COVID-19感染后手术时机与乳腺癌术后血栓并发症风险分析

doi:10.19401/j.cnki.1007-3639.2023.10.004

摘要/Abstract

摘要：

背景与目的： 乳腺癌患者术后深静脉血栓（deep venous thrombosis，DVT）发生率为2.00% ~ 6.40%。本研究旨在评估2019冠状病毒病（coronavirus disease 2019，COVID-19）感染后乳腺癌患者术后DVT并发症与手术时机之间的相关性，以期指导临床决策。方法： 入组2022年12月20日—2023年3月20日山东省肿瘤防治研究院（山东省肿瘤医院）乳腺病中心连续收治的317例确诊为COVID-19感染症状体征转阴的乳腺癌患者。对照组选择2019年5月1日—2019年9月30日接受手术的329例乳腺癌患者。按照COVID-19感染日期与患者手术日期的间隔进行分组，分析患者感染间隔时间及术后DVT发生情况。结果： 317例乳腺癌患者COVID-19感染后手术，感染0 ~ 2周、3 ~ 4周、5 ~ 6周、7 ~ 8周和8周后接受手术的分别有17例（5.36%）、29例（9.15%）、31例（9.78%）、50例（15.78%）和190例（59.90%），术后DVT发生率分别为11.76%、3.45%、3.23%、6.00%和1.58%。与未感染COVID-19的329例患者术后DVT发生率1.21%相比，COVID-19感染2周内手术患者术后DVT发生率显著升高（OR = 10.556；95% CI：1.095 ~ 303.313，P = 0.030），COVID-19感染3 ~ 8周手术患者术后DVT发生率为4.55%。多因素分析结果显示，COVID-19感染间隔时间是DVT的独立预测因素（OR = 2.795；95% CI：0.692 ~ 11.278，P = 0.024）。随访10例乳腺癌术后DVT的患者均痊愈，无肺栓塞等严重并发症，经对症处理后未影响后续辅助抗肿瘤治疗的进行。结论： COVID-19感染8周内乳腺癌术后DVT发生率显著高于未感染患者，尤其2周内手术患者DVT发生率高达11.76%，应避免COVID-19感染2周内进行乳腺癌择期手术。COVID-19感染3周后手术患者DVT发生率虽仍然稍高，考虑乳腺癌治疗的紧迫性、DVT的良好预后及其不影响后续辅助治疗，可以推荐手术治疗，但应详细记录患者COVID-19感染史，早期预防并密切监测，治疗术后DVT。

关键词: 乳腺癌, 2019冠状病毒病, 深静脉血栓, 手术时机

Abstract:

Background and purpose: The incidence of deep venous thrombosis (DVT) for patients with breast cancer after surgery is 2.00%-6.40%. The purpose of this study was to evaluate the correlation between postoperative DVT complications and surgical timing in breast cancer patients with coronavirus disease 2019 (COVID-19) infection, in order to guide clinical decision-making. Methods: From December 20, 2022 to March 20, 2023, 317 patients with breast cancer diagnosed with COVID-19 and with signs and symptoms of infection turning negative in Shandong Institute of Cancer Prevention and Treatment (Shandong Cancer Hospital), Shandong First Medical University (Shandong Academy of Medical Sciences) were enrolled. The control group included 329 patients with breast cancer who underwent surgery between May 1, 2019 and September 30, 2019 in the same hospital. Patients were grouped according to the interval between the date of COVID-19 infection and the date of surgery, and the interval time and postoperative DVT occurrence were analyzed. Results: Among 317 patients with breast cancer who underwent surgery after COVID-19 infection, 17 (5.36%), 29 (9.15%), 31 (9.78%), 50 (15.78%) and 190 (59.90%) underwent surgery after 0-2, 3-4, 5-6, 7-8 and 8 weeks, respectively. The incidence of postoperative DVT was 11.76%, 3.45%, 3.23%, 6.00% and 1.58%, respectively. The incidence of postoperative DVT in 329 patients without COVID-19 infection was 1.21%, and the incidence of postoperative DVT in patients receiving operation within 2 weeks of COVID-19 infection was significantly higher (OR=10.556; 95% CI: 1.095-303.313, P=0.03), the incidence of postoperative DVT in patients undergoing operation 3-8 weeks following COVID-19 infection was 4.55%. Multivariate analysis showed that COVID-19 infection interval was an independent predictor of DVT (OR=2.795; 95% CI: 0.692-11.278, P=0.024). All 10 patients with DVT after breast cancer surgery were recovered without serious complications such as pulmonary embolism, and the follow-up adjuvant anti-tumor therapy was not affected after symptomatic treatment. Conclusion: The incidence of DVT after breast cancer surgery within 8 weeks of COVID-19 infection is significantly higher than that of uninfected patients, especially the incidence of DVT in patients undergoing surgery within 2 weeks of COVID-19 infection is as high as 11.76%. Elective surgery for breast cancer within 2 weeks of COVID-19 infection should be avoided. Although the incidence of DVT in patients undergoing surgery 3 weeks after COVID-19 infection is still slightly high, surgical treatment can be recommended considering the urgency of breast cancer treatment, the good prognosis of DVT and the lack of influence on subsequent adjuvant therapy. However, detailed records of COVID-19 infection history of patients, early prevention and close monitoring should be made, and postoperative DVT should be treated.

