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肺癌合并静脉血栓栓塞症的临床特征及预后影响因素分析

Clinical characteristics and prognostic factors in patients with lung cancer complicated with venous thromboembolism

    摘要
  • 摘要:
    目的 探讨肺癌合并静脉血栓栓塞症（venous thromboembolism，VTE）的临床特征、治疗模式、转归及影响因素。
    方法 选择2015年1月1日至2020年12月31日大连医科大学附属第一医院收治的肺癌患者5 769例，筛选新发VTE患者，收集性别、年龄、吸烟史、临床分期、病理类型等临床资料，分析肺癌合并VTE的发生率、临床特征、发生时机及影响因素等。
    结果 5 769例肺癌患者中，新发VTE患者76例，发生率为1.3%。VTE患者中位年龄69岁，47.4%为男性，52.6%为女性。28.9%有吸烟史，25.0%有手术史，69.7%合并基础疾病。47.4%临床分期为Ⅰ~Ⅲ期，52.6%为Ⅳ期；76.3%病理类型为腺癌；驱动基因阳性者占18.4%。84.2%确诊肺癌时ECOG评分为0~2分；确诊肺癌时Khorana评估中危者占89.5%，高危者占10.5%。36.8%为深静脉血栓，32.9%为肺栓塞，30.3%为深静脉血栓合并肺栓塞。发生VTE时，D-二聚体100~29 900 μg/L，中位4 100 μg/L，升高者占94.7%。30.3%患者在肿瘤治疗期间发生VTE。42.9%（12/28）肺癌术后患者VTE出现在术后90 d内，术后30 d内风险最高。55.0%（22/40）晚期复发转移肺癌患者VTE出现在确诊复发转移9个月内，确诊后3个月内风险最高。92.1%接受了抗凝治疗；93.4%经过治疗好转，6.6%因VTE死亡。吸烟史、诊断肺癌时ECOG评分对VTE患者预后有影响（P < 0.05）。
    结论 肺癌患者可能发生VTE，合并VTE者临床特征复杂，需重视围手术期、晚期转移性患者VTE的预防、评估和筛查。

     

    Abstract:
    Objective To explore the clinical characteristics, treatment modes, outcomes, and risk factors in lung cancer patients with venous thromboembolism (VTE).
    Methods The date of 5 769 lung cancer patients admitted in the First Affiliated Hospital of Dalian Medical University between Jan 1, 2015 and Dec 31, 2020 were retrospectively analyzed, and the patients with VTE were collected. Clinical data such as sex, age, smoking history, clinical stage, and histopathologic type were collected. The incidence, clinical characteristics, timing, and influencing factors of VTE in patients with lung cancer were analyzed.
    Results The incidence of VTE in lung cancer patients was 1.3% (76/5 769); the median age was 69 years. male accounted for 47.4%; female accounted for 52.6%. 28.9% had smoking history, 25.0% had surgical history, 69.7% had basic disease. The chinical stage Ⅰ-Ⅲ, 47.4%, stage Ⅳ, 52.6%; adenocarcinoma, 76.3%; drive gene mutation, 18.4%. ECOG score at diagnosis of lung cancer in 84.2% patients was 0-2 points. 89.5% patients were in the middle-risk of Khorana score at diagnosis of lung cancer and 10.5% were in the high-risk. 36.8% had deep venous thrombosis, 32.9% had pulmonary embolism, and 30.3% had deep venous thrombosis combined with pulmonary embolism. In the VTE patients, D-dimer was 100-29 900 μg/L, with a median of 4 100 μg/L, and 94.7% patients increased. 30.3% of VTE occurred during tumor treatment. 42.9%(12/28) patients had VTE within 90 days after surgery, and the risk was the highest within 30 days after surgery. VTE occurred in 55.0%(22/40) patients with advanced lung cancer within 9 months of diagnosis, especially within 3 months. 92.1% received anticoagulant therapy; 93.4% improved after treatment, and 6.6% died due to VTE. The smoking history and ECOG score at the diagnosis of lung cancer were correlated with the outcome of VTE (P < 0.05).
    Conclusions The patients with lung cancer may complicated with VTE, and the clinical characteristics in the patiens are complex. It is necessary to pay attention to the prevention, evaluation, and screening of VTE in perioperative and advanced metastatic patients.

     

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