KANSERİN METASTATİK DURUMUNUN VE KEMOTERAPİNİN TAMAMEN İMPLANTE EDİLEBİLİR VENÖZ ERİŞİM PORTU AÇIKLIĞI VE PORT İLİŞKİLİ VENÖZ TROMBOEMBOLİK OLAYLAR ÜZERİNE ETKİSİ
Abstract
Amaç: Tamamen implante edilebilir venöz erişim portu (TIVAP), kanser hastalarının tedavisinde damar giriş yolu olarak büyük önem taşımaktadır. Bu çalışmada, kanser türlerinin, metastazların, kemoterapötik ilaçların ve girişim bölgelerinin, TIVAP açıklığı ve TIVAP ilişkili venöz tromboembolizm (VTE) üzerindeki etkilerini retrospektif olarak araştırdık.
Yöntem: 2017-2021 yılları arasında kliniğimizde TIVAP takılan 297 hasta ve çıkarma işlemi uygulanan 37 hastanın demografik özellikleri, kanser türleri, metastazları, damar girişim bölgeleri, kemoterapi ilaçları, TIVAP patensleri ve TIVAP’a bağlı komplikasyonları değerlendirildi.
Bulgular: TIVAP takılan 297 hasta ortalama 17.7±16.6 ay takip edildi. Enfeksiyon 14 (4.7%), okluzyon 8 (2.7%), VTE 9 (3%), malpoziasyon 1 (0.3%) ve tedavi tamamlanması 10 (3.3%) nedenleri ile toplam 37 hastada TIVAP çıkarıldı. 270 (90.9%) hastanın TIVAP’ı ortalama 18.5±17.1 ay süre ile kullanılabilir durumda saptandı. Toplam 71 (23.9%) hastada VTE, okluzyon, enfeksiyon ve malpozisyon komplikasyonları gelişti. Hastalarda metastaz varlığına göre bu komplikasyonların gelişimi karşılaştırıldığında, metastatik hastalarda anlamlı olarak yüksek saptandı (47-%27.9/24-%18.6, p<0.05). Özellikle taksanlar, metotreksat, etoposid ve vinorelbin ile VTE gelişme oranı arasında diğer kemoterapi ilaçlarına kıyasla anlamlı bir pozitif korelasyon saptandı (p<0.05). İleri yaş hastalarda, metastatik kanseri olanlarda ve akciğer kanseri hastalarında TIVAP ile ilişkili VTE oranı anlamlı yüksek saptandı (p<0.05). TIVAP açıklığı, komplikasyonları ve TIVAP ile ilişkili VTE'de venöz giriş yeri ve tarafı açısından anlamlı fark yoktu.
Sonuç: Primer kanser, metastazlar ve uygulanan kemoterapi, sistemik veya TIVAP ile ilişkili VTE gelişimi için önemli faktörlerdir. TIVAP ile ilişkili VTE riskini artıran belirli kanser türlerinde, kemoterapi rejimlerinde VTE'nin önlenmesi ve tedavisi için daha fazla çok merkezli çalışmalara ihtiyaç vardır.
Project Number
YOK
References
- Saber W, Moua T, Williams EC, et al. Risk factors for catheter-related thrombosis (CRT) in cancer patients: a patient-level data (IPD) meta-analysis of clinical trials and prospective studies. J Thromb Haemost 2011;9:312-329.
- Voog E, Campion L, du Rusquec P, et al. Totally implantable venous access ports: a prospective long-term study of early and late complications in adult patients with cancer. Support Care Cancer. 2018;26:81-89.
- Grant JD, Stevens SM, Woller SC, et al. Diagnosis and management of upper extremity deep-vein thrombosis in adults. Thromb Haemost 2012;108:1097-1108.
- Jiang M, Li CL, Pan CQ, Cui XW, Dietrich CF. Risk of venous thromboembolism associated with totally implantable venous access ports in cancer patients: A systematic review and meta-analysis. J Thromb Haemost. 2020;18:2253-2273.
- Horowitz NA, Brenner B. Thrombosis in hematological malignancies: mechanisms and implications. Thromb Res. 2020;191:58-62.
- Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer 2007;110:2339-2346.
- Franco-Moreno A, Cabezón-Gutiérrez L, Palka-Kotlowsa M, Villamayor-Delgado M, García-Navarro M. Evaluation of direct oral anticoagulants for the treatment of cancer-associated thrombosis: an update. J Thromb Thrombolysis. 2019;47:409-419.
- Raskob GE, van Es N, Verhamme P, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2018;378:615-624.
- Young AM, Marshall A, Thirlwall J, et al. Comparison of an Oral Factor Xa Inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol. 2018;36:2017-2023.
- Agnelli G, Becattini C, Meyer G, et al. Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med. 2020;382:1599-1607.
- Niederhuber JE, Ensminger W, Gyves JW, Liepman M, Doan K, Cozzi E. Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery.1982;92:706-712.
- Granziera E, Scarpa M, Ciccarese A, et al. Totally implantable venous access devices: retrospective analysis of different insertion techniques and predictors of complications in 796 devices implanted in a single institution. Bmc Surg. 2014;14:1-9.
- Jiang M, Li CL, Pan CQ, Cui XW, Dietrich CF. Risk of venous thromboembolism associated with totally implantable venous access ports in cancer patients: A systematic review and meta-analysis. J Thromb Haemost. 2020;18:2253-2273.
- Schmaier AH. The contact activation and kallikrein/kinin systems: pathophysiologic and physiologic activities. J Thromb Haemost. 2016;14:28-39.
- Schmaier AH. Antithrombotic potential of the contact activation pathway. Curr Opin Hematol.2016;23:445-452.
- Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol. 2015;12:464-474.
- Citla Sridhar D, Abou-Ismail MY and Ahuja SP. Central venous catheter-related thrombosis in children and adults. Thromb Res. 2020;187:103-112.
- Goltz JP, Noack C, Petritsch B, Kirchner J, Hahn D, Kickuth R. Totally implantable venous power ports of the forearm and the chest: initial clinical experience with port devicesapproved for high-pressure injections. Br J Radiol. 2012;85:966-972.
- Piran S, Ngo V, McDiarmid S, Le Gal G, Petrcich W, Carrier M. Incidence and risk factors of symptomatic venous thromboembolism related to implanted ports in cancer patients. Thromb Res. 2014;133:30-33.
- Levi M. Cancer-related coagulopathies. Thromb Res. 2014;133:70-75.
- Woodley-Cook J, Shin LY, Swystun L, Caruso S, Beaudin S, Liaw PC. Effects of the chemotherapeutic agent doxorubicin on the protein C anticoagulant pathway. Mol Cancer Ther. 2006;5:3303-3311.
- Iqubal A, Iqubal MK, Sharma S, et al. Molecular mechanism involved in cyclophosphamide-induced cardiotoxicity: Old drug with a new vision. Life Sci. 2019;218:112-131.
- Oppelt P, Betbadal A, Nayak L. Approach to chemotherapy-associated thrombosis. Vasc Med. 2015;20:153-161.
- Sara JD, Kaur J, Khodadadi R, et al. 5-fluorouracil and cardiotoxicity: a review. Ther Adv Med Oncol.2018;10:1758835918780140.
- Lyman GH, Carrier M, Ay C, et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer [published correction appears in Blood Adv. 2021 Apr 13;5(7):1953]. Blood Adv. 2021;5:927-974.
- Lobastov K, Schastlivtsev I, Kanzafarova I. Directoral anticoagulants in cancer-associated venous thromboembolism.Vasc Invest Ther 2020;3:46-53.
- Khorana AA, McCrae KR, Milentijevic D, et al. Current practice patterns and patient persistence with anticoagulant treatments for cancer-associated thrombosis. Res PractThrombHaemost. 2017;1:14–22.
- Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41:543-603.
- Key NS, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol. 2020;38:496-520.
- Cancer-associated venous thrombotic disease. NCCN clinical practice guidelines in oncology (NCCN Guidelines) version 3.2021 https://www. nccn.org/professionals/physician_ gls/pdf/vte.pdf (accessed 24/02/2022).
- Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s Choice- European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg. 2021;61:9-82.
- Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines [published correction appears in Chest. 2012;142(6):1698-1704]. Chest. 2012;141(2 Suppl):e419S-e496S.
THE EFFECTS OF CANCER’S METASTATIC STATUS AND CHEMOTHERAPY ON TOTALLY IMPLANTABLE VENOUS ACCESS PORT PATENCY AND PORT-RELATED VENOUS THROMBOEMBOLIC EVENTS
Abstract
Objective: Totally implantable venous access port (TIVAP) is of great importance as a vascular access route in the treatment of cancer patients. In this study, we retrospectively researched the effects of cancer types, metastases, chemotherapeutic drugs, and intervention sites on port patency and TIVAP-related venous thromboembolism (VTE).
Method: Demographics, cancer types, metastases, vascular access sites, chemotherapy drugs, TIVAP patency and TIVAP related complications were evaluated in 297 patients who had TIVAP implanted and 37 patients who underwent removal in our clinic between 2017-2021.
Results: TIVAP implanted 297 patients were followed-up for a mean 17.7±16.6 months. TIVAPs were removed in 37 patients due to infection 14 (4.7%), occlusion 8 (2.7%), VTE 9 (3%), malposition 1 (0.3%), and treatment completion 10 (3.3%). TIVAPs of 270 (90.9%) patients were found to be usable for an average of 18.5±17.1 months. Complications of VTE, occlusion, infection and malposition developed in a total of 71 (23.9%) patients. In the comparison of develepment of these complications according to the presence of metastasis in patients, it was found to be that they were significantly higher in metastatic patients (47-27.9%/24-18.6%, p<0.05). There was a significant positive correlation between taxanes, methotrexate, etoposide and vinorelbine and the rate of VTE development compared to other chemotherapy drugs(p<0.05). The rate of TIVAP associated VTE was found to be significantly higher in elderly patients, patients with metastatic cancer and patients with lung cancer (p<0.05). No significant difference was present in TIVAP patency, complications and TIVAP-related VTE, in terms of venous access site and side.
Conclusion: Primary cancer, metastases, and chemotherapy are important factors for the development of systemic or TIVAP-related VTE. More multicenter studies are needed for the prevention and treatment of VTE in certain types of cancer and chemotherapy regimens that increase the risk of TIVAP-associated VTE.
Supporting Institution
YOK
Project Number
YOK
Thanks
THANKS TO MUGLA SITKI KOCMAN UNIVERSTY/FACULTY OF SCİENCE DEPARTMENT OF STATİSTİCS RESEARCH ASSİSTAN ERSİN YILMAZ FOR THE CONTRIBUTION İN STATISTICAL ANALYSES
References
- Saber W, Moua T, Williams EC, et al. Risk factors for catheter-related thrombosis (CRT) in cancer patients: a patient-level data (IPD) meta-analysis of clinical trials and prospective studies. J Thromb Haemost 2011;9:312-329.
- Voog E, Campion L, du Rusquec P, et al. Totally implantable venous access ports: a prospective long-term study of early and late complications in adult patients with cancer. Support Care Cancer. 2018;26:81-89.
- Grant JD, Stevens SM, Woller SC, et al. Diagnosis and management of upper extremity deep-vein thrombosis in adults. Thromb Haemost 2012;108:1097-1108.
- Jiang M, Li CL, Pan CQ, Cui XW, Dietrich CF. Risk of venous thromboembolism associated with totally implantable venous access ports in cancer patients: A systematic review and meta-analysis. J Thromb Haemost. 2020;18:2253-2273.
- Horowitz NA, Brenner B. Thrombosis in hematological malignancies: mechanisms and implications. Thromb Res. 2020;191:58-62.
- Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer 2007;110:2339-2346.
- Franco-Moreno A, Cabezón-Gutiérrez L, Palka-Kotlowsa M, Villamayor-Delgado M, García-Navarro M. Evaluation of direct oral anticoagulants for the treatment of cancer-associated thrombosis: an update. J Thromb Thrombolysis. 2019;47:409-419.
- Raskob GE, van Es N, Verhamme P, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2018;378:615-624.
