Abbas Lailatulema, Muhamad Nor Ibtisam, Ismail Fuad, Palaniappan Sivakumar, Chong Guang Yong, Wan Puteh Sharifa Ezat, Muhamad Jamil Siti Afiqah, Tumian Nor Rafeah
Clinical Haematology Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, 56000, Malaysia.
Hospital Canselor Tuanku Muhriz (HCTM), Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, 56000, Malaysia.
Thromb J. 2025 Mar 14;23(1):25. doi: 10.1186/s12959-025-00710-2.
Patients with solid organ cancers are at increased risk of developing cancer-associated thrombosis (CAT), a complication driven by a complex interplay of patient-specific factors, cancer characteristics, and treatment modalities. Data on CAT and its associated risk factors within diverse ethnic groups, such as the Malaysian population, remains limited. This observational, cohort study aimed to address this gap by determining the incidence of CAT and identifying associated risk factors among multi-ethnic Malaysian patients with solid organ cancers.
This study included solid organ cancer patients aged ≥ 18 who attended HCTM and HKL from May 2022 to August 2023. The baseline demographics, and clinical characteristics, were acquired at the cancer diagnosis. Data on cancer treatment, thrombotic events and anticoagulation therapy during the study and its treatment were documented. Multivariable logistic regression analysis was performed to determine the independent factors associated with CAT in solid organ cancer.
A total of 250 solid organ cancer patients were included, with a mean age of 57.7 (13.7) years. This multi-ethnic cohort consisted of mostly Malay patients (55.2%), followed by Chinese (33.2%) and Indian & others (11.6%). The prevalence of CAT at baseline was 4.8%, while the incidence of CAT during follow-up was 12%. Poor performance status and obesity were associated with CAT at baseline. Univariable logistic regression showed platelets ≥ 450 × 10/L and Khorana score ≥ 3 had significantly higher risks of CAT at baseline. Stage IV disease, radiotherapy and chemotherapy, namely platinum-based chemotherapy and antimetabolites were associated with CAT during follow-up. The ROC analysis showed that the KRS significantly predicted CAT (area under the curve, 0.701 (95%CI: 0.594-0.808, p = 0.001).
This study highlights the prevalence of CAT at baseline and the incidence of CAT during follow-up, similar to other studies. Patients' clinical characteristics were associated with CAT at baseline while disease and treatment factors were associated with CAT at follow-up. These findings emphasise the need for targeted thromboprophylaxis in high-risk populations and highlight the importance of risk stratification tools such as the Khorana score for optimal patient management. Future studies involving larger patient cohorts and longer study duration would be beneficial. These findings provide valuable insights to inform clinical decision-making, optimise patient outcomes, and minimise potential risks.
实体器官癌症患者发生癌症相关血栓形成（CAT）的风险增加，这是一种由患者特异性因素、癌症特征和治疗方式之间复杂相互作用驱动的并发症。关于不同种族群体（如马来西亚人群）中CAT及其相关危险因素的数据仍然有限。这项观察性队列研究旨在通过确定CAT的发病率并识别多民族马来西亚实体器官癌症患者中的相关危险因素来填补这一空白。
本研究纳入了2022年5月至2023年8月在马来西亚国立癌症研究所（HCTM）和吉隆坡医院（HKL）就诊的年龄≥18岁的实体器官癌症患者。在癌症诊断时获取基线人口统计学和临床特征。记录研究期间及其治疗过程中关于癌症治疗、血栓形成事件和抗凝治疗的数据。进行多变量逻辑回归分析以确定实体器官癌症中与CAT相关的独立因素。
共纳入250例实体器官癌症患者，平均年龄为57.7（13.7）岁。这个多民族队列主要由马来患者（55.2%）组成，其次是中国患者（33.2%）和印度及其他族裔患者（11.6%）。基线时CAT的患病率为4.8%，而随访期间CAT的发病率为12%。基线时，较差的体能状态和肥胖与CAT相关。单变量逻辑回归显示，基线时血小板≥450×10⁹/L和科纳纳评分≥3的患者发生CAT的风险显著更高。IV期疾病、放疗和化疗，即铂类化疗和抗代谢药物与随访期间的CAT相关。ROC分析显示，科纳纳风险评分（KRS）能显著预测CAT（曲线下面积，0.701（95%CI：0.594 - 0.808，p = 0.001）。
本研究突出了基线时CAT的患病率和随访期间CAT的发病率，与其他研究相似。患者的临床特征在基线时与CAT相关，而疾病和治疗因素在随访时与CAT相关。这些发现强调了在高危人群中进行针对性血栓预防的必要性，并突出了风险分层工具（如科纳纳评分）对优化患者管理的重要性。未来涉及更大患者队列和更长研究持续时间的研究将是有益的。这些发现为临床决策提供了有价值的见解，以优化患者结局并最小化潜在风险。
