卵巢透明细胞癌患者并发静脉血栓栓塞症的影响因素

Influencing factors of venous thromboembolism in women with ovarian clear cell carcinoma

目的探讨卵巢透明细胞癌(OCCC)患者发生静脉血栓栓塞症(VTE)的影响因素。方法选择2012年2月至2021年2月,四川大学华西第二医院收治的221例OCCC患者为研究对象。采用回顾性分析方法,根据是否发生VTE,将其分别纳入VTE组(n=39)和无VTE组(n=182)。对2组患者相关临床资料、术中情况,以及VTE组患者临床特点进行统计学分析,并采用未校正的Kaplan-Meier曲线模型及log-rank检验,对2组患者的中位总体生存(OS)期和中位无进展生存(PFS)期进行统计学分析。对影响OCCC患者并发VTE因素进行多因素非条件logistic回归分析。2组患者年龄、人体质量指数(BMI)、绝经率、妊娠次数、肿瘤最大直径、原发性高血压和2型糖尿病发生率比较,差异均无统计学意义(P>0.05)。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。结果①本组221例OCCC患者的VTE发生率为17.6%(39/221)。术前,2组OCCC患者糖类抗原(CA)125水平与国际妇产科联盟(FIGO)不同临床分期占比比较,差异均有统计学意义(P<0.05)。②VTE组患者的开腹手术占比、G-Caprini评分、淋巴结阳性率、腹水或腹腔冲洗液细胞学检查阳性率,以及切除淋巴结≥20个及化疗次数>6次占比与铂耐药率,均高于无VTE组,并且差异均有统计学意义(P<0.05)。③VTE组39例患者中,26例(66.7%)被诊断为VTE时无自觉症状;术前发生VTE为7例(17.9%),术后为18例(46.1%),化疗期为9例(23.1%),复发期为5例(12.8%)。VTE发生部位位于下肢、上肢、上肢+下肢、肺部分别为24例(61.5%)、6例(15.4%)、4例(10.3%)、5例(12.8%)。④无VTE组患者中位OS期及中位PFS期,均明显长于VTE组,并且差异均有统计学意义(P<0.05)。⑤影响OCCC患者并发VTE因素的多因素非条件logistic回归分析结果显示,OCCC患者FIGO临床分期为晚期(Ⅲ~Ⅳ期)(OR=1.012,95%CI:0.110~1.900,P=0.026),术前CA125水平≥200 U/mL(OR=1.472,95%CI:0.476~2.433,P=0.036),是导致OCCC患者发生VTE的独立影响因素。结论VTE是影响OCCC患者预后的重要因素之一,对于FIGO临床分期为晚期(Ⅲ~Ⅳ期)及术前CA125水平≥200 U/mL的OCCC患者,应重点预防和监测VTE发生可能。

Objective To explore influencing factors of venous thromboembolism(VTE)in patients with ovarian clear cell carcinoma(OCCC).Methods From February 2012 to February 2021,221 women with OCCC who underwent gynecological surgery and confirmed by pathology in the West China Second University Hospital,Sichuan University were enrolled.According to whether the occurrence of VTE or not,they were divided into VTE group(n=39)and non-VTE group(n=182)by retrospective analysis mothod.The clinical data,intraoperative situation and VTE characteristics in two groups were retrospectively analyzed.The uncorrected Kaplan-Meier curve model and log-rank test were used to statistically analyze the median overall survival(OS)time and median progression-free survival(PFS)time between two groups.Multivariate unconditional logistic regression analysis was used to analyze the effect factors of OCCC patients complicated with VTE.There were no significant differences between two groups in age and body mass index(BMI),etc.(P>0.05).The procedure followed in this study was in accordance with the World Medical Association Declaration of Helsinki revised in 2013.Results①Among 221 OCCC patients,the incidence of VTE was 17.6%(39/221).There were statistically significant differences in preoperative carbohydrate antigen(CA)125 level and proportion of different International Federation of Gynecology and Obstetrics(FIGO)stages(P<0.05).②In VTE group,the proportion of open surgery,G-Caprini score,positive rate of lymph nodes,positive rate of cytological examination of ascites or peritoneal lavage fluid,the number of lymph node dissection≥20,proportion of chemotherapy>6 times,and platinum drug resistance rate were all higher than those in non-VTE group,and the differences between two groups were statistically significant(P<0.05).③Twenty-six patients(66.7%)had no self-conscious symptoms when they were diagnosed with VTE.VTE occurred in 7 cases(17.9%)before operation,18 cases(46.1%)after operation,9 cases(23.1%)during chemotherapy,and 5 cases(12.8%)during OCCC recurrence.VTE occurred in lower limbs,upper limbs,upper limbs+lower limbs and lungs in 24 cases(61.5%),6 cases(15.4%),4 cases(10.3%)and 5 cases(12.8%),respectively.④Survival analysis showed that the OS time and PFS time in non-VTE group were significantly longer than those in VTE group,and the differences were statistically significant(P<0.05).⑤The results of multivariate unconditional logistic regression analysis showed that advanced-stage(FIGO stagingⅢ-Ⅳ)(OR=1.012,95%CI:0.110-1.900,P=0.026),and preoperative CA125 level≥200 U/mL(OR=1.472,95%CI:0.476-2.433,P=0.036)were independent influencing factors of OCCC patients complicated with VTE.Conclusions VTE is one of the important factors affecting prognosis of patients with OCCC.The prevention and early diagnosis of VTE should be strengthened in FIGO stagingⅢ-Ⅳand preoperative CA125 level≥200 U/mL.