- Young AM, Marshall A, Thirlwall J, et al. Comparison of an Oral Factor Xa Inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol. 2018;36:2017-2023.
- Agnelli G, Becattini C, Meyer G, et al. Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med. 2020;382:1599-1607.
- Niederhuber JE, Ensminger W, Gyves JW, Liepman M, Doan K, Cozzi E. Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery.1982;92:706-712.
- Granziera E, Scarpa M, Ciccarese A, et al. Totally implantable venous access devices: retrospective analysis of different insertion techniques and predictors of complications in 796 devices implanted in a single institution. Bmc Surg. 2014;14:1-9.
- Jiang M, Li CL, Pan CQ, Cui XW, Dietrich CF. Risk of venous thromboembolism associated with totally implantable venous access ports in cancer patients: A systematic review and meta-analysis. J Thromb Haemost. 2020;18:2253-2273.
- Schmaier AH. The contact activation and kallikrein/kinin systems: pathophysiologic and physiologic activities. J Thromb Haemost. 2016;14:28-39.
- Schmaier AH. Antithrombotic potential of the contact activation pathway. Curr Opin Hematol.2016;23:445-452.
- Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol. 2015;12:464-474.
- Citla Sridhar D, Abou-Ismail MY and Ahuja SP. Central venous catheter-related thrombosis in children and adults. Thromb Res. 2020;187:103-112.
- Goltz JP, Noack C, Petritsch B, Kirchner J, Hahn D, Kickuth R. Totally implantable venous power ports of the forearm and the chest: initial clinical experience with port devicesapproved for high-pressure injections. Br J Radiol. 2012;85:966-972.
- Piran S, Ngo V, McDiarmid S, Le Gal G, Petrcich W, Carrier M. Incidence and risk factors of symptomatic venous thromboembolism related to implanted ports in cancer patients. Thromb Res. 2014;133:30-33.
- Levi M. Cancer-related coagulopathies. Thromb Res. 2014;133:70-75.
- Woodley-Cook J, Shin LY, Swystun L, Caruso S, Beaudin S, Liaw PC. Effects of the chemotherapeutic agent doxorubicin on the protein C anticoagulant pathway. Mol Cancer Ther. 2006;5:3303-3311.
- Iqubal A, Iqubal MK, Sharma S, et al. Molecular mechanism involved in cyclophosphamide-induced cardiotoxicity: Old drug with a new vision. Life Sci. 2019;218:112-131.
- Oppelt P, Betbadal A, Nayak L. Approach to chemotherapy-associated thrombosis. Vasc Med. 2015;20:153-161.
- Sara JD, Kaur J, Khodadadi R, et al. 5-fluorouracil and cardiotoxicity: a review. Ther Adv Med Oncol.2018;10:1758835918780140.
- Lyman GH, Carrier M, Ay C, et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer [published correction appears in Blood Adv. 2021 Apr 13;5(7):1953]. Blood Adv. 2021;5:927-974.
- Lobastov K, Schastlivtsev I, Kanzafarova I. Directoral anticoagulants in cancer-associated venous thromboembolism.Vasc Invest Ther 2020;3:46-53.
- Khorana AA, McCrae KR, Milentijevic D, et al. Current practice patterns and patient persistence with anticoagulant treatments for cancer-associated thrombosis. Res PractThrombHaemost. 2017;1:14–22.
- Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41:543-603.
- Key NS, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol. 2020;38:496-520.
- Cancer-associated venous thrombotic disease. NCCN clinical practice guidelines in oncology (NCCN Guidelines) version 3.2021 https://www. nccn.org/professionals/physician_ gls/pdf/vte.pdf (accessed 24/02/2022).
- Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s Choice- European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg. 2021;61:9-82.
- Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines [published correction appears in Chest. 2012;142(6):1698-1704]. Chest. 2012;141(2 Suppl):e419S-e496S.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Project Number | YOK |
| Publication Date | August 31, 2023 |
| Submission Date | March 29, 2023 |
| Published in Issue | Year 2023 Volume: 4 Issue: 2 |
This material is licensed by Creative Commons Attribution-NonCommercial-No Derivative 4.0 International License.