The Analysis About The High Risk Factors And Prognosis Of Gynecologic Cancer With Deep Venous Thrombosis

Objective:To discuss the risk factors and prognosis of gynecologic cancer patients with deep venous thrombosis,and to provide a reference for clinical prevention and treatment decision making.Methods:Date from 212 gynecologic oncology patients in Affiliated Tumor Hospital of Guangxi Medical University from January 1994 to Sep 2014 were analyzed retrospectively.It included 106 cases in the DVT group and 106 cases in the control group.We made univariate analysis and Logistic regression to evaluate the risk factors with SPSS 22.0 and used the Kaplan-Meier to conduct the survival analysis.Results:(1)The univariate analysis showed that tumor staging,body mass index,hypertension,diabetes,blood transfusion,history of thrombosis,stimulating factor and laparoscopic surgery were statistically significant(P<0.05)associated with DVT.(2)Logistic regression analysis revealed that tumor staging,BMI index,hypertension,diabetes may be the independent risk factors of gynecologic cancer with DVT.(3)The median survival time in DVT group was statistically significant shortened than the control group(P<0.05).(4)The staging,the scope of DVT(whether with pulmonary embolism)and the treatment of DVT were the effective factors influence the prognosis of gynecologic oncology patients with DVT.COX regression model showed that the staging and the scope of DVT were the ndependent risk factors.Conclusion:Gynecologic cancer with DVT is the common effect of various risk factors.We should identify the risk factors for high-risk patients and take preventive measures actively to reduce the deep venous thromboembolism,then improve the survival of patients,improve the prognosis.Objective:To evaluate and compare the different risk assessment model to predict of gynecologic malignancies associated with deep vein thrombosis,and to explore the suitable risk assessment model to predict gynecologica cancer patients with deep vein thrombosis,which can effectively facilitate the early identification of high-risk patients.Methods:Date from 212 gynecologic oncology patients in Affiliated Tumor Hospital of Guangxi Medical University from January 1994 to Sep 2014 were analyzed retrospectively.It included 106 cases in the DVT group and 106 cases in the control group.Patients were risk-stratified with three different risk assessment models individually,including Caprini model,Wells DVT model and Khorana model.The predictive values of these models were compared with nonparametric test and ROC curve.Results:(1)The difference of risk level evaluated with Capini model in the DVT group and the control group was not statistically significant(P>0.05);But with the Wells DVT model and Khorana model were statistically significant(P<0.05),DVT group had a higher risk level than the control group.(2)Compared between the Wells DVT model and Khorana model showed that Wells DVT model was more effectively stratified DVT group patients into the higher risk level,while control group patients into the lower risk level.(3)While taking the middle risk level as the positive index,Wells DVT model had a higher Sensitivity(1.00)and Specificity(0.88);while taking the high risk level as the positive index,Khorana model had a higher Sensitivity(0.24)and Specificity(0.97).(4)ROC curve analysis showed that the area under curve(AUC)of Wells DVT model was 0.995±0.002(P=0·000),while Khorana model was 0.642±0.038(P= 0.000).There was no statistically significant difference between Wells DVT model and Khorana model(Z = 9.289,P=1).Conclusion:The study demonstrated that the Wells DVT model and the Khorana model have more strongger predictive performance.The Wells DVT model has the highest value,which is easy and accurate.It can help Gynecologic Oncology Physicians identify potential risks in patients with DVT.Objective:This study was designed to systematically analyze the world’s literature on thromboembolism prophylaxis in gynecologic oncology perioperative and evaluate the efficacy and safety of prophylaxis regimen.Methods:Computerized searches electronic databases such as Pubmed,Cochrane Library,Medline,Embase and CNKI,VIP,CBM from the date of their establishment to Sep 2014.Meta-analysis was performed on the studies meeting the criterion.Results:It included 18 randomized controlled studies and 3 193 patients.Meta analysis showed that:(1)The analysis of heparin-versus-control revealed a significant decrease in DVT in patients receiving heparin(RR=0.59,95%CI:0.36～0.96),but not in PE(RR=4.08,95%CI:0.71～23.53).(2)LMWH-versus-control also revealed a significant decrease in DVT in patients receiving LMWH(RR=0.16,95%CI:0.05～0.47).(3)In the heparin-versus-LMWH studies,there was no significant difference(RR=0.98,95%CI:0.43-2.23).(4)Combination prophylaxis can be more effectively reduce the incidence of deep vein thrombosis(RR=0.15,95%CI:0.04～0.68).Conclusions:All gynecologic cancer patients should receive VTE prophylaxis.But no one prevention modality can be considered superior.Adequately powered RCTs are urgently needed to determine the optimal regimen in these high-risk patients.