Key words: Breast cancer, COVID-19, Deep vein thrombosis, Surgical time

中图分类号:

R737.9

程纬浩, 王微丽, 毕钊, 张朝蓬, 孙晓, 赵家贤, 邱鹏飞, 陈鹏, 王永胜. COVID-19感染后手术时机与乳腺癌术后血栓并发症风险分析[J]. 中国癌症杂志, 2023, 33(10): 920-926.

CHENG Weihao, WANG Weili, BI Zhao, ZHANG Chaopeng, SUN Xiao, ZHAO Jiaxian, QIU Pengfei, CHEN Peng, WANG Yongsheng. Timing of surgery and risk of postoperative thrombotic complications after recovery from Covid-19 in breast cancer patients[J]. China Oncology, 2023, 33(10): 920-926.

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参考文献 21

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Characteristic	Pre-COVID-19 surgery before September 30, 2019	Peri-COVID-19 surgery 0 to 2 weeks after COVID-19	Early post-COVID-19 surgery 3 to 4 weeks after COVID-19	Early post-COVID-19 surgery 5 to 6 weeks after COVID-19	Early post-COVID-19 surgery 7 to 8 weeks after COVID-19	Late post-COVID-19 surgery at least 8 weeks after COVID-19
Clinical N stage
cN₀	226 (68.7)	11 (64.7)	13 (44.8)	24 (77.4)	30 (60.0)	127 (66.8)
cN₁	72 (21.9)	5 (29.4)	10 (34.6)	2 (6.5)	15 (30.0)	41 (21.6)
cN₂	13 (3.9)	1 (5.9)	3 (10.3)	3 (9.6)	4 (8.0)	15 (7.8)
cN₃	18 (5.5)	0 (0.0)	3 (10.3)	2 (6.5)	1 (2.0)	7 (3.4)
Clinical T stage
cT₁	206 (62.6)	7 (41.2)	10 (34.6)	19 (61.3)	23 (46.0)	105 (55.3)
cT₂	116 (35.3)	9 (52.9)	16 (55.1)	8 (25.8)	22 (44.0)	77 (40.5)
cT₃	3 (0.9)	0 (0.0)	3 (10.3)	3 (9.7)	1 (2.0)	5 (2.6)
cT₄	4 (1.2)	1 (5.9)	0 (0.0)	1 (3.2)	4 (8.0)	3 (1.6)
Breast surgery
Mastectomy±PI	259 (78.7)	9 (52.9)	22 (75.8)	19 (61.3)	37 (74.0)	119 (62.6)
BCS	70 (21.3)	8 (47.1)	7 (24.2)	12 (38.7)	13 (36.0)	71 (37.4)
Concomitant syndromes
Hypertension	33 (10.0)	2 (11.8)	5 (17.2)	3 (9.7)	6 (12.0)	19 (10.0)
Diabetes	7 (2.1)	1 (5.9)	0 (0.0)	1 (3.2)	2 (4.0)	10 (5.2)
Liver disease	20 (6.1)	1 (5.9)	0 (0.0)	0 (0.0)	0 (0.0)	2 (1.1)
Stroke	2 (0.6)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	2 (1.1)
CAD	1 (0.3)	0 (0.0)	1 (3.4)	0 (0.0)	0 (0.0)	3 (1.5)
COVID-19 severity
Asymptomatic/mild	NA	16 (94.1)	28 (96.5)	31 (100.0)	49 (98.0)	189 (99.5)
Severe	NA	1 (5.9)	1 (3.4)	0 (0.0)	1 (2.0)	1 (0.5)

Groups	DVT
Groups	No.	Percentage/%
Pre-COVID-19 surgery before September 30, 2019 (n = 329)	4	1.21
Peri-COVID-19 surgery 0 to 2 weeks after COVID-19 (n = 17)	2	11.76
Early post-COVID-19 surgery 3 to 4 weeks after COVID-19 (n = 29)	1	3.45
Early post-COVID-19 surgery 5 to 6 weeks after COVID-19 (n = 31)	1	3.23
Early post-COVID-19 surgery 7 to 8 weeks after COVID-19 (n = 50)	3	6.00
Late post-COVID-19 surgery at least 8 weeks after COVID-19 (n = 190)	3	1.58

Characteristics	DVT		P value
Characteristics	Yes	No	P value
Age/year			0.541
<50	6	323
≥50	8	309
Clinical N stage			0.094
cN₀	7	424
cN₁	3	142
cN₂	3	36
cN₃	1	30
Clinical T stage			0.627
cT₁	8	362
cT₂	5	243
cT₃	1	14
cT₄	0	13
Breast surgery			0.558
Mastectomy±PI	10	493
BCS	4	139
Groups			0.024
Pre-covid	4	325
0-2 weeks	2	15
3-8 weeks	5	105
>8 weeks	3	187

Groups	OR	95% CI	P value
Pre-covid	Ref
0-2 weeks	10.556	1.095-303.313	0.030
3-8 weeks	4.551	1.020-14.674	0.048
>8 weeks	1.303	0.289-5.887	0.730