Hayashida Kenta, Kawabata Yusuke, Saito Keiju, Fujita Shintaro, Choe Hyonmin, Kato Ikuma, Takeyama Masanobu, Inaba Yutaka
Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Department of Molecular Pathology, Yokohama City University, Yokohama, Japan.
Thromb J. 2022 Apr 26;20(1):22. doi: 10.1186/s12959-022-00382-2.
Venous thromboembolism (VTE) is a major complication in patients with malignant tumors and orthopedic disorders. Although it is known that patients undergoing surgery for malignant musculoskeletal tumor are at an increased risk of thromboembolic events, only few studies have investigated this risk in detail. Therefore, the aim of this study was to determine the prevalence and risk factors for preoperative VTE in malignant musculoskeletal tumors patients.
We retrospectively reviewed the medical records of 270 patients who underwent surgical procedures, including biopsy for malignant musculoskeletal tumor, have undergone measurements of preoperative D-dimer levels, and were subsequently screened for VTE by lower extremity venous ultrasonography and/or contrast-enhanced computed tomography scans. Statistical analyses were performed to examine the prevalence and risk factors for VTE. Receiver operating characteristic (ROC) analysis was performed to verify the D-dimer cutoff value for the diagnosis of VTE.
Overall, 199 patients (103 with primary soft tissue sarcomas, 38 with primary bone sarcomas, 46 with metastatic tumors, and 12 with hematologic malignancies) were included. D-dimer levels were high in 79 patients; VTE was detected in 19 patients (9.5%). Multivariate analysis indicated that age ≥ 60 years (P = 0.021) and tumor location in the lower limbs (P = 0.048) were independent risk factors for VTE. ROC analysis showed that the D-dimer cutoff value for the diagnosis of VTE was 1.53 µg/mL; the sensitivity and specificity were 89.5% and 79.4%, respectively.
Our study indicated that age and tumor location in the lower limbs were independent risk factors for preoperative VTE in malignant musculoskeletal tumors patients. D-dimer levels were not associated with VTE in the multivariate analysis, likely because they are affected by a wide variety of conditions, such as malignancy and aging. D-dimer is useful for exclusion diagnosis because of its high sensitivity, but patients with high age and tumor location in the lower limbs are a high-risk group and should be considered for imaging evaluation such as ultrasonography regardless of D-dimer levels.
Our study was approved by the institutional review board. The registration number is B200600056 . The registration date was July 13, 2020.
静脉血栓栓塞症（VTE）是恶性肿瘤和骨科疾病患者的主要并发症。尽管已知接受恶性肌肉骨骼肿瘤手术的患者发生血栓栓塞事件的风险增加，但仅有少数研究对此风险进行了详细调查。因此，本研究的目的是确定恶性肌肉骨骼肿瘤患者术前VTE的患病率和危险因素。
我们回顾性分析了270例接受手术治疗的患者的病历，这些手术包括恶性肌肉骨骼肿瘤活检，术前进行了D - 二聚体水平测量，随后通过下肢静脉超声和/或增强CT扫描筛查VTE。进行统计分析以检查VTE的患病率和危险因素。采用受试者工作特征（ROC）分析来验证诊断VTE的D - 二聚体临界值。
总共纳入了199例患者（103例原发性软组织肉瘤、38例原发性骨肉瘤、46例转移性肿瘤和12例血液系统恶性肿瘤）。79例患者D - 二聚体水平升高；19例患者（9.5%）检测到VTE。多因素分析表明，年龄≥60岁（P = 0.021）和肿瘤位于下肢（P = 0.048）是VTE的独立危险因素。ROC分析显示，诊断VTE的D - 二聚体临界值为1.53μg/mL；敏感性和特异性分别为89.5%和79.4%。
我们的研究表明，年龄和肿瘤位于下肢是恶性肌肉骨骼肿瘤患者术前VTE的独立危险因素。多因素分析中D - 二聚体水平与VTE无关，可能是因为它们受到多种因素影响，如恶性肿瘤和衰老。由于D - 二聚体敏感性高，对排除诊断有用，但年龄较大且肿瘤位于下肢的患者是高危人群，无论D - 二聚体水平如何，都应考虑进行超声等影像学评估。
我们的研究经机构审查委员会批准。注册号为B200600056。注册日期为2020年7月13日。
