Lin Qing, Wang Shi, Zhang Xiangmei, Luo Jie, Chen Lijun, Xu Bingrui, Wang Shuqian
The First Department of Thoracic Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, 361001, Fujian, China.
Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xiamen University，School of Medicine, Xiamen University, Xiamen, 361001, Fujian, China.
BMC Surg. 2025 Aug 9;25(1):357. doi: 10.1186/s12893-025-03080-8.
To develop and validate a risk prediction model for postoperative venous thromboembolism (VTE) in elderly patients (≥ 60 years old) with lung cancer using internal and external datasets, providing a reference for clinical prevention and management.
A retrospective analysis was conducted on 320 elderly lung cancer patients who underwent surgery at our hospital between January 2023 and May 2024. Patients were categorized into a VTE group (55 cases) and a non-VTE group (265 cases) based on the occurrence of VTE within six months postoperatively. An additional 60 elderly lung cancer patients who underwent surgery between June and November 2024 were selected for external validation. General clinical characteristics were compared between the two groups, and risk factors for postoperative VTE were analyzed to construct and validate the predictive model.
The incidence of postoperative VTE was 17.19% (55/320). Compared with the non-VTE group, the VTE group had a significantly higher proportion of patients with a history of smoking, alcohol consumption, hypertension, extremely high-risk Caprini scores, surgical duration ≥ 120 min, open surgery, clinical stage III-IV disease, preoperative chemotherapy, positive D-dimer (D-D) >3.64 mg/L, and elevated C-reactive protein (CRP) levels (P < 0.05). Multivariate analysis identified extremely high-risk Caprini scores, surgical duration ≥ 120 min, open surgery, clinical stage III-IV disease, preoperative chemotherapy, positive D-D>3.64 mg/L, and elevated CRP levels as independent risk factors for postoperative VTE (P < 0.05). Receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) demonstrated that the model had excellent discrimination, accuracy, and predictive performance.
The incidence of postoperative VTE in elderly lung cancer patients is relatively high. Key risk factors include an extremely high-risk Caprini score, surgical duration ≥ 120 min, open surgery, clinical stage III-IV disease, preoperative chemotherapy, positive D-D>3.64 mg/L, and elevated CRP levels. The nomogram-based risk prediction model developed in this study exhibits high discrimination and accuracy, with good predictive ability and clinical utility, providing a basis for targeted prevention and management strategies.
利用内部和外部数据集开发并验证老年（≥60岁）肺癌患者术后静脉血栓栓塞症（VTE）的风险预测模型，为临床预防和管理提供参考。
对2023年1月至2024年5月在我院接受手术的320例老年肺癌患者进行回顾性分析。根据术后6个月内VTE的发生情况，将患者分为VTE组（55例）和非VTE组（265例）。另外选取2024年6月至11月接受手术的60例老年肺癌患者进行外部验证。比较两组患者的一般临床特征，分析术后VTE的危险因素，构建并验证预测模型。
术后VTE发生率为17.19%（55/320）。与非VTE组相比，VTE组患者中有吸烟史、饮酒史、高血压、Caprini评分极高危、手术时长≥120分钟、开放手术、临床分期为III-IV期疾病、术前化疗、D-二聚体（D-D）阳性>3.64mg/L以及C反应蛋白（CRP）水平升高的比例显著更高（P<0.05）。多因素分析确定Caprini评分极高危、手术时长≥120分钟、开放手术、临床分期为III-IV期疾病、术前化疗、D-D阳性>3.64mg/L以及CRP水平升高是术后VTE的独立危险因素（P<0.05）。受试者工作特征（ROC）曲线、校准曲线和决策曲线分析（DCA）表明该模型具有出色的区分度、准确性和预测性能。
老年肺癌患者术后VTE发生率较高。关键危险因素包括Caprini评分极高危、手术时长≥120分钟、开放手术、临床分期为III-IV期疾病、术前化疗、D-D阳性>3.64mg/L以及CRP水平升高。本研究开发的基于列线图的风险预测模型具有较高的区分度和准确性，具有良好的预测能力和临床实用性，为针对性的预防和管理策略提供了依据。
