切换至 "中华医学电子期刊资源库"

中华妇幼临床医学杂志(电子版) ›› 2022, Vol. 18 ›› Issue (02) : 150 -157. doi: 10.3877/cma.j.issn.1673-5250.2022.02.005

论著

卵巢透明细胞癌患者并发静脉血栓栓塞症的影响因素
邓洁1,2, 王一然1, 王平,1   
  1. 1四川大学华西第二医院妇产科、出生缺陷与相关妇儿疾病教育部重点实验室,成都 610041
    2成都医学院第一附属医院妇科 610500
  • 收稿日期:2021-11-19 修回日期:2022-03-01 出版日期:2022-04-01
  • 通信作者: 王平

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

Jie Deng1,2, Yiran Wang1, Ping Wang,1   

  1. 1Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
    2Department of Gynecology, First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
  • Received:2021-11-19 Revised:2022-03-01 Published:2022-04-01
  • Corresponding author: Ping Wang
  • Supported by:
    Key Research and Development Project of Science and Technology Department of Sichuan Province(2021YFS0015)
引用本文:

邓洁, 王一然, 王平. 卵巢透明细胞癌患者并发静脉血栓栓塞症的影响因素[J/OL]. 中华妇幼临床医学杂志(电子版), 2022, 18(02): 150-157.

Jie Deng, Yiran Wang, Ping Wang. Influencing factors of venous thromboembolism in women with ovarian clear cell carcinoma[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2022, 18(02): 150-157.

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)。② VTE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.

Results

①Among 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 staging Ⅲ-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 staging Ⅲ-Ⅳ and preoperative CA125 level ≥200 U/mL.

