肺癌患者并发静脉血栓发病时间及特征分析

Incidence and time characteristics of venous thromboembolism in patients with lung cancer

目的静脉血栓栓塞症(venous thromboembolism,VTE)是肿瘤患者的常见并发症,本研究旨在了解肺癌患者中VTE的发生风险,分析肺癌合并VTE的发生特征,探讨在肺癌患者中开展血栓预防研究的必要性和最佳干预时机。方法回顾性分析北京大学肿瘤医院胸部肿瘤内二科2012-09-01-2019-08-31收治的1766例肺癌患者的基本资料,筛选其中发生VTE的病例115例。VTE的诊断以临床症状和影像学检查为主要依据。收集该组患者的临床病例资料,用SPSS 21.0进行统计分析,计算肺癌患者VTE的发病率,分析VTE发生的高危时间。结果1766例肺癌患者中115例发生VTE,发病率为6.5%。其中男78例(67.8%),女37例(32.2%);中位年龄61岁(27~79岁)。肺腺癌76例(66.1%),肺鳞癌19例(16.5%),小细胞肺癌13例(11.3%),其他类型肺癌7例(6.1%)。肿瘤分期Ⅰ~Ⅲ期36例(31.3%),Ⅳ期79例(68.7%)。VTE包括深静脉血栓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%)。76.5%(88例)的VTE发生在肿瘤系统性治疗期间。以抗肿瘤治疗开始的时间为起点,肺癌患者发生VTE的时间为-19~62个月,中位时间1个月。53.0%(61例)的VTE发生在抗肿瘤治疗前的1个月到治疗后的2个月之间。结论VTE是肺癌患者常见并发症,在接受抗肿瘤治疗前的1个月到治疗后的2个月之间,肺癌患者发生VTE的风险最高。

OBJECTIVE Venous thromboembolism(VTE)is a common complication of tumor patients.The purpose of this study was to understand the risk of VTE in lung cancer patients,to observe the occurrence time of VTE as well as to explore the necessity and the optimal time of intervention to prevent thromboembolism in patients with lung cancer.METHODS The basic data of 1766 lung cancer patients from September 1,2012 to August 31,2019 in DepartmentⅡof Thoracic Oncology,Peking University Cancer Hospital were analyzed retrospectively,and the cases of VTE were screened.The diagnosis of VTE is based on clinical symptoms and imaging examinations.The incidence of VTE in lung cancer patients was calculated and the high-risk time of VTE was analyzed by SPSS 21.0.RESULTS VTE occurred in 115 out of 1766 patients with lung cancer,with an incidence of 6.5%.There were 78 males(67.8%)with a median age of 61 years(27-79 years).There were 76 cases of adenocarcinoma(66.1%),19 cases of squamous cell carcinoma(16.5%),13 cases of small cell lung cancer(11.3%)and 7 cases of other types(6.1%).Tumor staging:36 cases(31.3%)in stageⅠ-Ⅲand 79 cases(68.7%)in stageⅣ.VTE included 82 cases of deep venous thrombosis(71.3%),21 cases of pulmonary embolism(18.3%)and 12 cases of both(10.4%).76.5%(88 cases)of VTE occurred during the period of systematic treatment.From the beginning of antineoplastic therapy,the time of VTE ranged from-19 to 62 months,and the median time was 1 month.53.0%(61 cases)of thrombosis occurred between 1 month before antineoplastic therapy and 2 months after.CONCLUSIONS VTE is a common complication of patients with lung cancer.The highest risk of VTE is between one month before receiving antineoplastic treatment and two months after that.