Risk Factors And Survival Analysis Of Lymphoma Patients With Venous Thromboembolism

Venous thromboembolism(VTE)belongs to venous reflux disorder,including two types:deep venous thrombosis(DVT)and pulmonary embolism(PE).VTE is a common complication in cancer patients,which is about 5 times higher than that in the general population,and is the second leading cause of morbidity and death in cancer patients.Now people pay more and more attention to solid tumor-related VTE,but ignore hematological tumor-related VTE.It is generally believed that the risk of solid tumors complicated with VTE is much higher than that of hematological tumors.However,foreign studies have shown that the incidence of VTE in patients with hematological tumors is similar to that in patients with solid tumors.Based on this background,this study retrospectively analyzed the clinical data of 453 newly diagnosed patients with lymphoma to analyze the risk factors of lymphoma patients with VTE and the impact of VTE on survival.ObjectiveTo analyze the incidence,clinical characteristics and prognosis of symptomatic VTE in newly diagnosed patients with lymphoma after diagnosis and treatment,and to statistically analyze the risk factors that may affect the incidence of VTE,to find the independent risk factors of VTE,and to analyze the effect of VTE on survival and prognosis.According to the Khorana score and Thro Ly score,the predictive efficacy of the two scores in newly diagnosed lymphoma patients with VTE was analyzed and compared.Materials and MethodsThis study was conducted through a retrospective analysis of the clinical data of newly diagnosed lymphoma patients diagnosed and treated in the Hospital from January 2015 to January 2020.The incidence,clinical characteristics and prognosis of symptomatic VTE in newly diagnosed patients with lymphoma were analyzed.According to the occurrence of VTE during admission,the patients were divided into VTE group and non-VTE group,and VTE group included all patients with DVT and PE.The risk factors related to VTE were divided into patient’s own factors,laboratory examination factors and tumor-related factors.Patients’own factors included age(actual age,age),gender(male/female),body mass index(BMI)(weight/height~2),(ECOG)score of American Eastern Cancer Cooperation Group(0-1)/(2-4),and previous diagnosis of VTE history/coronary heart disease/stroke(yes/no).Laboratory factors(all were the first fasting examination on admission):hemoglobin Hb),platelet count before chemotherapy(PLT),leukocyte count(WBC),D-dimer,fibrinogen(Fib),mean platelet volume(MPV),serum albumin,neutrophils.Tumor related factors:disease stage(Ann Arbor stage),disease type,extranodal invasion,mediastinal invasion.And Khorana score and Thro Ly score model.The collected risk factors were analyzed by single factor analysis,and the factors with statistical significance in single factor analysis were included in binary logistic for multiple factor regression analysis.Kaplan-Meier analysis was used to determine the mortality,P<0.05.The difference was statistically significant.Results1.A total of 51 cases of symptomatic VTE were confirmed in this study,including 9 cases(6.9%)of Hodgkin’s lymphoma complicated with VTE and 42 cases(10.4%)of non-Hodgkin’s lymphoma complicated with VTE.There were 28 cases(12.6%)of diffuse large B-cell lymphoma complicated with VTE,4 cases(13.7%)of peripheral T-cell lymphoma with VTE,3 cases(15%)of mantle cell lymphoma with VTE,2 cases(5.2%)of follicular lymphoma with VTE,and 5 cases(33%)of 15cases of primary central nervous system lymphoma with VTE.In the univariate analysis of the risk factors of lymphoma complicated with VTE,the tumor type of primary central nervous system lymphoma was statistically significant(p=0.0006).2.There were 34 males and 17 females,the median age was 17-87 years old,the median age was 63 years old,ECOG score(0-1 score)16 cases,ECOG score(2-4 score)35 cases,previously diagnosed VTE history/coronary heart disease/stroke 20cases,undiagnosed VTE history/coronary heart disease/stroke 30 cases,body mass index(Body Mass Index,BMI)15.7-34.1kg/m~2,mean 23.6kg/m~2.The incidence of VTE in ECOG score(2-4 score)was 68.6%higher than Non-VTE group in ECOG score(2-4 score)39.6%(P<0.000).The incidence of VTE in previously diagnosed VTE history/coronary heart disease/stroke history was 39.2%higher than Non-VTE group in VTE history/coronary heart disease/stroke history VTE7.4%,P<0.000.3.In laboratory examination,the incidence of VTE in patients