表1 2组OCCC患者临床资料比较
表2 2组OCCC患者手术情况比较
表3 39例OCCC并发VTE患者的VTE类型及发生部位比较[例数(%)]
表4 2组OCCC患者生存结局比较
图2 VTE组与无VTE组患者的PFS曲线
表5 OCCC患者发生VTE影响因素的多因素非条件logistic回归分析结果
[17]
Di Nisio M, Candeloro M, Rutjes AWS, et al.Venous thromboembolism in cancer patients receiving neoadjuvant chemotherapy: a systematic review and Meta-analysis[J]. J Thromb Haemost201816(7):1336-1346. DOI: 10.1111/jth.14149.
[18]
Fernandes CJ, Morinaga LTK, Alves JL Jr, et al. Cancer-associated thrombosis: the when, how and why[J]. Eur Respir Rev, 2019, 28(151): 180119. DOI: 10.1183/16000617.0119-2018.
[19]
Zhang W, Liu X, Cheng H, et al. Risk factors and treatment of venous thromboembolism in perioperative patients with ovarian cancer in China[J]. Medicine (Baltimore), 2018, 97(31): e11754. DOI: 10.1097/MD.0000000000011754.
[1]
Yamaguchi K, Kitamura S, Furutake Y, et al. Acquired evolution of mitochondrial metabolism regulated by HNF1B in ovarian clear cell carcinoma[J]. Cancers, 2021, 13(10): 2413. DOI: 10.3390/cancers13102413.
[2]
Zhu C, Xu Z, Zhang T, et al. Updates of pathogenesis, diagnostic and therapeutic perspectives for ovarian clear cell carcinoma[J]. J Cancer, 2021, 12(8): 2295-2316. DOI: 10.7150/jca.53395.
[3]
Key NS, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update[J]. Clin Oncol, 2020, 38(5): 496-520. DOI: 10.1200/JCO.19.01461.
[4]
Duska LR, Garrett L, Henretta M, et al. When ′never-events′ occur despite adherence to clinical guidelines: the case of venous thromboembolism in clear cell cancer of the ovary compared with other epithelial histologic subtypes[J]. Gynecol Oncol, 2010, 116(3): 374-377. DOI: 10.1016/j.ygyno.2009.10.069.
[5]
张家怡,张玉泉.妇产科患者静脉血栓栓塞症风险评估模型的研究现状[J/OL].中华妇幼临床医学杂志(电子版)2021, 17(1): 15-22. DOI: 10.3877/cma.j.issn.1673-5250.2021.01.003.
[6]
任爽,李大江,胡果,等. 医院规范化静脉血栓栓塞症防治与管理体系的建立[J]. 华西医学2017, 32(2): 4. DOI: 10.7507/1002-0179.201512097.
[7]
Armstrong DK, Alvarez RD, Bakkum-Gamez JN, et al.Ovarian cancer, version 2.2020, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2021, 19(2): 191-226. DOI: 10.6004/jnccn.2021.0007.
[8]
Shuang Y, Yang J, Cao D, et al. Characteristic and prognostic implication of venous thromboembolism in ovarian clear cell carcinoma: a 12-year retrospective study[J]. PLoS One, 2015, 10(3): e0121818. DOI:10.1371/journal.pone.0121818.
[9]
Weeks KS, Herbach E, McDonald M, et al. Meta-analysis of VTE risk: ovarian cancer patients by stage, histology, cytoreduction, and ascites at diagnosis[J]. Obstet Gynecol Int, 2020, 2020: 2374716. DOI: 10.1155/2020/2374716.
[10]
Fujiwara K, Shintani D, Nishikawa T. Clear-cell carcinoma of the ovary[J]. Ann Oncol, 2016, 27(Suppl 1): i50-i52. DOI: 10.1093/annonc/mdw086.
[11]
郭涛,程志鹏.《中国人群静脉血栓常见遗传危险因素》解读[J].临床血液学杂志2015, 28(1): 1-4. DOI: 10.13201/j.issn.1004-2806.2015.01.001.
[12]
Swier N, Versteeg HH. Reciprocal links between venous thromboembolism, coagulation factors and ovarian cancer progression[J]. Thromb Res, 2017, 150: 8-18. DOI: 10.1016/j.thromres.2016.12.002.
[13]
Awkar N, Amireh S, Rai S, et al. Association between level of tumor markers and development of VTE in patients with pancreatic, colorectal and ovarian Cancer: retrospective case-control study in two community hospitals[J]. Pathol Oncol Res, 2018, 24(2): 283-287. DOI: 10.1007/s12253-017-0239-x.
[14]
Steidel C, Ender F, Rody A, et al. Biologically active tissue factor-bearing larger ectosome-like extracellular vesicles in malignant effusions from ovarian cancer patients: correlation with incidence of thrombosis[J]. Int J Mol Sci, 2021, 22(2): 790. DOI: 10.3390/ijms22020790.
[15]
Mahdi H, Aljebori Q, Lockart D, et al.Risk of venous thromboembolism after laparoscopic surgery for gynecologic malignancy[J]. J Minim Invasive Gynecol201623(7):1057-1062. DOI: 10.1016/j.jmig.2016.06.011.
[16]
Latif N, Oh J, Brensinger C, et al. Lymphadenectomy is associated with an increased risk of postoperative venous thromboembolism in early stage endometrial cancer[J]. Gynecol Oncol, 2021, 161(1): 130-134. DOI: 10.1016/j.ygyno.2021.01.030.
[1] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[2] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[3] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[4] 屈翔宇, 张懿刚, 李浩令, 邱天, 谈燚. USP24及其共表达肿瘤代谢基因在肝细胞癌中的诊断和预后预测作用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 659-662.
[5] 顾雯, 凌守鑫, 唐海利, 甘雪梅. 两种不同手术入路在甲状腺乳头状癌患者开放性根治性术中的应用比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 687-690.
[6] 付成旺, 杨大刚, 王榕, 李福堂. 营养与炎症指标在可切除胰腺癌中的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 704-708.
[7] 关小玲, 周文营, 陈洪平. PTAAR在乙肝相关慢加急性肝衰竭患者短期预后中的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 841-845.
[8] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[9] 董佳, 王坤, 张莉. 预后营养指数结合免疫球蛋白、血糖及甲胎蛋白对HBV 相关慢加急性肝衰竭患者治疗后预后不良的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 555-559.
[10] 刘郁, 段绍斌, 丁志翔, 史志涛. miR-34a-5p 在结肠癌患者的表达及其与临床特征及预后的相关性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 485-490.
[11] 陈倩倩, 袁晨, 刘基, 尹婷婷. 多层螺旋CT 参数、癌胚抗原、错配修复基因及病理指标对结直肠癌预后的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 507-511.
[12] 曾明芬, 王艳. 急性胰腺炎合并脂肪肝患者CT 与彩色多普勒超声诊断参数与其病情和预后的关联性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 531-535.
[13] 沈炎, 张俊峰, 唐春芳. 预后营养指数结合血清降钙素原、胱抑素C及视黄醇结合蛋白对急性胰腺炎并发急性肾损伤的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 536-540.
[14] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
[15] 于洁, 金小红, 顾艳楣, 王慧, 葛杨杨, 李燕. 癌症相关静脉血栓栓塞症患者疾病体验与需求的质性研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 739-744.
阅读次数
全文
0
HTML PDF
最新录用 在线预览 正式出版 最新录用 在线预览 正式出版
0 0 0 0 0 0


摘要
172
最新录用 在线预览 正式出版
0 0 172
  来源 本网站 其他网站
  次数 86 86
  比例 50% 50%