Risk factors for chemotherapy-associated venous thromboembolism in a prospective observational study
Risk factors for chemotherapy-associated venous thromboembolism in a prospective observational study
复制标题
DOI：
10.1002/cncr.21496
复制
发表时间：
2005-12-15
期刊：
影响因子：
6.2
通讯作者：
Lyman, GH
中科院分区：
文献类型：
--
作者：
Khorana, AA;Francis, CW;Lyman, GH
背景静脉血栓栓塞症（VTE）的发生率在癌症中增加，但关于癌症患者化疗的危险因素的信息很少。我们分析了一项前瞻性、多中心观察性研究的数据，以确定开始新化疗方案的非卧床癌症患者发生VTE的频率和危险因素。静脉血栓栓塞与临床变量的相关性采用单变量和多变量分析。在3003例接受至少一个周期化疗的患者中，58例（1.93%）在中位随访2.4个月（0.8%/月）内发生VTE。癌症部位的发病率差异显著（P = 0.01），上消化道癌（2.3%/月）、肺癌（1.2%/月）和淋巴瘤（1.1%/月）的发病率最高。化疗前血小板计数升高与VTE发生率升高显著相关（趋势P = 0.005）。化疗前血小板计数>= 350，000的患者的VTE发生率为3.98%（1.66%/月），而血小板计数<200，000的患者为1.25%（0.52%/月）（趋势P =0.0003）。多变量分析显示，化疗前血小板计数≥ 350，000/mm 3（调整OR 2.81，95%CI 1.63-4.93，P = 0.0002）、癌症部位、血红蛋白<10 g/dL或使用促红细胞生成素、癌症高危部位使用白色细胞生长因子与VTE显著相关。症状性静脉血栓栓塞是化疗的常见并发症。化疗前的血小板计数是一个独特的危险因素，可以帮助确定高风险患者的血栓预防未来的试验。
BACKGROUND. The incidence of venous thromboembolism (VTE) is increased in cancer, but little information is available about risk factors in cancer patients on chemotherapy.METHODS. We analyzed data from a prospective, multicenter observational study to determine the frequency and risk factors for VTE in ambulatory cancer patients initiating a new chemotherapy regimen. The association of VTE with clinical variables was characterized using univariate and multivariate analysis.RESULTS. Among 3003 patients treated with at least one cycle of chemotherapy, VTE occurred in 58 (1.93%) over a median follow-up of 2.4 months (0.8%/mo). The incidence varied significantly by site of cancer (P = 0.01) with highest rates in upper gastrointestinal (2.3%/mo) and lung cancer (1.2%/mo), and lymphoma (1.1%/mo). An elevated prechemotherapy platelet count was significantly associated with an increased rate of VTE (P for trend = 0.005). The incidence of VTE was 3.98% (1.66%/mo) for patients with a prechemotherapy platelet count >= 350,000, compared with 1.25% (0.52%/mo) for patients with platelet counts of < 200,000 (P for trend=0.0003). In multivariate analysis, a prechemotherapy platelet count of >= 350,000/mm(3) (adjusted OR 2.81, 95% CI 1.63-4.93, P = 0.0002), site of cancer, hemoglobin < 10g/dL or use of erythropoietin, and use of white cell growth factors in high-risk sites of cancer were significantly associated with VTE.CONCLUSIONS. Symptomatic VTE is a frequent complication of chemotherapy. The prechemotherapy platelet count is a unique risk factor and can help identify high-risk patients for future trials of thromboprophylaxis.