食管癌患者术后静脉血栓栓塞症的危险因素分析及预测模型建立

doi:10.20047/j.issn1673-7210.2022.33.14

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摘要目的探究食管癌患者术后静脉血栓栓塞症（VTE）的危险因素，构建个性化预测患者术后VTE发生率的统计学模型。方法回顾性分析2020年1月至2021年6月于河北医科大学第四医院胸外科行标准食管癌根治术的127例患者的临床资料，分为VTE组（32例）和非VTE组（95例）。采用logistic回归分析探究食管癌患者术后VTE的危险因素，构建预测食管癌患者术后VTE风险的列线图。结果 VTE组年龄、高血压、糖尿病、体重指数、术前D-二聚体、手术时长、开左胸高于非VTE组，差异有统计学意义（P ＜ 0.05）。多因素logistic分析显示，糖尿病是VTE发生的独立危险因素（OR ＞ 1，P ＜ 0.05）；而手术时长及手术方式是影响VTE发生的独立保护因素（OR ＜ 1，P ＜ 0.05）。构建了预测食管癌患者术后VTE风险的列线图，校准曲线与理想曲线较为贴近，ROC曲线的曲线下面积为0.769，决策曲线显示阈值概率在0～73.1%时对患者进行干预可能会使患者获得临床受益。结论糖尿病、手术时长、手术方式是食管癌患者术后VTE的独立危险因素，本研究中所构建的列线图模型对术后VTE发生有较高的预测价值。

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	王明博1 黄超1 董克勤1 张建锋2 刘泊亨1 田子强1

关键词 ：静脉血栓栓塞症, 食管癌, 围手术期, 危险因素

Abstract：Objective To investigate the risk factors of postoperative venous thromboembolism (VTE) in patients with esophageal cancer and to construct a statistical model for personalized prediction of the incidence of postoperative VTE in patients. Methods The clinical data of 127 patients who underwent standard radical esophageal cancer surgery in the Department of Thoracic Surgery of the Fourth Hospital of Hebei Medical University from January 2020 to June 2021 were retrospectively analyzed and divided into VTE group (32 patients) and non-VTE group (95 patients). Logistic regression analysis was used to explore the risk factors for postoperative VTE in patients with esophageal cancer and to construct a column line graph predicting the risk of postoperative VTE in patients with esophageal cancer. Results Age, hypertension, diabetes mellitus, body mass index, preoperative D-dimer, duration of surgery, and open left chest were higher in the VTE group than in the non-VTE group, with statistically significant differences (P ＜ 0.05). Multi-factor logistic analysis showed that diabetes was an independent risk factor for the development of VTE (OR ＞ 1, P ＜ 0.05); while the length of surgery and the mode of surgery were independent protective factors for the development of VTE (OR ＜ 1, P ＜ 0.05). Column plots were constructed to predict the risk of postoperative VTE in patients with esophageal cancer, and the calibration curve was more closely aligned with the ideal curve, with an area under the curve of 0.769 for the ROC curve, and the decision curve showed that interventions in patients with a threshold probability of 0 to 73.1% may result in clinical benefit. Conclusion Diabetes mellitus, duration of surgery, and mode of surgery are independent risk factors for postoperative VTE in patients with esophageal cancer, and the column line graph model constructed in this study has a high predictive value for the occurrence of postoperative VTE.

Key words： Venous thromboembolism Esophageal cancer Perioperative period Risk factors

引用本文:

王明博1 黄超1 董克勤1 张建锋2 刘泊亨1 田子强1. 食管癌患者术后静脉血栓栓塞症的危险因素分析及预测模型建立[J]. 中国医药导报, 2022, 19(33): 66-70.
WANG Mingbo1 HUANG Chao1 DONG Keqin1 ZHANG Jianfeng2 LIU Boheng1 TIAN Ziqiang1. Risk factor analysis and estoblishment of predictive modeling of postoperative venous thromboembolism in patients with esophageal cancer. 中国医药导报, 2022, 19(33): 66-70.

