The Study On Venous Thromboembolism In Patients With Cancer

Objective:This study explored the clinical characteristics of cancer patients with Venous thromboembolism(VTE),verified the modified Ottawa score to evaluate the recurrence efficacy of VTE,and discussed the value of thrombelastogram(TEG)in predicting VTE in patients with cancer,in order todeepen the understanding of VTE with cancer,achieve early recognition and intervention and improve the prognosis of those patients.Methods:1.The study is divided into two parts,part Ⅰ:data were collected from Nanchong Central Hospital in 2016 January to December 2019 cases of cancer patients with VTE data,and retrospective analysis was made on the high-risk population of cancer with VTE,the characteristics of the disease and the prognosis of treatment and so on,at the same time verified the modified Ottawa score to evaluate the recurrence efficacy of VTE.2.Part Ⅱ:collected the general case data and TEG parameters of cancer patients from January 2018 to December 2019 in Nanchong Central Hospital,and discussed the predictive value of TEG in evaluating cancer patients with VTE.3.Statistical methods:T test and chi-square test were used to compare the differences of data,kaplan-meier method was used to draw the survival curve,and the differences between groups were compared by Breslow test.Receiver operating characteristic curve(ROC)was used to evaluate the performance of test indicators.Results:1.Part Ⅰ:(1)General information of included patients:a total of 212 cancer patients with VTE were collected,including 108 males(50.94%)and 104 females(49.06%).83(39.15%)patients were less than 60 years old,and 129(60.85%)patients were ≥60 years old.A total of 169 patients(79.72%)were associated with basic diseases,among which 16(7.55%)were associated with more than one basic disease.The majority of basic diseases were hypertension(21.70%),acute infectious diseases(17.92%),diabetes(15.09%)and chronic lung diseases(8.49%).(2)Tumor related situation:78 cases of VTE with lung cancer(36.79%),59 cases of digestive system cancer(27.83%),42 cases of gynecological cancer(19.81%),of which 16 cases of esophageal cancer(7.55%),14 cases of cervical cancer(6.60%)and 14 cases of ovarian cancer(6.60%).Pathological types:91 cases(42.92%)were adenocarcinoma,121 cases(57.08%)were other pathological types.Differentiation degree:73 cases(74.49%)were low differentiation,low medium differentiation and medium differentiation,25 cases(25.51%)were other differentiation degrees.TNM stage:55 cases(30.90%)in stage Ⅲ,74 cases(41.57%)in stage IV and 49 cases(27.53%)in other stages.Before VTE,128 patients were treated with chemotherapy,94 with surgery and 79 with radiotherapy.142 patients(66.98%)were received PICC/CVC.(3)VTE related situation:58 cases(27.36%)had VTE before tumor diagnosis,and 154 cases had VTE after tumor diagnosis.The cumulative incidence rate of VTE at the 1st,3rd,6th,9th and 12th months after diagnosis was 29.87%,40.26%,59.10%,67.53%and 75.97%.Among the 128 cases with VTE after chemotherapy,the cumulative rate of VTE at the 1st,3rd,6th,9th and 12th months after chemotherapy was 26.56%,35.16%,40.63%,50.78%and 61.72%.In 94 patients with VTE after tumor treatment-related surgery,the cumulative rate of VTE was 22.34%,37.23%,41.49%,48.94%,56.38%and 68.10%in the 2 weeks,1,3,6,9 and 12 months after surgery.Antithrombotic therapy:116 cases(54.72%)were treated by anticoagulation alone(71 cases with LMWH)and 54 cases(25.47%)by combination therapy.The treatment was safe and no fatal bleeding event occurred.(4)Prognostic information:in this study,the overall median OS of 212 cancer patients with VTE was 14.2 months,the median OS of lung cancer patients with VTE was 8.2 months,and the median OS of digestive system malignant tumor patients with VTE was 12.5 months.The cumulative mortality at 3,6,9 and 12 months after diagnosis of VTE was 18.87%,27.36%,31.60%and 34.91%,respectively.(5)Ottawa score validation:176 patients were evaluated with Ottawa score,19 cases(10.80%)were in the low-risk group,75 cases(42.61%)in the middle-risk group and 82 cases(46.59%)in the high-risk group.24(13.64%)patients recurred followed up for 6 months.The recurrence rates of the low,middle and high-risk groups were 5.26%,9.33%and 19.51%,respectively.The difference among the three groups was statistically significant(p=0.030,Breslow test).2.Part Ⅱ(1)A total of 96 patients with cancer were included,including 54 in the thrombus group and 42 in the control group.In comparison of TEG parameters between the two groups,the levels of R in the thrombotic group were lower than those in the control group(5.406±1.6397 VS 5.869±1.3968),angle(72.509±9.5118 VS 65.055±9.3004),MA(74.178±8.8689 VS 65.981±9.3225),and CI(2.338±9.4877 VS 1.537±2.7390),all of which were statistically significant(p<0.05).(2)Value of TEG parameters predicted the occurrence of VTE:the AUC of angle was 0.742(p<0.001),when the Cut-off point was 67.9,the sensitivity was 81.5%and the specificity was 57.1%.The AUC of MA was 0.737(p<0.001),When the cut-off point was 68.0,the sensitivity was 85.2%and the specificity was 59.5%.Conclusion:1.Advanced age,pathological type of adenocarcinoma,low degree of differentiation,late TNM stage,chemotherapy,surgical treatment and PICC/CVC may be high risk factors for VTE in patients with malignant tumors.2.Lung cancer,digestive system malignancy and gynecological malignancy are the main tumor types complicated with VTE,and esophageal cancer with high incidence in our region is a high-risk tumor type complicated.with VTE,which cannot be ignored.3.Antithrombotic therapy in our hospital is mainly anticoagulant therapy,and LMWH is still the main treatment choice.4.6 months after diagnosis,6 months after chemotherapy,and 2 weeks after surgery may be the high-risk time periods for cancer to occur with VTE;The prognosis of patients with malignant tumors after VTE is poor,and 3 months after diagnosis of VTE may be a high-risk time period for death.5.The Ottawa score can distinguish the low,medium and high risk of VTE recurrence in cancer patients,which is worthy of application in clinical work.6.TEG parameter has a certain value in predicting VTE in patients with cancer,among which angle and MA are more effective in predicting VTE.7.Among the TEG parameters,the decrease of R,the increase of angle,MA and CI may be a signal of hypercoagulability of patients with cancer,and propreventive treatment can be given after the comprehensive assessment of the risk of bleeding and coagulation.