Leukocytosis, thrombosis and early mortality in cancer patients initiating chemotherapy.
Leukocytosis, thrombosis and early mortality in cancer patients initiating chemotherapy.
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DOI：
10.1016/j.thromres.2010.05.012
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发表时间：
2010-08
影响因子：
7.5
通讯作者：
Lyman GH
中科院分区：
文献类型：
--
作者：
Connolly GC;Khorana AA;Kuderer NM;Culakova E;Francis CW;Lyman GH
白细胞增多与癌症患者的血栓形成和死亡率有关。我们探讨了开始化疗的癌症患者中白细胞增多与静脉血栓栓塞（VTE）和早期死亡率的关系。本分析使用了一项前瞻性、多中心观察性研究的数据，该研究对4,405例开始化疗的非卧床癌症患者进行了治疗相关并发症的研究。在单因素和多因素分析中评估了化疗过程中白细胞增多、VTE和死亡率的关系。在中位随访75天（范围0-384天）内，93例患者（2.1%）发生VTE，134例（3%）死亡。在4391例具有可用基线白色血细胞（WBC）计数的患者中，561例（12.8%）治疗前白细胞计数升高，定义为WBC > 11×109个细胞/L。基线白细胞增多的561例患者中有25例（4.5%）发生VTE，而WBC ≤ 11×109个细胞/L的3830例患者中有68例（1.8%）发生VTE（P<0.0001）。通过多变量分析，基线白细胞增多也与VTE相关（HR 2.1，95%置信区间1.3-3.4，p=0.003）。白细胞增多组死亡41例（7.3%），白细胞≤ 11×109 cells/L组死亡92例（2.4%）（P<0.0001）。多变量分析显示，基线白细胞增多与早期死亡率相关（HR 2.2，95%置信区间1.5-3.3，p<0.0001）。白细胞增多和VTE患者的死亡率最高。在多变量分析中，有几个因素是白细胞增多的预测因素。在接受全身化疗的癌症患者中，升高的WBC，特别是中性粒细胞，与VTE风险和死亡率增加密切相关。需要进一步的研究来揭示所涉及的机制。
Leukocytosis has been associated with thrombosis and mortality in cancer patients. We explored the association of leukocytosis with venous thromboembolism (VTE) and early mortality in cancer patients initiating chemotherapy. Data from a prospective, multicenter observational study of treatment-related complications in 4,405 ambulatory cancer patients initiating chemotherapy was used for this analysis. The association of leukocytosis, VTE and mortality during the course of chemotherapy was evaluated in univariate and multivariate analysis. Ninety-three patients (2.1%) developed VTE and 134 (3%) died over a median follow up of 75 days (range 0–384). Of 4391 patients with available baseline white blood cell (WBC) count, 561 (12.8%) had elevated pretreatment leukocyte counts, defined as WBC > 11×109 cells/L. VTE occurred in 25 of 561 patients (4.5%) with baseline leukocytosis compared to 68 of 3830 (1.8%) with WBC ≤ 11×109 cells/L (P<0.0001). Baseline leukocytosis was associated with VTE by multivariate analysis as well (HR 2.1, 95% confidence interval 1.3–3.4, p=0.003). Forty one patients (7.3%) with leukocytosis died compared to 92 (2.4%) with WBC ≤ 11×109 cells/L (P<0.0001). Baseline leukocytosis was associated with early mortality by multivariate analysis as well (HR 2.2, 95% confidence interval 1.5–3.3, p<0.0001). Mortality was greatest in patients with both leukocytosis and VTE. In multivariate analysis several factors were predictive of leukocytosis. Elevated WBC, particularly neutrophils, is strongly associated with increased risk of VTE and mortality in cancer patients receiving systemic chemotherapy. Further studies are needed to elicit the mechanisms involved.
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