表皮生长因子受体驱动基因及肿瘤因素对围手术期肺腺癌患者深静脉血栓的影响

Effect of epidermal growth factor receptor oncogenes and tumor factors on venous thromboembolism in patients with lung adenocarcinoma during perioperative period

目的分析肺腺癌患者肿瘤因素及表皮生长因子受体(EGFR)驱动基因对肺腺癌伴发静脉血栓栓塞症的影响因素,为肺腺癌患者的静脉血栓栓塞症(VTE)预防提供参考。方法选择2020年1月至2021年1月江南大学附属医院胸外科住院治疗的420例肺腺癌患者,手术前、后行双下肢静脉彩超检查并收集临床信息资料,根据彩超检查结果将患者分为VTE组和非VTE组,采用SPSS 25.0对两组患者进行单因素分析和多因素Logistic回归分析肿瘤因素及EGFR驱动基因对VTE发生的影响。结果420例肺腺癌患者中,发生VTE患者41例,发生率为9.76%。41例患者中,有21例为左侧小腿肌间静脉血栓(CMVT),其中4例合并左侧胫腓静脉血栓;有7例为右侧孤立性CMVT;有5例为双侧CMVT,其中4例合并下肢近端深静脉血栓(DVT);有8例患者存在下肢近端DVT。单因素结果分析发现两组患者在性别、年龄、吸烟、肺癌部位、手术术式、中心静脉置管、肿瘤大小、肺腺癌分期Ⅲ~Ⅳ期、恶性肿瘤史、EGFR基因突变阳性方面差异有统计学意义(P<0.05);多因素Logistic回归分析显示,肺腺癌Ⅲ~Ⅳ期[比值比(OR)=3.951,P<0.05]、肿瘤直径≥2 cm(OR=2.291,P<0.05)、EGFR基因突变阳性(OR=3.503,P<0.05)在VTE组和非VTE组间差异有统计学意义。结论Ⅲ~Ⅳ期的肺腺癌、肿瘤直径(≥2 cm)、EGFR基因突变阳性是肺腺癌患者发生VTE的危险因素。

Objective To analyze the factors influencing tumor factors and epidermal growth factor receptor(EGFR)oncogene on venous thromboembolism(VTE)in patients with lung adenocarcinoma,and to provide a reference for VTE prevention in patients with lung adenocarcinoma.Methods Totally,420 patients with lung adenocarcinoma who were hospitalized in the Affiliated Hospital of Jiangnan University from January 2020 to January 2021 were selected.Before and after surgery,color Doppler ultrasound examination of both lower extremities was performed and clinical information was collected.According to the results of color Doppler ultrasound examination,patients were divided into VTE group and non-VTE group,and SPSS 25.0 was used to conduct univariate analysis and multivariate Logistic regression to analyze the impact of tumor factors and EGFR oncogene on the occurrence of VTE.Results Among 420 patients with lung adenocarcinoma,VTE occurred in 41 patients,with an incidence of 9.76%.Of the 41 patients,21 had left-sided calf muscle venous thrombosis(CMVT),of which 4 had combined left-sided tibiofibular vein thrombosis;7 had right isolated CMVT;5 had bilateral CMVT,of which 4 had combined proximal deep venous thrombosis(DVT)of the lower extremities;8 patients had proximal DVT of the lower extremities.Univariate outcome analysis revealed significant differences between the two groups in terms of gender,age,smoking,site of lung cancer,surgical procedure,central venous catheterization,tumor size,stage Ⅲ-Ⅳ lung adenocarcinoma,history of malignancy,and positive EGFR oncogene.Multi-factor logistic regression analysis showed that there were statistically significant differences in stage Ⅲ-Ⅳ lung adenocarcinoma,tumor size,and positive EGFR oncogene between VTE and non-VTE groups.Conclusion Stage Ⅲ-Ⅳ lung adenocarcinoma[odds ratio(OR)=3.951,95%confidence interval(CI):1.618-9.647,P<0.05],tumor diameter(≥2 cm)(OR=2.291,95%CI:1.245-6.854,P<0.05),and EGFR oncogene(OR=3.503,95%CI:1.245-7.486,P<0.05)are risk factors for the lung adenocarcinoma patients.