Development and Validation of a Multi-parameter Nomogram for Venous Thromboembolism in Gastric Cancer Patients: a Retrospective Analysis

Overview

Journal PeerJ

Specialties Biology
Environmental Health
General Medicine

Date 2024 Jul 1

PMID 38948205

Authors

Hang Zhou

Haike Lei

Huai Zhao

Kaifeng Huang

Yundong Wang

Ruixia Hong

Jishun Huo

Li Luo

Fang Li

Affiliations

Soon will be listed here.

Abstract

Objective: Gastric cancer (GC), one of the highest venous thromboembolism (VTE) incidence rates in cancer, contributes to considerable morbidity, mortality, and, prominently, extra cost. However, up to now, there is not a high-quality VTE model to steadily predict the risk for VTE in China. Consequently, setting up a prediction model to predict the VTE risk is imperative.

Methods: Data from 3,092 patients from December 15, 2017, to December 31, 2022, were retrospectively analyzed. Multiple logistic regression analysis was performed to assess risk factors for GC, and a nomogram was constructed based on screened risk factors. A receiver operating curve (ROC) and calibration plot was created to evaluate the accuracy of the nomogram.

Results: The risk factors of suffering from VTE were older age (OR = 1.02, 95% CI [1.00-1.04]), Karnofsky Performance Status (KPS) ≥ 70 (OR = 0.45, 95% CI [0.25-0.83]), Blood transfusion (OR = 2.37, 95% CI [1.47-3.84]), advanced clinical stage (OR = 3.98, 95% CI [1.59-9.99]), central venous catheterization (CVC) (OR = 4.27, 95% CI [2.03-8.99]), operation (OR = 2.72, 95% CI [1.55-4.77]), fibrinogen degradation product (FDP) >5 µg/mL (OR = 1.92, 95% CI [1.13-3.25]), and D-dimer > 0.5 mg/L (OR = 2.50, 95% CI [1.19-5.28]). The area under the ROC curve (AUC) was 0.82 in the training set and 0.85 in the validation set.

Conclusion: Our prediction model can accurately predict the risk of the appearance of VTE in gastric cancer patients and can be used as a robust and efficient tool for evaluating the possibility of VTE.

Citing Articles

Application and progress of nomograms in gastric cancer.

Wang H, Ding Y, Zhuang M, Li K, Zhao S, Li D Front Med (Lausanne). 2025; 12:1510742.

PMID: 39944483 PMC: 11813919. DOI: 10.3389/fmed.2025.1510742.

References

Chi G, Gibson C, Liu Y, Hernandez A, Hull R, Cohen A . Inverse relationship of serum albumin to the risk of venous thromboembolism among acutely ill hospitalized patients: Analysis from the APEX trial. Am J Hematol. 2018; 94(1):21-28. DOI: 10.1002/ajh.25296. View

Gervaso L, Dave H, Khorana A . Venous and Arterial Thromboembolism in Patients With Cancer: : State-of-the-Art Review. JACC CardioOncol. 2021; 3(2):173-190. PMC: 8352228. DOI: 10.1016/j.jaccao.2021.03.001. View

Hammond J, Kozma C, Hart J, Nigam S, Daskiran M, Paris A . Rates of venous thromboembolism among patients with major surgery for cancer. Ann Surg Oncol. 2011; 18(12):3240-7. DOI: 10.1245/s10434-011-1723-2. View

Khorana A, DeSancho M, Liebman H, Rosovsky R, Connors J, Zwicker J . Prediction and Prevention of Cancer-Associated Thromboembolism. Oncologist. 2020; 26(1):e2-e7. PMC: 7794203. DOI: 10.1002/onco.13569. View

Lee K, Bang S, Kim S, Lee H, Shin D, Koh Y . The incidence, risk factors and prognostic implications of venous thromboembolism in patients with gastric cancer. J Thromb Haemost. 2009; 8(3):540-7. DOI: 10.1111/j.1538-7836.2009.03731.x. View

van Hylckama Vlieg A, Rosendaal F . High levels of fibrinogen are associated with the risk of deep venous thrombosis mainly in the elderly. J Thromb Haemost. 2003; 1(12):2677-8. DOI: 10.1111/j.1538-7836.2003.0543b.x. View

