Exploration of high-risk factors for pulmonary embolism in patients undergoing postoperative anti-thrombotic therapy among gynecologic oncology surgery: a retrospective study

Pulmonary embolism in patients with cancer: An updated and operative guide for diagnosis and management

Cancer-associated venous thromboembolism (VTE) is a leading cause of morbidity and mortality in patients with cancer. Appropriate risk stratification for primary and secondary VTE prevention as well as for risk of early death in acute setting is needed for an adequate treatment. Despite enormous advances have been made in the management of VTE in the last two decades, optimal medical therapy remains a major concern due to still high incidence of both symptomatic and incidental pulmonary embolism (PE), its recurrence, poor survival rate, bleeding risk and multiple drugs interactions. Novel oral anticoagulants (NOACs) simplified the treatment of VTE as compared to low-molecular-weight heparin (LMWH) due to their oral administration, fixed dose regimens and lower cost. However, their prescription requires extra caution, especially in patients with gastrointestinal malignancies. Lastly, data on reperfusion approaches remain confined to case series and subgroups analysis. The aim of this review is to summarize recent knowledge concerning PE in patients with malignancies, focusing on available treatments and decision making.

A Prognostic Scoring System for Predicting Overall Survival of Patients with the TNM 8th Edition Stage I and II Hepatocellular Carcinoma After Surgery: A Population-Based Study

Purpose

Postoperative prognosis prediction models for patients with stage Ⅰ and Ⅱ hepatocellular carcinoma (HCC) according to the 8th edition of the Tumor-Node-Metastasis staging system after surgery are rare. This study aimed to build a prognostic score to predict survival outcomes and stratify these patients into different prognostic strata.

Patients and Methods

We developed a web-based nomogram that incorporated four selected risk factors based on the multivariate Cox regression, using a training set (n=3567) from the Surveillance, Epidemiology, and End Results (SEER) database. It was validated with an independent internal set from the SEER database (n=1783) and an external validation set of 516 Chinese patients. The predictive performance and discrimination ability of our model were further evaluated and compared with those of the conventional HCC staging systems.

Results

Our nomogram consistently outperformed the conventional staging systems in the training, internal validation set, and external validation set. We quantified the nomogram model into a numerical SNIG (an abbreviation of the incorporated variables – size, number, MVI, and grade) score by summing the points assigned to each incorporated variable, leading to the optimal cut-off values of 6 and 10, which could stratify patients into 3 categories (SNIG score <6, 6–10, ≥10). This yielded significantly different median overall survivals (interquartile ranges) of 42.0 (20.0–72.0) and 37.0 (17.0–67.0); 28.0 (12.0–60.0) and 42.0 (21.75–82.0); 40.0 (18.0–70.0) and 29.0 (11.5–61.0) months for the 3 categories in the entire SEER and external validation sets, respectively.

Conclusion

We developed a web-based SNIG model to graphically and numerically predict the overall survival of stage Ⅰ and Ⅱ HCC. This scoring system may shed light on risk stratification for these patients in clinical practice and clinical trials.

The risk factors for perioperative venous thromboembolism in patients with gynecological malignancies: A meta-analysis

OBJECTIVE

This meta-analysis aimed to identify the risk factors for venous thromboembolism (VTE) in patients with gynecological malignancy during the perioperative period.

METHODS

Studies on the risk factors for VTE in patients with gynecological malignancy during the perioperative period were collected from the Cochrane Library, MEDLINE, EMBASE, Web of Science, EBSCO, and several Chinese databases (from inception to September 2019). Two reviewers independently performed article screening, data extraction, and study quality evaluation. Review Manager 5.3 software was used for data analysis.

RESULTS

A total of 9555 articles were initially retrieved, including 7498 in Chinese and 1987 in English, and 22 articles were finally included, which were published from 2011 to 2019. The quality scores of the included studies ranged from 5 to 9, suggesting a relatively high quality. A total of 16,318 patients were included for analysis, 922 in the VTE group and 15,396 in the non-VTE group. A total of 20 risk factors related to surgery or with inconsistent conclusions in the current studies were pooled, and the results showed that age, body mass index (BMI > 26 kg/m²), platelet count, D-dimer, duration of surgery, postoperative days in bed, length of hospital stay, intraoperative blood loss, tumor differentiation (GREAD3), tumor staging (stage IV), and operative approach (laparotomy versus laparoscopy) were significant risk factors for VTE in patients with gynecological malignancy during the perioperative period.

CONCLUSION

It is important to develop targeted prevention and treatment strategies against these risk factors to reduce the occurrence of VTE in patients with gynecological malignancy during the perioperative period.

Analysis on risk factors of lung cancer complicated with pulmonary embolism

INTRODUCTION

Pulmonary embolism (PE) is a potentially fatal complication and its morbidity together with fatalness will further increase when in patients with malignant tumors. Fast and accurate early diagnosis of PE thus seems considerably important.

OBJECTIVE

To explore the risk factors of lung cancer complicated with PE.

MATERIALS AND METHODS

A retrospective cohort study consisted of 40 lung cancer patients with PE (PE group) and 60 lung cancer patients without PE (non-PE group) were analyzed.

RESULTS

The white blood cell (WBC) count, D-dimer and low-density lipoprotein (LDL) were higher in PE group than those in non-PE group (P < 0.05), whereas the arterial partial pressure of oxygen (PaO₂ ) in PE group was lower than that in non-PE group (P < 0.05). Carcinoembryonic antigen (CEA) level between two groups also exhibited statistical difference (P < 0.05). Those lung adenocarcinoma patients with stages III and IV tumor, coupled with deep venous thrombosis (DVT), having experienced bevacizumab treatment or platinum-based chemotherapy more likely suffered from PE (P < 0.05). The multivariate analysis revealed that high D-dimer, chemotherapy, DVT, stages III to IV, adenocarcinoma were independent risk factors associated with PE (P < 0.05). The overall survival time of patients in case group was significantly shorter than that in the control group with a median survival duration being 10.5 months (95%CI, 8.95-12.05) and 16.8 months (95%CI, 14.62-18.98), respectively, (P < 0.01).

CONCLUSIONS

High D-dimer, chemotherapy, DVT, stages III to IV and adenocarcinoma might have a positive correlation with PE, meanwhile, PE always predicted a poor prognosis in lung cancer patients.