肺癌患者发生 VTE 的临床特点、相关危险因素和预后分析

Clinical Characteristics, Related Risk Factor and Prognostic of VTE in Patients with Lung Cancer

摘要:

〔摘 要〕 目的：探讨肺癌患者发生静脉血栓栓塞症（VTE）的临床特征及危险因素，分析 VTE 对肺癌患者生存预 后的影响。方法：收集2019年10月至2020年10月吉首大学第一附属医院肿瘤中心肺癌患者的一般资料及实验室指标， 依据为是否发生 VTE 分为 VTE 组和非 VTE 组，分别采用 logistic 回归与 Kaplan–Meier 曲线对肺癌患者发生 VTE 的 危险因素及 VTE 事件对肺癌患者生存的影响进行分析。结果：本研究共纳入 300 例肺癌患者，64 例患者发生 VTE， 发生率为 21.3 %。多因素 logistic 回归分析显示，肺腺癌、Ⅳ 期、白细胞计数、抗凝血酶 Ⅲ（ATⅢ）、D– 二聚体、 静脉置管为肺癌患者合并 VTE 的危险因素（P ＜ 0.05）；242 例接受内科一线治疗的肺癌患者中，发生 VTE 56 例， 合并 VTE 与无 VTE 患者的中位无进展生存期（mPFS）分别为 7.8 个月、9.3 个月（P = 0.035），中位生存时间（mOS） 分别为 15.8 个月、17.1 个月（P = 0.056）。亚组分析显示，82 例驱动基因突变阳性的非小细胞肺癌（NSCLC）患者中， 合并 VTE 与无 VTE 的 mPFS 分别为 10.0 个月、18.8 个月（P ＜ 0.001），mOS 分别为 22.7 个月、25.8 个月（P = 0.014）。结论：肺腺癌、Ⅳ 期、白细胞计数、ATⅢ、D– 二聚体、静脉置管为肺癌患者合并 VTE 的危险因素，VTE 事件会增 加肺癌患者死亡风险，肺癌驱动基因突变状态与 VTE 的关系值得进一步探讨。

Abstract:

〔Abstract〕 Objective To investigate the clinical characteristics and risk factors of venous thromboembolism (VTE) in patients with lung cancer, and analyze the impact of VTE on the survival prognosis of patients with lung cancer. Methods The general data and laboratory indexes of lung cancer patients in the cancer center of the First Affiliated Hospital of Jishou University from October 2019 to October 2020 were collected. According to the presence or absence of VTE, patients were divided into VTE group and non-VTE group. Logistic regression and Kaplan-Meier curve were used to analyze the risk factors of VTE in patients with lung cancer and the effect of VTE on the survival of patients with lung cancer. Results A total of 300 patients with lung cancer were enrolled in this study, and 64 patients developed VTE, with an incidence of 21.3 %. Multivariate logistic regression analysis showed that lung adenocarcinoma, stage Ⅳ, white blood cell count, antithrombin Ⅲ (ATⅢ), D-dimer and venous catheterization were risk factors for VTE in patients with lung cancer (P < 0.05). Among 242 lung cancer patients who received first-line medical treatment, 56 patients developed VTE. The median progression-free survival (mPFS) of patients with VTE and without VTE were 7.8 months and 9.3 months respectively (P = 0.035). The median overall survival (mOS) was 15.8 months and 17.1 months respectively (P = 0.056). Subgroup analysis showed that in 82 patients with non-small cell lung cancer (NSCLC) with or without VTE, the mPFS was 10.0 months and 18.8 months (P < 0.001), and mOS was 22.7 months and 25.8 months (P = 0.014), respectively. Conclusion Lung adenocarcinoma, stage Ⅳ, white blood cell count, ATⅢ, D-dimer and venous catheterization are risk factors for VTE in patients with lung cancer. VTE events can increase the risk of death in patients with lung cancer. The relationship between lung cancer driver gene mutation status and VTE is worthy of further study.