食管癌静脉血栓栓塞症发生情况的真实世界研究（附8 458例报告）
Incidence of venous thromboembolism in esophageal cancer: a real‑world study of 8 458 cases
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摘要:目的 探讨食管癌患者静脉血栓栓塞症（VTE）的发生情况。方法 采用回顾性队列研究方法。收集2017年1月至2021年12月四川省肿瘤医院收治的8 458例食管癌患者的临床病理资料；男6 923例,女1 535例；年龄为（64±9）岁；行手术治疗3 187例,非手术治疗5 271例。观察指标：（1）食管癌患者VTE的发生情况。（2）VTE患者治疗和转归情况。正态分布的计量资料以x±s表示,组间比较采用t检验。偏态分布的计量资料以M（范围）表示,组间比较采用非参数秩和检验。计数资料以绝对数或百分比表示,组间比较采用χ²检验或Fisher确切概率法。等级资料比较采用非参数秩和检验。结果 （1）食管癌患者VTE的发生情况。8 458例食管癌患者中,175例发生VTE,发生率为2.069%（175/8 458）；其中深静脉血栓形成164例,肺栓塞4例,深静脉血栓形成合并肺栓塞7例；手术患者59例,非手术患者116例。手术与非手术食管癌合并VTE患者血栓类型比较,差异无统计学意义（χ²=1.95,P>0.05）。3 187例手术患者VTE发生率为1.851%（59/3 187）,其中肺栓塞发生率为0.157%（5/3 187）,占手术患者VTE的比例为8.475%（5/59）。5 271例非手术治疗患者VTE发生率为2.201%（116/5 271）,其中肺栓塞发生率为0.114%（6/5 271）,占非手术患者VTE的比例为5.172%（6/116）。手术与非手术患者VTE及肺栓塞发生率比较,差异均无统计学意义（χ²=1.20、0.05,P>0.05）。（2）VTE患者治疗和转归情况。175例食管癌合并VTE患者中,163例行药物治疗,12例未治疗。163例行药物治疗患者中,158例行抗凝治疗,5例行溶栓治疗,均好转出院。结论 食管癌患者VTE的发生率较低,为2.069%；手术与非手术患者VTE的发生情况、合并VTE的血栓类型比较,差异均无统计学意义。Abstract:Objective To investigate the incidence of venous thromboembolism (VTE) in patients with esophageal cancer (EC).Methods The retrospective cohort study was conducted. The clinicopathological data of 8 458 EC patients who were admitted to Sichuan Cancer Hospital from January 2017 to December 2021 were collected. There were 6 923 males and 1 535 females, aged (64±9)years. There were 3 187 patients undergoing surgical treatment, and 5 271 cases undergoing non‑surgical treatment. Observation indicators: (1) incidence of VTE in EC patients; (2) treatment and outcomes of patients with VTE. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the nonparameter rank sum test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi‑square test or Fisher exact probability. Comparison of ordinal data was analyzed using the nonparameter rank sum test.Results (1) Incidence of VTE in EC patients. Of 8 458 EC patients, 175 cases developed VTE, with an incidence rate of 2.069%(175/8 458). Among 175 VTE patients, there were 164 cases of deep venous thrombosis (DVT), 4 cases of pulmonary embolism (PE), 7 cases of DVT and PE. There were 59 surgical patients and 116 non‑surgical patients. There was no significant difference in thrombus type between surgical and non-surgical EC patients with VTE (χ²=1.95, P>0.05). Of 3 187 surgical patients, the incidence of VTE was 1.851%(59/3 187), including an incidence of 0.157%(5/3 187) of PE. PE accounted for 8.475%(5/59) of surgical patients with VTE. Of 5 271 non‑surgical patients, the incidence of VTE was 2.201%(116/5 271), including an incidence of 0.114%(6/5 271) of PE. PE accounted for 5.172%(6/116) of non‑surgical patients with VTE. There was no significant difference in the incidence of VTE or PE between surgical patients and non‑surgical patients (χ²=1.20, 0.05, P>0.05). (2) Treatment and outcomes of patients with VTE. Among 175 EC patients with VTE, 163 cases underwent drug treatment, and 12 cases did not receive treatment. Among 163 cases with drug therapy, 158 cases underwent anticoagulant therapy, 5 cases were treated with thrombolysis. All the 163 patients were improved and discharged from hospital.Conclusions The incidence of VTE in patients with EC is relatively low, as 2.069%. There is no significant difference in the incidence of VTE or thrombus type between surgical EC patients and non‑surgical EC patients.
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