Analysis Of Risk Factors For Venous Thromboembolism In Patients With Digestive System Malignancies

Objective: To explore the risk factors of venous thromboembolism(VTE)in patients with digestive system malignancies,and to screen the high-risk population of VTE in patients with digestive system malignancies,so as to lay a foundation for the establishment of venous thrombosis risk prediction system in patients with digestive system malignancies.Methods: Retrospective analysis was performed on the clinical data of 728 patients with digestive system malignancies who underwent the last venous thrombus screening cut-off point after definite pathological diagnosis in the oncology department of the first hospital of Jilin University from March 2017 to August 2019.The included subjects were gastric cancer,colorectal cancer,pancreatic cancer,hepatobiliary system cancer(primary liver cancer,gallbladder cancer,cholangiocarcinoma),and esophageal cancer.There were 273 cases in VTE group and 455 cases in non-VTE group.Analyze the clinical and pathological characteristics such as gender,age,body mass index(BMI),smoking history,operation history,hypertension history,diabetes history,tumor primary site,pathological type,degree of tissue differentiation,metastasis or not,as well as the laboratory test results such as blood routine,coagulation routine,D-dimer,fibrinogen degradation product(FDP),high-density lipoprotein cholesterol,etc differences between the two groups.Pulmonary embolism was diagnosed by pulmonary artery CT(PTA)and venous thrombosis of upper and lower limbs by color doppler ultrasound(US).SPSS 24.0 statistical software was used for results analysis.The c2 test,Fisher's exact probability method and non-parametric rank sum test were mainly used to compare the general data of the two groups.The statistically significant factors in the univariate analysis were taken into the multivariate Logistic regression analysis to further obtain the independent risk factors of VTE in gastrointestinal malignancy.Results: 1.The incidence of VTE in digestive system malignancies The incidence of VTE in patients with digestive system malignancies was 37.5%(273/728),which was higher than the reported incidence of tumors with VTE of 4% to 20%.2.The time when digestive system malignancies is prone to be associated with VTE The median time between the occurrence of VTE and the diagnosis of digestive system malignancies was 1.30(0.83,3.53)months,and 73.3% of patients developed VTE within 3 months after the diagnosis of digestive system malignancies.3.Univariate Logistic regression analysis of VTE in digestive system malignancies(1)Basic characteristics related to the risk of VTE occurrence: patients with age ?65 and lower limb edema have an increased risk of VTE.The incidence rate of VTE was 56.5% in patients aged ?65 years,which was higher than 29.9% in patients aged < 65 years(OR:3.042,95%CI:2.181-4.242,P<0.001).The incidence rate of VTE in patients with lower limb edema was 70.0%,higher than that in patients without lower limb edema(36.1%)(OR:4.140,95 %CI:1.863-9.154,P<0.001).(2)Clinicopathological features related to the risk of VTE: patients with the primary tumor of pancreas,stomach or right colon,pathological type of adenocarcinoma,low degree of tissue differentiation,clinical stage IV,and number of metastatic organs ?3 had an increased risk of VTE.The incidence rate of VTE was 47.1% in patients with the primary tumor of pancreas,stomach or right colon,which was higher than 28.2% in patients with primary tumor foci of left colon,esophagus and hepatobiliary system(OR 2.266,95%CI:1.667-3.083,P<0.001).The incidence rate of VTE in patients with adenocarcinoma was 40.4%,which was higher than that in patients without adenocarcinoma(24.8%)(OR:2.057,95%CI:1.350-3.134,P<0.001).The incidence rate of VTE in patients with low differentiation was 45.8%,higher than 32.9% in patients with moderate/high differentiation(OR:1.725,95 %CI:1.230-2.419,P=0.002).The incidence rate of VTE in patients with clinical stage IV was 42.5%,higher than 34.2% in patients with stage I+II+III(OR:1.426,95%CI:1.045-1.946,P=0.025).There were 275 patients with metastasis.The incidence rate of VTE in patients with the number of metastatic organs ?3 was 76.5%,much higher than that in patients with 1-2 metastatic organs 40.3%(OR:4.812,95%CI:1.527-15.167,P=0.007).