Ⅰa期非小细胞肺癌术后静脉血栓栓塞症发生情况及相关因素分析

Analysis of incidence and risk factors for postoperative venous thromboembolism in patients with stageⅠa non-small-cell lung cancer

目的分析Ⅰa期非小细胞肺癌(NSCLC)患者术后静脉血栓栓塞症(VTE)的发生情况及相关因素,从而为进一步预防性抗凝的研究提供依据。方法回顾性选择2017年1月至2020年10月在首都医科大学附属北京朝阳医院胸外科接受住院手术治疗的132例Ⅰa期NSCLC患者,男42例,女90例,年龄26-79(57±10)岁。术前术后均行下肢静脉超声,按照术后是否发生VTE分为VTE组(11例)和非VTE组(121例)。比较两组间手术情况、检验指标、影像学信息、病理学信息等的差异,并将差异有统计学意义的因素纳入logistic回归分析得到独立相关因素。结果术后共发生VTE 11例(8.3%),其中下肢深静脉血栓形成(DVT)10例(90.9%),DVT合并肺栓塞(PE)1例(9.1%)。VTE组年龄大于非VTE组[(65±9)岁比(57±10)岁,P=0.009];两组术后第5天D-二聚体值及其较术前的差值的差异具有统计学意义[3.18(1.55,5.15)比1.54(1.09,2.57),2.66(1.17,4.65)比1.34(0.78,2.04)](均P<0.05);VTE组中神经元特异性烯醇化酶值(NSE)、术中切除淋巴结的数量明显高于非VTE组[(21.54±12.37)比(14.72±5.75),(19.7±8.2)比(13.0±7.9)](均P<0.05)。两组在手术方式、影像学特征(肿瘤位置、血管集束征等)、病理学信息(病理类型等)方面的差异无统计学意义(均P>0.05)。将上述差异有统计学意义的因素纳入logistic回归分析得到术中切除淋巴结的数量是VTE发生的独立相关因素[OR=1.306(95%CI:1.000-1.600),P<0.05]。结论Ⅰa期NSCLC患者术后VTE发生率约为8.3%,术中切除淋巴结的数量可能是Ⅰa期非小细胞肺癌患者术后VTE发生的独立相关因素。

Objective To analyze the incidence and risk factors for postoperative venous thromboembolism(VTE)in patients with stageⅠa non-small-cell lung cancer(NSCLC),so as to find evidence for further research of prophylactic anticoagulation.Methods A total of 132 patients with stageⅠa NSCLC,42 males and 90 females aged from 26 to 79 years with an average of(57±10)years,were retrospectively included in this study.All of them underwent surgical treatment at the Department of Thoracic Surgery of Beijing Chaoyang Hospital Affiliated with Capital Medical University from January 2017 to October 2020.A lower extremity venous ultrasound was performed before and after the operation.Participants were divided into VTE group(n=11)or non-VTE group(n=121)according to whether or not VTE occurred after operation.The surgical conditions,test indicators,imaging information,pathology information were compared between the two groups.Logistic regression analysis was performed to test the associations of VET with putative risks factors in which significant differences were observed.The independent risk factors of VET were determined by this way.Results Postoperative VTE occurred in 11 cases(8.3%),including 10 cases(90.9%)of deep vein thrombosis(DVT)of lower limbs and 1 case(9.1%)of DVT complicated with pulmonary embolism(PE).The mean age of Patients in the VTE group was older than that in non-VTE Group((65±9)years vs(57±10)years,P=0.009).On the fifth day after operation,patients in both groups had significantly higher D-dimer level compared with that before operation(3.18(1.55,5.15)vs 1.54(1.09,2.57);2.66(1.17,4.65)vs 1.34(0.78,2.04))(both P<0.05).The value of neuron-specific enolase(NSE)and the number of lymph nodes removed during the operation in the VTE group were significantly higher than those in the non-VTE group((21.54±12.37)vs(14.72±5.75);(19.7±8.2)vs(13.0±7.9))(both P<0.05).There was no statistically significant difference in the approach of surgery,imaging features(tumor location,vascular cluster signs,etc.),and pathological information(pathological types,etc.)(all P>0.05).The logistic regression analysis showed that the number of lymph nodes removed during the operation was an independent risk factor related to the occurrence of VTE(OR=1.306,95%CI:1.000-1.600,P<0.05).Conclusions The incidence of postoperative VTE in patients with stageⅠa NSCLC is approximately 8.3%.The number of lymph nodes removed during the operation may be an independent risk factor for postoperative VTE in patients with stageⅠa NSCLC.