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[1] Sung H，Ferlay J，Siegel RL，et al. Global Cancer Statistics 2020：GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries [J]. CA Cancer J Clin，2021，71（3）：209-249.
[2] Schizas D，Kosmopoulos M，Giannopoulos S，et al. Meta- analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy [J]. Br J Surg，2019，106（5）：534-547.
[3] Mboumi IW，Reddy S，Lidor AO. Complications After Esop- hagectomy [J]. Surg Clin North Am，2019，99（3）：501-510.
[4] Hanna NM，Williams E，Kong W，et al. Incidence，Timing，and Outcomes of Venous Thromboembolism in Patients Undergoing Surgery for Esophagogastric Cancer：A Population-Based Cohort Study [J]. Ann Surg Oncol，2022，29：4393- 4404.
[5] Hata T，Ikeda M，Miyata H，et al. Frequency and risk factors for venous thromboembolism after gastroenterological surgery based on the Japanese National Clinical Database （516 217 cases） [J]. Ann Gastroenterol Surg，2019，3（5）：534-543.
[6] De Martino RR，Goodney PP，Spangler EL，et al. Variation in thromboembolic complications among patients undergoing commonly performed cancer operations [J]. J Vasc Surg，2012，55（4）：1035-1040.e4.
[7] Adiamah A，Ban L，West J，et al. The risk of venous thromboembolism after surgery for esophagogastric malignancy and the impact of chemotherapy：a population-based cohort study [J]. Dis Esophagus，2020，33（6）：doz079.
[8] Martin JT，Mahan AL，Ferraris VA，et al. Identifying Esophagectomy Patients at Risk for Predischarge Versus Postdischarge Venous Thromboembolism [J]. Ann Thorac Surg，2015，100（3）：932-938.
[9] Mantziari S，Gronnier C，Pasquer A，et al. Incidence and Risk Factors Related to Symptomatic Venous Thromboembolic Events After Esophagectomy for Cancer [J]. Ann Thorac Surg，2016，102（3）：979-984.
[10] Schulman S，Ageno W，Konstantinides SV. Venous thromboembolism：Past，present and future [J]. Thromb Haemost，2017，117（7）：1219-1229.
[11] 姚璜，魏守蓉，覃秀敏，等.食管癌合并静脉血栓栓塞临床特点分析[J].胃肠病学和肝病学杂志，2020，29（12）：1359-1363.
[12] Sanfilippo KM. Complementing venous thromboembolism，a risky move [J]. Blood，2021，138（21）：2018-2019.
[13] Adiamah A，Ban L，West J，et al. The risk of venous thromboembolism after surgery for esophagogastric malignancy and the impact of chemotherapy：a population-based cohort study [J]. Dis Esophagus，2020，33（6）：doz079.
[14] Kato F，Takeuchi H，Matsuda S，et al. Incidence of and risk factors for venous thromboembolism during surgical treatment for esophageal cancer：a single-institution study [J]. Surg Today，2016，46（4）：445-452.
[15] Key NS，Khorana AA，Kuderer NM，et al. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer：ASCO Clinical Practice Guideline Update [J]. J Clin Oncol，2020，38（5）：496-520.
[16] O’Connell C，Escalante CP，Goldhaber SZ，et al. Treatment of Cancer-Associated Venous Thromboembolism with Low-Molecular-Weight Heparin or Direct Oral Anticoagulants：Patient Selection，Controversies，and Caveats [J]. Oncologist，2021，26（1）：e8-e16.
[17] McBane RD，Wysokinski WE，Le-Rademacher JG，et al. Apixaban and dalteparin in active malignancy-associated venous thromboembolism：The ADAM VTE trial [J]. J Thromb Haemost，2020，18（2）：411-421.
[18] Ay C，Pabinger I，Cohen AT. Cancer-associated venous thromboembolism： Burden，mechanisms，and management [J]. Thromb Haemost，2017，117（2）：219-230.
[19] Lyman GH，Carrier M，Ay C，et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism： prevention and treatment in patients with cancer [J]. Blood Adv，2021，5（4）：927-974.
[20] Theochari NA，Theochari CA，Kokkinidis DG，et al. Venous thromboembolism after esophagectomy for cancer：a systematic review of the literature to evaluate incidence，risk factors，and prophylaxis [J]. Surg Today，2022，52（2）：171-181.
[21] Elsayed AS，Ozair S，Iqbal U，et al. Prevalence and Predictors of Venous Thromboembolism After Robot-Assisted Radical Cystectomy [J]. Urology，2021，149：146-153.
[22] Schlick C，Liu JY，Yang AD，et al. Pre-Operative，Intra- Operative，and Post-Operative Factors Associated with Post-Discharge Venous Thromboembolism Following Colorectal Cancer Resection [J]. J Gastrointest Surg，2020，24（1）：144-154.
[23] Hinton W，Nemeth B，de Lusignan S，et al. Effect of type 1 diabetes and type 2 diabetes on the risk of venous thromboembolism [J]. Diabet Med，2021，38（5）：e14452.
[24] Bell EJ，Folsom AR，Lutsey PL，et al. Diabetes mellitus and venous thromboembolism：A systematic review and meta- analysis [J]. Diabetes Res Clin Pract，2016，111：10-18.
[25] 崔松平，李辉，田博，等.肺癌术后静脉血栓栓塞症相关危险因素分析：单中心研究[J].中国肺癌杂志，2018，21（10）：753-760.
[26] 杨兴国，李辉，于磊，等.胸腺恶性肿瘤术后静脉血栓栓塞症的影响因素分析[J].中国肺癌杂志，2021，24（7）：497-502.
[27] Yang J，Zhang Y，Yang P，et al. A novel nomogram based on prognostic factors for predicting venous thrombosis risk in lymphoma patients [J]. Leuk Lymphoma，2021，62（10）：2383-2391.