膀胱癌新辅助化疗期间的血栓预防可减少血栓栓塞和出血。
Thromboprophylaxis during neoadjuvant chemotherapy for bladder cancer reduces thromboembolism and bleeding.
发表日期：2024 Jul 03
作者：
Luca Antonelli, Pedro David Wendel-Garcia, Manja Deforth, Luca Afferi, Costantino Leonardo, Francesco Esperto, Marco Borghesi, Alessandro Antonelli, Karl Tully, Paolo Umari, Simone Albisinni, Andrea Mari, Renate Pichler, Francesco Claps, Jeremy Yuen-Chun Teoh, Mathieu Roumiguié, Gerald Bastian Schulz, Luca Orecchia, Francesco Soria, Morgan Roupret, Gautier Marcq, Cedric Poyet, Majed Alrumayyan, Michael Rink, Stefania Zamboni, Maria Riaza Montes, Steven Okoye, Riccardo Campi, Wojciech Krajewski, Laura Mertens, Meftun Culpan, Luke T Lavallée, Marco Moschini, Ulrike Held, Christian Daniel Fankhauser,
来源：
BJU INTERNATIONAL
摘要：
旨在评估计划行根治性膀胱切除术的膀胱癌患者在新辅助化疗期间发生静脉血栓栓塞事件 (VTE) 和出血（无论有无血栓预防）的风险。我们对 28 个中心的 4886 名接受膀胱切除术的非转移性膀胱癌患者进行了一项回顾性队列研究。 1990 年至 2021 年间对 13 个国家进行了逆概率加权分析，以评估血栓预防对 VTE 和出血的影响。第一年内记录了 147 名患者 (3%) 的 VTE。这些发生的中位时间（四分位距 [IQR]）为膀胱癌诊断后 127 (82-198) 天。第一年内有 131 名患者 (3%) 发生出血事件。这些发生的中位时间 (IQR) 为癌症诊断后 101 (83-171) 天。在逆概率加权分析中，与化疗期间未进行血栓预防的患者相比，进行血栓预防的患者不仅发生 VTE 的风险较低（风险比 [HR] 0.32，95% 置信区间 [CI] 0.12-0.81；P = 0.016），而且发生 VTE 的风险也较低。出血风险较低（HR 0.03，95% CI 0.09-0.12；P <0.0001）。该研究的回顾性是其主要局限性。在这项回顾性分析中，膀胱切除术前新辅助化疗期间预防血栓的益处与其他恶性肿瘤随机试验的数据一致。我们的数据表明血栓预防可以预防 VTE，并且应该成为新辅助化疗期间的护理标准。© 2024 作者。 BJU International 约翰·威利 (John Wiley) 出版
To assess the risk of venous thromboembolic events (VTEs) and bleeding with or without thromboprophylaxis during neoadjuvant chemotherapy in bladder cancer patients scheduled for radical cystectomy.We conducted a retrospective cohort study in 4886 patients with non-metastatic bladder cancer undergoing cystectomy across 28 centres in 13 countries between 1990 and 2021. Inverse probability weighting analyses were performed to estimate the effect of thromboprophylaxis on VTE and bleeding.In 147 patients (3%) VTEs were recorded within the first year. These occurred a median (interquartile range [IQR]) of 127 (82-198) days after bladder cancer diagnosis. Bleeding events occurred in 131 patients (3%) within the first year. These occurred a median (IQR) of 101 (83-171) days after cancer diagnosis. In inverse probability weighting analyses, compared to patients without thromboprophylaxis during chemotherapy, patients with thromboprophylaxis had not only a lower risk of VTE (hazard ratio [HR] 0.32, 95% confidence interval [CI] 0.12-0.81; P = 0.016) but also a lower bleeding risk (HR 0.03, 95% CI 0.09-0.12; P <0.0001). The retrospective nature of the study was its main limitation.In this retrospective analysis, the benefit of thromboprophylaxis during neoadjuvant chemotherapy before cystectomy is in line with data from randomised trials in other malignancies. Our data suggest thromboprophylaxis is protective against VTEs and should be the standard of care during neoadjuvant chemotherapy.© 2024 The Author(s). BJU International published by John Wiley & Sons Ltd on behalf of BJU International.