Donnellan E, Khorana A . Cancer and Venous Thromboembolic Disease: A Review. Oncologist. 2017; 22(2):199-207. PMC: 5330704. DOI: 10.1634/theoncologist.2016-0214. View

Kang M, Ryoo B, Ryu M, Koo D, Chang H, Lee J . Venous thromboembolism (VTE) in patients with advanced gastric cancer: an Asian experience. Eur J Cancer. 2011; 48(4):492-500. DOI: 10.1016/j.ejca.2011.11.016. View

Wada T, Fujiwara H, Morita S, Fukagawa T, Katai H . Incidence of and risk factors for preoperative deep venous thrombosis in patients undergoing gastric cancer surgery. Gastric Cancer. 2017; 20(5):872-877. DOI: 10.1007/s10120-017-0690-0. View

10.

Khan F, Tritschler T, Kahn S, Rodger M . Venous thromboembolism. Lancet. 2021; 398(10294):64-77. DOI: 10.1016/S0140-6736(20)32658-1. View

11.

Wang C, Kou H, Li X, Lan J . Association Between Preoperative Blood Transfusion and Postoperative Venous Thromboembolism: Review Meta-Analysis. Ann Vasc Surg. 2020; 73:463-472. DOI: 10.1016/j.avsg.2020.11.033. View

12.

Xenos E, Vargas H, Davenport D . Association of blood transfusion and venous thromboembolism after colorectal cancer resection. Thromb Res. 2011; 129(5):568-72. DOI: 10.1016/j.thromres.2011.07.047. View

13.

Kreuziger L, Edgren G, Hauser R, Zaccaro D, Kiss J, Westlake M . Red blood cell transfusion does not increase risk of venous or arterial thrombosis during hospitalization. Am J Hematol. 2020; 96(2):218-225. PMC: 8142264. DOI: 10.1002/ajh.26038. View

14.

Wanebo H, Kennedy B, CHMIEL J, Steele Jr G, Winchester D, Osteen R . Cancer of the stomach. A patient care study by the American College of Surgeons. Ann Surg. 1993; 218(5):583-92. PMC: 1243028. DOI: 10.1097/00000658-199321850-00002. View

15.

Moik F, Ay C, Pabinger I . Risk prediction for cancer-associated thrombosis in ambulatory patients with cancer: past, present and future. Thromb Res. 2020; 191 Suppl 1:S3-S11. DOI: 10.1016/S0049-3848(20)30389-3. View

16.

Kanias T, Lanteri M, Page G, Guo Y, Endres S, Stone M . Ethnicity, sex, and age are determinants of red blood cell storage and stress hemolysis: results of the REDS-III RBC-Omics study. Blood Adv. 2017; 1(15):1132-1141. PMC: 5638435. DOI: 10.1182/bloodadvances.2017004820. View

17.

Fuentes H, Oramas D, Paz L, Wang Y, Andrade X, Tafur A . Venous Thromboembolism Is an Independent Predictor of Mortality Among Patients with Gastric Cancer. J Gastrointest Cancer. 2017; 49(4):415-421. DOI: 10.1007/s12029-017-9981-2. View

18.

Streiff M, Holmstrom B, Angelini D, Ashrani A, Elshoury A, Fanikos J . Cancer-Associated Venous Thromboembolic Disease, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021; 19(10):1181-1201. DOI: 10.6004/jnccn.2021.0047. View

19.

Fuentes H, Paz L, Wang Y, Oramas D, Simons C, Tafur A . Performance of Current Thromboembolism Risk Assessment Tools in Patients With Gastric Cancer and Validity After First Treatment. Clin Appl Thromb Hemost. 2017; 24(5):790-796. PMC: 6714876. DOI: 10.1177/1076029617726599. View

20.

Lyman G, Culakova E, Poniewierski M, Kuderer N . Morbidity, mortality and costs associated with venous thromboembolism in hospitalized patients with cancer. Thromb Res. 2018; 164 Suppl 1:S112-S118. DOI: 10.1016/j.thromres.2018.01.028. View