目的：分析并发静脉血栓栓塞症（ VTE）恶性肿瘤患者的原发肿瘤种类、分期、分化程度等，以识别高危患者，提高防治意识，减少VTE的发生。方法回顾性分析北京医院2003年1月至2013年1月期间并发静脉血栓栓塞症的恶性肿瘤患者的年龄、性别、基础疾病、原发肿瘤种类、病理类型、分化程度、TNM分期、化疗方案及预后等临床信息。结果在所有18531例恶性肿瘤患者中，280例并发VTE，其中男性157例，女性123例，年龄（66．60±12．60）岁。包括单纯肺栓塞（ PTE）41例，单纯下肢深静脉血栓形成（DVT）189例，PTE合并DVT 50例。肺癌82例，消化道肿瘤78例，泌尿系肿瘤32例，妇科肿瘤27例，血液科肿瘤27例，乳腺癌12例，其他部位肿瘤22例。相比未并发VTE肿瘤患者，并发VTE多见于肺癌、妇科肿瘤和其他肿瘤患者，差异有统计学意义（P＜0．05）。151例（53．9％）并发VTE肿瘤患者病理类型为腺癌；206例（73．6％）患者发生VTE时，肿瘤处于进展期；247例有明确TNM分期患者中Ⅲ～Ⅳ期患者187例（66．8％）；144例有明确病理组织分化程度报告，中、低度分化程度者120例（85．4％）。至随访结束，共有130例患者死亡，中位生存时间为（24．0±7．8）个月，明确诊断VTE后3，6，9，12个月的累积死亡率分别为46．9％、69．2％、80．0％和82．3％。导致死亡的主要原因是肿瘤本身、肺栓塞和感染。结论肿瘤与VTE密切相关，腺癌、进展期肿瘤、分化程度低的肿瘤患者和化疗方案中含铂类药物者更易发生VTE，临床医师应注意对这部分患者进行VTE风险评估，采取必要的预防措施，减少VTE的发生。%Objective To identify the clinical features of cancer patients with venous thromboembolism ( VTE) , including types , stages and differentiation of the primary cancers , in order to identify high-risk patients, improve awareness of prevention and control, and reduce the occurrence of the disease .Methods A total of 280 cancer patients who were diagnosed with VTE in our hospital from January 2003 to January 2013 were recruited in this study.Their demographic and clinical data , including age, gender, differentiation, pathological types , TNM stages , chemotherapeutic regimens and prognosis were collected and retrospectively analyzed .Results A total of 280 cancer patients with VTE were enrolled , including 157 males and 123 females at an age of (66.60 ±12.60) years.There were 41 cases of isolated pulmonary thromboembolism (PTE), 189 of deep vein thrombosis (DVT) and 50 of PTE combined with DVT.Among them, 82 patients were lung cancers , 78 gastrointestinal cancer , 32 urinary tract tumor , 27 gynecological tumor , 27 haematological tumor , 12 breast cancer , and 22 other cancers .Compared with the cancer patients without VTE , VTE was more common in the patients with lung, gynecological and other cancers (P<0.05).Among all the patients, 151(53.9%) were diagnosed with adenocarcinoma, and 206 patients (73.6%) presented advanced cancer when developing VTE .For the 247 patients with explicit TNM stage, 187(66.8%) of them were at stage Ⅲ-Ⅳ.Among the 144 patients with definite cancer differentiation , 120(85.4%) were at moderate and poor differentiation .Till the end of follow-up, 130 patients died with a median survival time of (24.0 ±7.8) months.The cumulative mortality rates within 3, 6, 9 and 12 months were 46.9%, 69.2%, 80.0% and 82.3% respectively.The top 3 causes of death were cancer, PTE and infection.Conclusion Cancer is closely associated with VTE .Adenocarcinoma, advanced cancer, low differentiation of tumor and chemotherapeutic regimens containing platinum are more prone to developing VTE. Clinicians should pay attention to these patients , perform VTE risk evaluation , and take the necessary precautionary measures to reduce the incidence of VTE .
展开▼
