Risk Factors Analysis of Postoperative Venous Thromboembolism in Early Stage Cervical Carcinoma

doi:10.3877/cma.j.issn.1673-5250.2014.01.011

Objective

To explore the high risk factors of postoperative venous thromboembolism (VTE) among patients undergoing surgery for stageⅠA2-ⅡA cervical carcinoma, for distinguishing the high-risk patients and establishing preventive strategy.

Methods

From January 2010 to July 2013, a retrospective study was carried out in the 243 patients with stageⅠA2-ⅡA cervical carcinoma who underwent surgery. The high risk factors for postoperative VTE were investigated. Various clinic-pathologic variables were tested for an association with the development of postoperative VTE using standard statistical tests. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of The First Affiliated Hospital with Nanjing Medical University. Informed consent was obtained from each patients.

Results

The incidence rate of VTE was 7.8% (19/ 243) in the study．Multivariate logistic regression analysis indicated that elevated body mass index (BMI) [OR=1.23, 95% CI (1.08-1.47) , P=0.030], cigarette smoking[OR=2.42, 95 %CI(2.11-5.31) , P=0.010], a history of VTE [OR=6.49, 95%CI(1.23-26.16) , P=0.001]and cancer[OR=4.62, 95%CI(1.01-6.95) , P=0.000], and elevated levels of D-dimer on the 3rd day post-surgery [OR=2.99, 95%CI(1.27-4.22) , P=0.023] were independent risk factors for postoperative VTE.

Conclusions

Each patient with early stage cervical cancer before surgery should be assessed for postoperative thromboembolic risk according to the risk factors identified in this study. Prophylaxis therefore should be used to prevent postoperative VTE events.

Key words: Uterine cervical carcinoma, Venous thromboembolism, Risk factors

表1 术后VTE形成相关因素的单因素分析结果[n（％）]

Table 1 Univariate analysis for factors association with postoperative VTE[n（%）]

危险因素		VTE		P
危险因素		有	无	P
n		19	224
手术方式
	经腹手术	14(73.7)	177(78.1)	0.566
	经腹腔镜手术	5(26.3)	47 (1.9)
年龄(岁,±s)		45.2±9.0	46.6 ± 9.9	0.487
BMI(kg/m²,±s)		23.9±3.7	29.5±3.2	0.000
D-dimer (mg/L,±s)		0.5 ± 0.6	1.9±1.1	0.000
吸烟史		5 (5.3)	2 (0.9)	0.000
口服避孕药		2(10.5)	10 (4.5)	0.000
合并高血压		1 (5.3)	11 (4.9)	1.000
合并糖尿病		1 (5.3)	4 (1.8)	0.564
合并其他恶性肿瘤		5(26.3)	2 (0.9)	0.000
既往血栓史		1 (5.3)	1 (0.5)	0.003
术中出血量(mL,±s)		805 ± 568	615±363	0.352
手术时间(min,±s)		254± 40	273± 49	0.098
麻醉持续时间(min,±s)		328± 36	343± 51	0.092
腹主动脉旁淋巴结清扫		2(10.5)	9 (4.0)	0.025
输血量(mL,±s)		749 ± 687	528±561	0.107
临床分期
	Ⅰ_A2	2(10.5)	35(15.6)	0.915
	Ⅰ_B1	12(63.2)	119(53.1)
	Ⅰ_B2	1 (5.3)	22 (9.8)
	Ⅱ_A	4(21.0)	48(21.5)
淋巴转移		7(36.8)	37(16.5)	0.045
脉管内癌栓		13(68.4)	71(31.7)	0.002
术后LMWH使用		6(31.5)	78(34.8)	0.314
弹力袜使用		2(10.5)	29(11.6)	0.342
LMWH及弹力袜均使用		2(10.5)	21 (9.4)	0.297

表1 术后VTE形成相关因素的单因素分析结果[n（％）]

Table 1 Univariate analysis for factors association with postoperative VTE[n（%）]

危险因素		VTE		P
危险因素		有	无	P
n		19	224
手术方式
	经腹手术	14(73.7)	177(78.1)	0.566
	经腹腔镜手术	5(26.3)	47 (1.9)
年龄(岁,±s)		45.2±9.0	46.6 ± 9.9	0.487
BMI(kg/m²,±s)		23.9±3.7	29.5±3.2	0.000
D-dimer (mg/L,±s)		0.5 ± 0.6	1.9±1.1	0.000
吸烟史		5 (5.3)	2 (0.9)	0.000
口服避孕药		2(10.5)	10 (4.5)	0.000
合并高血压		1 (5.3)	11 (4.9)	1.000
合并糖尿病		1 (5.3)	4 (1.8)	0.564
合并其他恶性肿瘤		5(26.3)	2 (0.9)	0.000
既往血栓史		1 (5.3)	1 (0.5)	0.003
术中出血量(mL,±s)		805 ± 568	615±363	0.352
手术时间(min,±s)		254± 40	273± 49	0.098
麻醉持续时间(min,±s)		328± 36	343± 51	0.092
腹主动脉旁淋巴结清扫		2(10.5)	9 (4.0)	0.025
输血量(mL,±s)		749 ± 687	528±561	0.107
临床分期
	Ⅰ_A2	2(10.5)	35(15.6)	0.915
	Ⅰ_B1	12(63.2)	119(53.1)
	Ⅰ_B2	1 (5.3)	22 (9.8)
	Ⅱ_A	4(21.0)	48(21.5)
淋巴转移		7(36.8)	37(16.5)	0.045
脉管内癌栓		13(68.4)	71(31.7)	0.002
术后LMWH使用		6(31.5)	78(34.8)	0.314
弹力袜使用		2(10.5)	29(11.6)	0.342
LMWH及弹力袜均使用		2(10.5)	21 (9.4)	0.297

表2 术后VTE形成危险因素的多因素非条件logistic回归分析结果

Table 2 Multivariate unconditional logistic regression analysis for factors association with postoperative VT E

危险因素	B	OR	95%CI	P
BMI	0.165	1.23	1.08 ?1.47	0.030
吸烟	0.882	2.42	2.11 ?5.31	0.010
合并其他恶性肿瘤	2.117	6.49	1.23?26.16	0.001
既往血栓史	1.634	4.62	1.01 ?6.95	0.000
D-dimer	1.069	2.99	1.27~ 4.22	0.023

表2 术后VTE形成危险因素的多因素非条件logistic回归分析结果

Table 2 Multivariate unconditional logistic regression analysis for factors association with postoperative VT E

危险因素	B	OR	95%CI	P
BMI	0.165	1.23	1.08 ?1.47	0.030
吸烟	0.882	2.42	2.11 ?5.31	0.010
合并其他恶性肿瘤	2.117	6.49	1.23?26.16	0.001
既往血栓史	1.634	4.62	1.01 ?6.95	0.000
D-dimer	1.069	2.99	1.27~ 4.22	0.023

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