Clinical Characteristics And Establishment Of Risk Assessment Model For Gynecological Cancer Complicated With Venous Thromboembolism

Objective Venous thromboembolism(VTE)is a frequent complication during gynecological cancer therapy,and also the main cause leading to the sudden death of patients.Therefore,it’s crucial to precisely identify the risk factors of early venous thromboembolism in gynecological cancers,and take timely prevention and treatment measures to improve the prognosis of gynecological cancers.The purpose of this article is to investigate the clinical characteristics of VTE in gynecologic cancer patients,identify high-risk factors and establish a VTE risk prediction model,aiming to identify high-risk patients in early stage.Methods 1.Data acquisition The data of patients with gynecological cancer admitted to Changhai Hospital of Naval Medical University from January 1,2010 to September 30,2020 were analyzed retrospectively.44 patients with gynecological cancer complicated with venous thromboembolism were screened according to the inclusion criteria and exclusion criteria.According to the disease type of the case group,176 patients without VTE admitted in the same period were randomly selected as the control group.The relevant clinical data were collected through the electronic medical record system of our hospital,including age,body mass index,FIGO stage,histological and pathological grade,previous history of thrombosis,vessel carcinoma embolus,complication and treatment of gynecological cancer.Laboratory parameters included neutrophilto-lymphocyte rate(NLR),platelet to lymphocyte ratio(PLR),fibrinogen to albumin ratio(FAR),platelets and coagulation index et al.2.Statistical analysis Applied statistical software SPSS 21.0 was used for data analysis,chi-square test,t-test or nonparametric test were used to describe the difference of clinical characteristics and clinical variables.Variables(P < 0.2)in univariate analysis were included in the multivariate Logistic regression model.Stepwise forward regression method was used to screen the factors of the risk assessment model for the incidence of VTE according to gynecological cancers.The nomogram was validated by computer repeated sampling(Bootstrap)for 1000 times,additional clinical data of 113 patients were collected for external validation of the model.The receiver operating characteristic(ROC)curves were also used to evaluate the predictive value of laboratory indicators and risk assessment model for the occurrence of VTE.Results 1.The case group included 44 cases,involving 12 cases of cervical cancer(27.3%),24 cases of ovarian cancer(54.5%)and 8 cases of endometrial cancer(18.2%).Among them,8cases were pulmonary embolism and 36 cases were deep venous thrombosis,and one of them was deep venous thrombosis with pulmonary embolism.In terms of the amount time elapsed between cancer diagnosis and the first occurrence of a thromboembolic event,12 cases occurred before cancer treatment,32 occurred during cancer treatment.Specificly,1case occurred during radiotherapy,4 cases during neoadjuvant chemotherapy,18 cases during 2～60 days after operation,and 9 cases during postoperative adjuvant radiotherapy and chemotherapy.All patients were treated with anticoagulation immediately when diagnosed with VTE.Venous filters were placed to prevent thrombosis in 16 cases,thrombectomy was performed in 4 cases,thrombolysis was performed in 3 cases,and balloon dilatation and stent implantation were performed in 4 cases.2.Univariate analysis results: The case group and the control group were significantly different in hypertension(P=0.027),diabetes(P=0.002),hyperlipidemia(P=0.008),histological and pathological grades(P=0.005),ascites volume(P=0.028),neoadjuvant chemotherapy(P=0.016)and prophylaxis(P < 0.001),NLR(P < 0.001),PLR(P=0.001),FAR(P=0.041),PT(P=0.009),APTT(P=0.014),FIB(P=0.005),FDP(P < 0.001)and Ddimer(P<0.001).3.Results of multivariate analysis: diabetes(OR=3.350,95%CI : 1.216～9.228),neoadjuvant chemotherapy(OR=2.900,95%CI: 1.071～7.848),radiotherapy(OR=3.917,95%CI:1.048～14.635),histopathological grade G3 or undifferentiated(OR=3.592,95%CI:1.513～8.529),high NLR(OR=4.267,95%CI:1.685～10.805),high FAR(OR=3.164,95%CI:1.344～7.447)are independent risk factors for venous thromboembolism in gynecological cancers,and prophylaxis(OR=0.153,95%CI: 0.064～0.367)is independent protective factor for venous thromboembolism in gynecological cancers.4.Based on the results of multivariate analysis,the equation was constructed as follows:Y=-3.412 diabetes+1.209 diabetes + 1.065 neoadjuvant chemotherapy + 1.365 radiotherapy + 1.279 histopathological grade-1.879 prophylaxis + 1.451NLR+1.152 FAR.The nomogram of gynecological cancers complicated with VTE was established based on the equation,and resampled by computer for 1000 times for internal verification.The area under curve of Nomogram for predicting the risk of the occurrence of VTE in gynecological cancers was 0.860(95%CI:0.791～0.929),which indicated the prediction effect was good.The AUC of the Caprini risk assessment model for predicting the probability of VTE in gynecological malignancies was 0.563(95%CI: 0.465～0.662).The clinical data of 113 patients with gynecological malignancies were also collected for verification.The AUC of Nomogram for predicting the occurrence of VTE in gynecological malignancies was 0.911(95%CI: 0.767～1.0000).Conclusions The incidence of VTE in patients with gynecological cancer is the result of multiple factors.Diabetes,neoadjuvant chemotherapy,radiotherapy,histological pathological grade,NLR≥3.19 and FAR≥0.1 are independent risk factors of gynecological cancers complicated with VTE,taking precautions is an independent protective factor.The management of patients with high risk factors should be strengthened and prophylaxis should be taken in time to reduce the incidence of VTE in gynecological cancers.Based on the above results,this study constructed a Nomogram for predicting the risk of VTE in gynecological cancers.The model has good differentiation and prediction effect,and has a certain clinical value.