具有不同特点,卵巢癌患者VTE多发生于初步诊断时(65% vs 9.1%,P=0.003),而宫颈癌患者VTE多发生于手术后(81.8%vs 25%,P=0.006)。两组患者新辅助化疗期间VTE发生率(10% vs 0%,P=0.53)以及术后辅助化疗期间VTE发生率(0%vs 9.1%,P=0.354)均无显著差异。多数患者合并的VTE均为下肢静脉血栓,仅1例卵巢癌患者发生肺栓塞。单因素分析发现卵巢癌患者绝经后状态(17.9% vs 5.8%,P=0.045)为VTE发生的高危因素。结论:卵巢癌患者与宫颈癌患者VTE发生特点存在显著差异。卵巢癌患者易自发发生VTE,宫颈癌患者VTE多于手术后发生。卵巢癌患者与宫颈癌患者合并VTE的总发病率无统计学差异。化疗不增加两组患者VTE的发生率。

Objective： The purpose of this study was to compare the incidence,type and timing of venous thromboembolism（ VTE） in patients who were diagnosed with epithelial ovarian cancer（ EOC） with patients who were diagnosed with cervical cancer. Methods： We retrospectively reviewed the charts of patients admitted to our institution with gynecologic malignancy.This study is limited to cases of EOC and cervical cancer. Cases of EOC patients（ n = 147）were compared with cervical cancer patients（ n = 149）.Descriptive statistics were generated and incidence of VTE in patients with EOC was compared with patients with cervical cancer by incidental finding / at diagnosis,during / after neoadjuvant chemotherapy（ NACT）,after surgery and during / after adjuvant chemotherapy（ ACT）. Results： Patients with EOC were more likely to have VTE compared with patients with cervical cancer（ 13.6% vs 7.4%,P = 0.08）,but with no significant statistical difference. Timing of VTE was noted and compared in EOC patients and cervical cancer patients as： incidental finding / at diagnosis（ 65% vs 9.1%,P = 0.003）; during /after NACT（ 10% vs 0%,P = 0.53）; after surgery（ 25% vs 81.8%,P = 0.006） and during / after ACT（ 0% vs 9.1%,P = 0.354） respectively.Among 13.6% of events in EOC patients 12.9%were LEDVT and 0. 7% were PE. In cervical cancer patients all events were LEDVT（ 7. 4%）.Conclusion： VTE as an incidental finding / at diagnosis occurred significantly more commonly in patients with EOC compared to patients with cervical cancer.On the other hand,VTE after surgery was increasingly noticed among cervical cancer patients compared to EOC patients. There was no significant difference among the overall incidence of VTE in EOC patients compared to patients with cervical cancer.Type of chemotherapy（ NACT or ACT） did not statistically alter the incidence of VTE among both the cancers.