Analysis of risk factors for deep vein thrombosis of lower extremity after thoracoscopic surgery for elderly lung cancer and establishment and validation of prediction model

doi:10.3760/cma.j.cn371439-20220621-00103

Abstract

Abstract:

Objective To analyze the risk factors of lower extremities deep vein thrombosis after thoracoscopic surgery in elderly patients with lung cancer, establish a nomogram prediction model and conduct internal verification. Methods A total of 183 elderly patients with lung cancer who underwent thoracoscopic radical resection in Nanchong Central Hospital from February 2018 to February 2022 were selected as the study subjects. According to the presence or absence of deep venous thrombosis of the lower extremities within one month after operation, the patients were divided into lower extremities deep venous thrombosis group （n=61） and non-deep lower extremities venous thrombosis group （n=122）. Univariate and multivariate analyses of deep venous thrombosis of lower extremities after thoracoscopic surgery for lung cancer in the elderly were performed, and a nomogram prediction model was constructed according to the multivariate analysis results, and the model was verified. Results There were statistically significant differences in smoking history （χ²=13.40, P<0.001）, preoperative chemotherapy （χ²=8.79, P=0.003）, surgical method （χ²=7.97, P=0.005）, operation time （t=7.23, P<0.001）, postoperative bed rest time （t=10.40, P<0.001）, combined with diabetes （χ²=6.37, P=0.012）, combined with hyperlipidemia （χ²=9.58, P=0.002）, preoperative D-dimer （t=13.08, P<0.001）, preoperative fibrinogen （t=5.84, P<0.001） and preoperative platelet count （t=7.01, P<0.001） between the lower extremity deep venous thrombosis group and the non-lower extremity deep venous thrombosis group. The results of multivariate logistic regression analysis showed that preoperative chemotherapy （OR=2.45, 95%CI： 1.05-5.71, P=0.038）, surgical method （OR=2.55, 95%CI： 1.14-5.73, P=0.023）, postoperative bed rest time （OR=1.50, 95%CI： 1.24-1.81, P<0.001）, combined with diabetes （OR=3.60, 95%CI： 1.05-12.33, P=0.042）, and preoperative D-dimer （OR=1.01, 95%CI： 1.01-1.01, P<0.001） were all independent risk factors for lower extremity deep vein thrombosis in elderly patients with lung cancer after thoracoscopic surgery. The C-index of nomogram for predicting lower extremity deep vein thrombosis-related factors was 0.86 （95%CI： 0.81-0.93）. The calibration curve showed that the model had a good correlation in predicting lower extremities deep venous thrombosis. Conclusion Preoperative chemotherapy, surgical method, postoperative bed rest time, combined with diabetes, and postoperative D-dimer level are influence factors for lower extremity deep vein thrombosis in elderly patients with lung cancer after thoracoscopic surgery. The nomogram prediction model established in this study has high accuracy and discrimination for the prediction of lower extremity deep vein thrombosis in elderly patients with lung cancer after thoracoscopic surgery.

Key words: Lung neoplasms, Aged, Thoracoscopy, Venous thrombosis, Risk factors

Yang Sha, Yang Xiaohua, Wang Suhua, Xue Xiaoyan, Xu Jun. Analysis of risk factors for deep vein thrombosis of lower extremity after thoracoscopic surgery for elderly lung cancer and establishment and validation of prediction model[J]. Journal of International Oncology, 2022, 49(9): 532-536.

Figures/Tables 4

References 18

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因素	下肢深静脉血栓组（n=61）	非下肢深静脉血栓组（n=122）	χ²/t值	P值
性别
男	35（57.38）	74（60.66）	0.18	0.670
女	26（42.62）	48（39.34）	0.18	0.670
年龄（岁）	67.81±9.03	69.54±10.16	-1.13	0.262
BMI（kg/m²）	22.03±4.71	21.85±5.03	0.23	0.816
吸烟史
无	18（29.51）	71（58.20）	13.40	<0.001
有	43（70.49）	51（41.80）	13.40	<0.001
病理类型
腺癌	19（31.15）	38（31.15）
鳞状细胞癌	40（65.57）	79（64.75）	0.08	0.963
其他	2（3.28）	5（4.10）
TNM分期
Ⅰ	24（39.34）	52（42.62）
Ⅱ	25（40.98）	45（36.89）	0.30	0.862
Ⅲ	12（19.67）	25（20.49）
术前化疗
无	34（55.74）	94（77.05）	8.79	0.003
有	27（44.26）	28（22.95）	8.79	0.003
手术方式
肺段切除	22（36.07）	71（58.20）	7.97	0.005
肺叶切除	39（63.93）	51（41.80）	7.97	0.005
术中出血量（ml）	250.11±68.01	237.13±71.35	1.18	0.240
手术时间（h）	3.35±0.97	2.41±0.75	7.23	<0.001
术后卧床时间（d）	4.81±1.35	3.11±0.83	10.40	<0.001
肺部感染
无	52（85.25）	107（87.70）	0.22	0.642
有	9（14.75）	15（12.30）	0.22	0.642
合并糖尿病
无	48（78.69）	112（91.80）	6.37	0.012
有	13（21.31）	10（8.20）	6.37	0.012
合并高脂血症
无	45（73.77）	111（90.98）	9.58	0.002
有	16（26.23）	11（9.02）	9.58	0.002
术前D-二聚体（mg/L）	631.08±95.11	451.03±83.96	13.08	<0.001
术前纤维蛋白原（g/L）	4.51±1.17	3.58±0.93	5.84	<0.001
术前血小板计数（×10⁹/L）	373.27±102.11	284.02±68.51	7.01	<0.001
术前白细胞计数（×10⁹/L）	11.03±2.51	10.81±2.36	0.58	0.561

变量	Β值	SE值	Wald值	OR值	95%CI	P值
常量	-6.98	1.04	44.86	0.01		<0.001
吸烟史	0.32	0.19	2.84	1.37	0.95~1.99	0.092
术前化疗	0.90	0.43	4.30	2.45	1.05~5.71	0.038
手术方式	0.94	0.41	5.16	2.55	1.14~5.73	0.023
手术时间	0.23	0.14	2.49	1.26	0.95 ~1.66	0.115
术后卧床时间	0.41	0.10	17.32	1.50	1.24~1.81	<0.001
合并糖尿病	1.28	0.63	4.15	3.60	1.05~12.33	0.042
合并高脂血症	0.46	0.25	3.44	1.59	0.97 ~2.59	0.064
术前D-二聚体	0.01	0.01	26.40	1.01	1.01~1.02	<0.001
术前纤维蛋白原	0.30	0.17	3.02	1.35	0.96 ~1.88	0.082
术前血小板计数	0.23	0.15	2.15	1.25	0.93 ~1.70	0.142