Risk prediction of venous thromboembolism associated with gynaecologic cancer on the basis of the COMPASS-CAT risk assessment model
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摘要:
目的 探讨COMPASS-CAT模型以及新模型对妇科恶性肿瘤相关静脉血栓形成的风险预测价值。 方法 纳入2015年1月—2020年6月在湖南省肿瘤医院住院治疗并发静脉血栓栓塞症(VTE)的妇科恶性肿瘤患者161例，根据时间配对1 ∶ 2抽取对照组322例。收集2组患者临床资料，分析妇科恶性肿瘤相关VTE的危险因素，构建新模型并绘制受试者工作特征(ROC)曲线，与原COMPASS-CAT模型进行比较。 结果 2组患者在年龄、肿瘤分期、高血压、高血脂、糖尿病、绝经状态、VTE既往史、输血史、中心静脉导管、化学治疗、血小板计数和D-2聚体的比较，差异有统计学意义(均P < 0.05)；多因素分析显示处于绝经状态、有输血史、接受化学治疗和D-2聚体≥0.55 μg/mL均为妇科恶性肿瘤相关VTE的独立危险因素(均P < 0.05)。新模型的灵敏度为75.8%，特异度为67.7%，约登指数为0.435。2种模型的ROC曲线下面积(AUC)分别为0.698(95% CI：0.647~0.750)和0.768(95% CI：0.723~0.813)，与COMPASS-CAT模型比较，新模型AUC面积增加0.07(P < 0.001)。 结论 构建的新COMPASS-CAT血栓风险评估模型对妇科恶性肿瘤相关VTE形成的风险预测水平较高，提高了识别血栓发生高风险患者的准确性。 -
关键词:
- 妇科恶性肿瘤 /
- 静脉血栓栓塞症 /
- COMPASS-CAT血栓风险评估模型 /
- 预测
Abstract:Objective To explore the value of the COMPASS-CAT model and new model in predicting the risk of venous thrombosis associated with gynaecological malignancies. Methods From January 2015 to June 2020, 161 patients with gynaecological malignancies who were hospitalised with venous thromboembolism (VTE) in Hunan Cancer Hospital were enrolled. A total of 322 patients in the control group were selected according to the time matching 1 ∶ 2. The clinical data of the two groups of patients were collected. The risk factors of VTE related to gynaecological malignancies were analysed. A new model was constructed, and the receiver operating characteristic (ROC) curve was drawn and compared with the original COMPASS-CAT assessment model. Results The comparison between the two groups of patients in age, tumour stage, hypertension, hyperlipidaemia, diabetes, menopausal status, history of VTE, history of blood transfusion, central venous catheter, chemotherapy, platelet count and D-dimer showed statistically significant differences (all P < 0.05). Multivariate analysis showed that menopausal status, history of blood transfusion, chemotherapy and D-dimer≥0.55 μg/mL are independent risk factors for VTE related to gynaecological malignancies (all P < 0.05). The sensitivity of the new model was 75.8%, the specificity was 67.7%, and the Youden index was 0.435. The areas under the ROC curve (AUCs) of the two models were 0.698 (95% CI: 0.647-0.750) and 0.768 (95% CI: 0.723-0.813). Compared with the COMPASS-CAT model, the AUC area of the new model increased by 0.07 (P < 0.001). Conclusion The newly constructed COMPASS-CAT thrombosis risk assessment model has a high level of risk prediction for the formation of VTE related to gynaecological malignancies and improves the accuracy of identifying patients at high risk of thrombosis. -
表 1 妇科肿瘤患者VTE单因素分析
项目 类别 VTE组
(n=161)对照组
(n=322)统计量 P值 年龄(x±s，岁) 52.80±8.62 49.31±9.71 3.863a ＜0.001 BMI(例) ＜30 151 309 1.118b 0.290 ≥30 10 13 肿瘤类型(例) 子宫颈癌 89 200 8.123b 0.087 卵巢癌 41 67 子宫内膜癌 25 47 外阴癌 3 8 输卵管癌 3 0 肿瘤分期(例) Ⅰ~Ⅱ期 97 229 5.780b 0.016 Ⅲ~Ⅳ期 64 93 高血压(例) 有 36 27 18.482b ＜0.001 无 125 295 高血脂(例) 有 14 11 6.096b 0.014 无 147 311 糖尿病(例) 有 27 7 34.945b ＜0.001 无 134 315 冠心病(例) 有 7 5 3.461b 0.063 无 154 317 饮酒史(例) 有 3 6 0.124b 0.725 无 158 315 绝经状态(例) 有 109 146 21.533b ＜0.001 无 52 176 VTE既往史(例) 有 5 0 7.300b 0.007 无 156 322 手术史(例) 有 142 300 3.412b 0.065 无 19 22 输血史(例) 有 57 69 10.872b 0.001 无 104 253 中心静脉导管(例) 有 72 98 9.604b 0.002 无 89 224 化学治疗(例) 有 147 264 7.345b 0.007 无 14 58 放射治疗(例) 有 47 87 0.253b 0.615 无 114 235 血小板计数(例) ＜350×109/L 126 293 15.139b ＜0.001 ≥350×109/L 35 29 D-2聚体(例) ＜0.55 μg/mL 81 235 24.387b ＜0.001 ≥0.55 μg/mL 80 87 注：a为t值，b为χ2值。 
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表 2 妇科恶性肿瘤相关VTE影响因素logistic回归分析变量赋值方法
变量 赋值方法 VTE发生 无=0，有=1 年龄 ＜50岁=0，≥50岁=1 肿瘤分期 Ⅰ~Ⅱ期=0，Ⅲ~Ⅳ期=1 高血压 无=0，有=1 高脂血症 无=0，有=1 糖尿病 无=0，有=1 绝经状态 无=0，有=1 VTE既往史 无=0，有=1 输血史 无=0，有=1 中心静脉导管 无=0，有=1 化学治疗 无=0，有=1 血小板计数 ＜300×109/L=0，≥300×109/L=1 D-2聚体 ＜0.55 μg/mL=0，≥0.55 μg/mL=1 COMPASS-CAT得分 ＜7分=0，≥7分=1
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表 3 妇科恶性肿瘤相关VTE影响因素的多因素logistic回归分析
项目 B SE Wald χ2 P值 OR值 95% CI 绝经状态(是) 0.635 0.250 13.422 0.011 1.887 1.156~3.079 输血史(是) 0.955 0.278 8.247 0.001 2.599 1.506~4.484 化学治疗(是) 1.298 0.402 10.446 0.001 3.662 1.667~8.044 血小板计数(≥300×109/L) 1.074 0.270 9.363 0.000 2.926 1.724~4.965 D-2聚体(≥0.55 μg/mL) 0.568 0.250 5.171 0.023 1.764 1.082~2.878 COMPASS-CAT得分≥7分 0.842 0.344 6.009 0.014 2.322 1.184~4.555
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