(3)Treatment factors related to the risk of VTE: tumor resection and chemotherapy were associated with VTE.The incidence rate of VTE in patients with tumor resection was 41.3%,higher than 27.3% in patients without tumor resection(OR:1.859,95%CI:1.300-2.658,P=0.001).There were 530 patients who underwent tumor resection and 528 patients who could determine the time of surgery.The incidence rate of VTE within 3 months was 54.9%,which was higher than 25.6% in patients over 3 months(OR:3.381,95%CI:2.343-4.878,P<0.001).The incidence rate of VTE in patients undergoing chemotherapy was 25.0%,which was lower than that in patients without chemotherapy(45.3%)(OR:0.402,95%CI:0.290-0.559,P<0.001).(4)Laboratory test results related to the risk of VTE occurrence:(1)Blood routine examination: patients with neutrophil absolute value of > 6.50×109/L,HGB < 120g/L,NLR > 3.00,PLR > 120.00 had an increased risk of VTE(P<0.05).(2)D-Dimer?FDP: patients with D-Dimer multiple>2?FDP>5.00?g/ml were at increased risk for VTE(P<0.001).(3)Blood biochemical: Patients with albumin < 30g/L and HDL-C< 0.76 mmol/L had an increased risk of VTE(P<0.05).(5)Gender,BMI,history of hypertension,heart disease,diabetes,stroke,intestinal obstruction,smoking history,varicose veins,presence of a large amount of ascites,radiotherapy,leukocyte count,lymphocyte absolute value,the monocyte absolute value,platelet count,fibrinogen,creatinine and VTE were not significantly correlated.4.Multivariate Logistic regression analysis of VTE in digestive system malignancies Age ?65 years(OR:3.871,95%CI:2.350-6.377,P < 0.001),the primary tumor were pancreas,stomach or right semicolon(OR:1.973,95%CI:1.258-3.094,P=0.003),clinical stage IV(OR:1.817,95%CI:1.073-3.078,P=0.026),history of tumor resection(OR:5.197,95%CI:2.464-10.964,P<0.001),chemotherapy(OR:0.271,95%CI:0.160-0.461,P<0.001),platelet/lymphocyte ratio>120.00(OR : 2.252,95%CI:1.397-3.628,P=0.001),D-dimer ULN multiple>2(OR : 1.926,95%CI:1.007-3.684,P=0.048),FDP > 5.00?g /ml(OR: 2.704,95%CI:1.333-5.489,P=0.006)independently correlated with VTE in digestive system malignancies.Conclusion: 1.The risk of VTE in patients with digestive system malignancies is significantly higher than that previously reported for tumor-related VTE,which should arouse our high attention.It is of great significance to analyze the risk factors of digestive system malignancies complicated with VTE and further construct the VTE evaluation and screening system for digestive system malignancies.2.VTE occurs frequently within 3 months after diagnosis of digestive system malignancies,preventive anticoagulation therapy should be performed as early as possible to reduce the occurrence of VTE.3.Age ?65 years old,the primary tumor of pancreas,stomach or right semicolon,clinical stage IV,tumor resection history,PLR > 120.00,D-dimer ULN multiple > 2,FDP > 5?g/ml are independent risk factors for VTE in digestive system malignancies,the above factors are simple and easy to obtain,the previous VTE risk assessment model is not included,and the weights can be considered as a valuation item to construct a VTE risk assessment model for digestive system malignancies to improve its prediction accuracy.4.At present,the left and right colons are important stratification factors for treatment selection and prognosis evaluation of metastatic colorectal cancer.Whether they are also stratification factors for colorectal cancer in predicting the risk of VTE has yet to be further verified.