癌症患者诊断后不同治疗环境中静脉血栓栓塞的发生率和相关因素：一项系统综述和荟萃分析

摘要(中文译文)

背景：静脉血栓栓塞症（VTE）是癌症患者的主要并发症。尽管胃癌被认为是VTE的高危恶性肿瘤，但现有证据主要集中在围手术期。诊断后更广泛治疗场景中血栓事件的疾病负担仍缺乏充分描述。本研究旨在估计胃癌患者诊断后各治疗场景中血栓事件的发生率，并总结已报道的相关因素。方法：按照PRISMA 2020指南进行系统评价和荟萃分析。检索PubMed、Embase、Web of Science和Cochrane Library，检索时间从建库至2026年1月31日。纳入报告经病理确诊的胃癌患者血栓事件发生率和/或相关因素的研究。采用随机效应模型。使用I²统计量评估异质性。在适用的情况下进行敏感性和探索性亚组分析。结果：共纳入10项研究，包含9，689例患者。在主要分析中，诊断后各治疗场景中血栓事件的合并发生率为9.0%（95% CI 6.1%–13.2%），存在显著异质性（I² = 97.4%）。对相关因素（包括性别、体重指数≥ 25 kg/m²、腹膜转移、肺转移和骨转移）的定量分析未能在随机效应模型下建立一致且可重复的独立关联。结论：在胃癌患者中，诊断后各治疗场景中的血栓风险似乎具有临床相关性，其范围超出短期围手术期。然而，当前证据尚未确立稳健且可重复的预测因素以直接应用于临床。需要进一步开展大规模前瞻性研究，以改进风险估计并支持未来在该人群中验证风险评估方法。

Abstract

BACKGROUND: Venous thromboembolism (VTE) is a major complication in patients with cancer. Although gastric cancer is recognized as a high-risk malignancy for VTE, existing evidence has mainly focused on perioperative settings. The burden of thrombotic events across broader treatment settings after diagnosis remains less well characterized. This study aimed to estimate the incidence of thrombotic events in patients with gastric cancer across treatment settings after diagnosis and to summarize reported associated factors. METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to January 31, 2026. Studies reporting thrombotic event incidence and/or associated factors in patients with pathologically confirmed gastric cancer were included. Random-effects models were applied. Heterogeneity was assessed using the I² statistic. Sensitivity and exploratory subgroup analyses were performed where applicable. RESULTS: Ten studies comprising 9,689 patients were included. In the primary analysis, the pooled incidence of thrombotic events across treatment settings after diagnosis was 9.0% (95% CI 6.1%–13.2%), with substantial heterogeneity (I² = 97.4%). Quantitative analyses of associated factors, including sex, body mass index ≥ 25 kg/m², peritoneal metastasis, lung metastasis, and bone metastasis, did not establish consistent and reproducible independent associations under random-effects models. CONCLUSIONS: Thrombotic risk appears clinically relevant in patients with gastric cancer across treatment settings after diagnosis, beyond short-term perioperative settings. However, current evidence does not establish robust and reproducible predictors for direct clinical implementation. Further large-scale prospective studies are needed to improve risk estimation and support future validation of risk assessment approaches in this population.

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