Analysis Of Risk Factors And Establishment Of Prediction Model For Postoperative Venous Thromboembolism Of Ovarian Cancer

Objective: To explore the influencing factors of venous thromboembolism(VTE)after ovarian cancer surgery,construct and evaluate its risk prediction model,so as to provide theoretical basis for reducing the incidence of VTE after ovarian cancer surgery.Methods: A total of 67 patients with ovarian cancer who developed VTE after surgery were selected from October 2008 to June 2020 in the Department of Obstetrics and Gynecology,First Hospital of Lanzhou University,and conducted a retrospective study with 100 patients without VTE after the operation who were confirmed by imaging during the same period.The clinical data of the two groups of patients were analyzed and compared,and the risk prediction model was established.The ROC curve was drawn to evaluate the prediction effect of the model.Results: 1.The results of univariate analysis showed that the two groups of patients were in age(P=0.001),hypertension(P=0.036),menopausal status(P=0.016),neoadjuvant chemotherapy(P=0.013),FIGO stage of tumor(P=0.004),lymph node metastasis(P= 0.032),operation time(P=0.047),preoperative plasma FIB(P=0.004)and plasma D-dimer(P<0.001)were statistically different.2.The results of multivariate analysis showed that advanced age(OR=1.054,95%CI: 1.003 ～ 1.108,P=0.038),neoadjuvant chemotherapy(OR=2.502,95%CI:1.116 ～ 5.607,P=0.026),late FIGO staging(OR=2.602,95%CI: 1.096 ～ 6.178,P=0.030),The preoperative high level of plasma FIB(OR=1.489,95%CI: 1.084～2.044,P=0.014)and D-dimer(OR=1.700,95%CI: 1.186～2.437,P=0.004)were ovarian cancer Independent risk factors for VTE after surgery.3.The prediction model was constructed based on the results of multivariate regression analysis: Logit(P)= 0.053 × age + 0.917 × neoadjuvant chemotherapy +0.956×tumor FIGO staging + 0.398 × preoperative plasma FIB + 0.531 ×preoperative D-dimer-7.679(neoadjuvant Chemotherapy,yes=1,no=0;tumor FIGO stage Ⅰ+Ⅱ=1,Ⅲ+Ⅳ=2;age,preoperative plasma FIB and D-dimer are actual values).The HosmerLemeshow test method analyzes the degree of fit of the model,P=0.436,greater than0.05,indicating that the model has a good fit and can be used to predict the occurrence of VTE after ovarian cancer.4.The ROC curve shows: The AUC value of the model was 0.773(95%CI:0.701～0.844),the sensitivity of predicting postoperative thrombosis was 74.6%,the specificity was 71.0%,and the total prediction accuracy rate was 70.1%(117/167).Conclusion: 1.advanced age,neoadjuvant chemotherapy,late FIGO staging,high levels of plasma FIB and D-dimer before surgery were high risk factors for VTE after ovarian cancer surgery.In the perioperative period,the clinical management of highrisk VTE patients should be strengthened to reduce the incidence of venous thromboembolism after ovarian cancer surgery.2.The risk prediction model constructed in this study has excellent prediction ability,with sensitivity of 74.6%,specificity of 71.0% and total prediction accuracy of70.1%,which has certain clinical application value.