with neutrophils<1×10~9/L was significantly higher than Non-VTE group in patients with neutrophils<1×10~9/L(13.4%;P<0.022),and the incidence of VTE in patients with hemoglobin<100g/L was significantly higher than Non-VTE group in patients with hemoglobin<100g/L(37.3%;P<0.003).The incidence of VTE in patients with mean platelet volume<6.8f L was 17.6%higher than Non-VTE group in patients with mean platelet volume<6.8f L(8.5%;P<0.05).These three groups of data are statistically significant.4.Stratification of risk factors related to tumor:whether the disease stage is III-IV stage,whether there is extranodal lymph node invasion,whether there is mediastinal invasion,whether the Khorana score≤3 and whether the Thro Ly score>3,and the laboratory indexes are tested by chi-square test between groups,taking p<0.05 the difference test standard,that is,there is statistical significance in the univariate analysis of Thro Ly score.The univariate analysis of Khorana score>3showed no statistical significance(P>0.05).The incidence of extranodal lymph node invasion in the VTE group was 15.7%higher than that in the non-VTE group(14.9%)(0.000),which was statistically significant.5.Binary logistic multivariate analysis showed that tumor type PCNSL,hemoglobin<100g/L,ECOG score(2-4 score)and Thro Ly score>3 were independent risk factors for symptomatic VTE in newly diagnosed lymphoma patients,that is,the risk of symptomatic VTE in newly diagnosed lymphoma patients after diagnosis and treatment:the risk of tumor type PCNSL complicated with VTE was 5.816 times higher than that of non-PCNSL lymphoma.The incidence of VTE in newly diagnosed lymphoma patients with a previous positive history of VTE/coronary heart disease/stroke was 3.339 times higher than that in patients with negative VTE.The incidence of VTE in newly diagnosed lymphoma patients with hemoglobin<100 hg/L was 2.436 times higher than that in patients with hemoglobin>100 hg/L.The risk of VTE in newly diagnosed lymphoma patients with ECOG score(2-4)was 2.597 times higher than that in patients with ECOG score(0-2).The incidence of VTE in newly diagnosed lymphoma patients with Thro Ly score>3 was 4.654 times higher than that with Thro Ly score≤3.6.51 cases of symptomatic VTE,including 45 cases of simple DVT,5 cases of simple PE,no cases of DVT and PE coexist.The incidence of symptomatic DVT is46/453(10.1%),and symptomatic PE5/453(1%).We will analyze the risk factors of the appeal and the criteria for stratification of risk factors between DVT and PE.According to the figure below,we can see In the statistical analysis,the incidence of white blood cells>11×10~9/L in the PE group was 60%higher than that in the DVT group by 13%,which was statistically significant(P=0.009);Thro Ly score>The incidence of 3 points in the PE group was 80%higher than the 17.4%in the DVT group,which was statistically significant(P=0.002).7.Survival analysis prompt:Kaplan-Meier survival analysis shows that VTE is related to survival.The average survival time of patients with venous thromboembolism was 46.154 months(95%CI,39.160～53.149),while the average survival time of those without venous thromboembolism was 55.03 months(95%CI,53.471～56.636),at 51 Among the VTE patients,11 died,and the relationship between death and the occurrence of VTE was significant(P=0.000).Among the patients with Throly>3 points,there were 17 deaths,and the relationship between death and Throly>3 points was significant(P=0.000).Kaplan-Meier survival analysis showed that VTE is related to survival.The average survival time of patients with Throly>3points is 28.190 months(95%CI,24.212～32.368),while the average survival time of patients with Throly less than or equal to 3 points is 55.976 months(95%CI,54.535～57.419).Conclusions1.The incidence of symptomatic VTE in newly diagnosed lymphoma patients was 11.3%.Independent risk factors for symptomatic VTE in newly diagnosed lymphoma patients:the tumor type is PCNSL,hemoglobin<100g/L,ECOG score(2-4 score),and Thro Ly score are the high-risk group for the complications of newly diagnosed lymphoma patients after diagnosis and treatment Independent risk factors for sexual VTE,and Throly score is more suitable for predicting lymphoma complicated with VTE than Khorana score.2.VTE affects the life cycle of lymphoma patients.It suggests that the prognosis of lymphoma patients with VTE is not good.3.We can group the tumor types and assign values to improve the Thro Ly score and increase the sensitivity of the Thro Ly score.