Predictors of recurrent venous thromboembolism and bleeding in patients with cancer: a meta-analysis.

This study aimed to identify prognostic factors for these complications.

本研究旨在识别这些并发症的预后因素。

Methods

A systematic reviewwas performed for randomized trials and cohort studies evaluating prognostic factors for recurrent VTE or anticoagulant-related bleeding in adult patients with cancer and VTE.

对评估癌症和静脉血栓栓塞症（VTE）成人患者复发性VTE或抗凝相关出血的预后因素的随机试验和队列研究进行了系统评价。

Adjusted hazard ratios (aHRs) for factors were pooled using random-effects meta-analysis.

使用随机效应荟萃分析汇总了因素的调整后风险比（aHRs）。

The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.

证据的确定性是使用推荐、评估、发展和评估方法（Grading of Recommendations, Assessment, Development and Evaluation，GRADE）进行评估的。

Results

Thirty-three studies (n = 96 753) were included in the meta-analyses.

共有33项研究（n = 96 753）被纳入了荟萃分析。

Factors with high certainty of association with increased risk of recurrent VTE included a previous history of VTE [aHR 1.50 (95% CI 1.08-2.09)], Eastern Cooperative Oncology Group (ECOG) performance status >0 [1.81 (1.34-2.46)] or >1 [2.44 (1.55-3.84)], advanced cancer [1.38 (1.15-1.65)], and specific cancer sites including lung [1.78 (1.29-2.46)], hepatobiliary [2.37 (1.70-3.30)], pancreas [3.20 (2.06-4.96)], and genitourinary [1.38 (1.14-1.67)].

与复发性深静脉血栓形成（VTE）风险增加高度相关的因素包括既往VTE病史[aHR 1.50 (95% 置信区间 1.08-2.09)]、Eastern Cooperative Oncology Group (ECOG)表现状态>0 [1.81 (1.34-2.46)] 或 >1 [2.44 (1.55-3.84)]、晚期癌症 [1.38 (1.15-1.65)]，以及特定癌症部位，包括肺 [1.78 (1.29-2.46)]、肝胆 [2.37 (1.70-3.30)]、胰腺 [3.20 (2.06-4.96)] 和泌尿生殖系统 [1.38 (1.14-1.67)]。

Conversely, recent surgery [aHR 0.56 (95% CI 0.40-0.76)] and breast cancer [0.43 (0.23-0.81)] had a high certainty of association with a decreased risk.

相反，近期手术[aHR 0.56 (95% 置信区间 0.40-0.76)]和乳腺癌[0.43 (0.23-0.81)]与降低的风险高度相关。

Factors with a high certainty of association with an increased risk of anticoagulant-related bleeding included a history of bleeding [aHR 2.41 (95% CI 1.50-3.88)], ECOG performance status ≥2 [2.10 (1.48-2.99)], advanced cancer [1.60 (1.29-1.97)], and cancers of the brain [2.25 (1.64-3.09)], gastrointestinal system [1.74 (1.44-2.11)], genitourinary system [1.90 (1.48-2.45)], and prostate [1.72 (1.26-2.34)].

与抗凝剂相关出血风险增加高度相关的因素包括出血史[aHR 2.41 (95% CI 1.50-3.88)]、ECOG表现状态≥2 [2.10 (1.48-2.99)]、晚期癌症 [1.60 (1.29-1.97)]，以及脑部癌症 [2.25 (1.64-3.09)]、胃肠道系统 [1.74 (1.44-2.11)]、泌尿生殖系统 [1.90 (1.48-2.45)] 和前列腺癌 [1.72 (1.26-2.34)]。

Conclusions

The prognostic factors identified in this meta-analysisshould be considered as part of risk stratification frameworks for anticoagulation management in patients with cancer and VTE.

本荟萃分析确定的预后因素应作为癌症和静脉血栓栓塞症患者抗凝治疗风险分层框架的一部分进行考虑。