肺癌、消化及泌尿系恶性肿瘤合并静脉血栓栓塞症的临床特点及预后比较  

Clinical characteristics and outcomes of patients with lung cancer, gastrointestinal cancer and urologic cancer with venous thromboembolism

作　　者：乔力松[1] 许小毛[1] 杨鹤[1] 方保民[1] 谭政[1] 金金[1] Qiao Lisong, Xu Xiaomao, Yang He, Fang Baomin, Tan Zheng, Jin Jin(Division of Respiratory and Critical Care Medicine, Beifing Hospital, National Center of Gerontology, National Center of Respiratory Disease, Beijing 100730, Chin)

机构地区：[1]北京医院呼吸与危重症医学科国家老年医学中心国家呼吸系统疾病临床医学研究中心,100730

出　　处：《中华医学杂志》2018年第18期1403-1407,共5页National Medical Journal of China

基　　金：国家重点研发计划（2016YFC0905602）;国家科技支撑计划（2011BAI11B17）

摘　　要：目的比较肺癌、消化及泌尿系恶性肿瘤合并静脉血栓栓塞症（VTE）患者的临床特点及预后。方法对2003年1月至2013年1月北京医院192例肺癌、消化及泌尿系恶性肿瘤合并VTE患者的临床资料进行回顾性分析，分析比较其临床特点和预后。结果192例患者中肺癌组82例，消化系肿瘤组78例，泌尿系肿瘤组32例。消化系肿瘤组美国东部肿瘤协作组体能状态评分显著高于肺癌组和泌尿系肿瘤组[（2．4±1．1）比（2．0±1．4）和（1．8±1．0）分，均P〈0．05]；肺癌组吸烟比例显著高于消化系肿瘤组和泌尿系肿瘤组（79．3％比30．8％和53．1％，均P〈0．05），而手术患者比例显著低于后两组（35．4％比53．8％和68．8％，均P〈0．05）。患者病理类型以腺癌居多，其中肺癌组和消化系肿瘤组腺癌比例显著高于泌尿系肿瘤组（76．9％和73．8％比37．9％，均P〈0．001），两组中．低分化比例显著高于泌尿系肿瘤组（90．0％和95．7％比40．0％，均P〈0．001）；肺癌组Ⅲ-Ⅳ期患者比例显著高于泌尿系肿瘤组（87．0％比64．3％，P〈0．05）。肺癌组肿瘤确诊后6个月、化疗后6个月及术后6个月VTE发病率均显著高于消化系肿瘤组和泌尿系肿瘤组（79．3％比60．3％及46．9％、76．5％比48．6％及36．4％、92．3％比57．9％及59．1％，均P〈0，05）。肺癌组和消化系肿瘤组1年内病死率显著高于泌尿系肿瘤组（51．2％和52．6％比18．8％，均P〈0．01）。肺癌组与消化系肿瘤组中位生存时间显著短于泌尿系肿瘤组（P=0．001和0．010）。结论腺癌、晚期肿瘤、病理分化程度低的患者发生VTE的风险较高，且多发生于肿瘤诊断后6个月之内；肺癌和消化系肿瘤合并VTE的预后差于泌尿系肿瘤合并VTE。Objective To compare the clinical characteristics and outcomes of patients with lung cancer, gastrointestinal （GI） cancer and urologic cancer with venous thromboembolism （VTE）. Methods From January 2003 to January 2013, 192 lung cancer, GI cancer and urologic cancer patients with VTE were retrospectively evaluated for the clinical characteristics and outcomes. Results Among 192 patients, 82 cases of lung cancer, 78 cases of GI cancer, 32 cases of urologic cancer were involved. The Eastern Cooperative oncology Group Performance Status score of GI cancer group was significantly higher than those of thelung cancer and urologic cancer groups[（2.4 ±1.1） vs （2.0±1.4）, （1.8 ±1.0）, both P〈 0. 05）. The proportion of smoking patients in lung cancer group was significantly higher than that in GI cancer and urologic cancer groups （79.3% vs 30. 8% , 53.1% , both P 〈0. 05）, while the proportion of operation was significantly lower than that in the latter two groups （35.4% vs 53.8% , 68.8% , both P 〈 0. 05 ）. Pathological types of cancer were mostly adeuocarcinoma, and the proportion of adenocarcinoma in lung cancer and GI cancer groups was significantly higher than that in urologic cancer group （76.9% , 73. 8% vs 37. 9%, both P 〈 0. 001 ） . The proportion of moderately and/or poorly differentiated histodifferentiation in the first two groups was significantly higher than that of urologic cancer group（90. 0% , 95.7% vs 40. 0% , both P 〈0. 001 ）. The proportion of patients with TNM stage Ⅲ - Ⅳ in lung cancer group was significantly higher than that of the urological cancer group （ 87.0% vs 64. 3% , P 〈 0. 05 ）. The incidence of VTE in lung cancer group was significantly higher than those of GI cancer and urologic cancer groups within 6 months after tumor diagnosis, chemotherapy and operation （79.3% vs 60.3%, 46.9%; 76.5% vs 48.6%, 36.4%; 92.3% vs 57.9%, 59.1%; all P〈0.05）. The case fatality rate within one year in lung cancer and GI cancer groups was significantl

关 键 词：肺肿瘤 消化系肿瘤 泌尿系肿瘤 静脉血栓栓塞症 

分 类 号：R734.2[医药卫生—肿瘤] R735[医药卫生—临床医学] R737