直肠癌完全植入式中心静脉输液港血栓形成的危险因素分析

Analysis of Risk Factors for Thrombosis in Totally Implantable Venous Access Ports in Colorectal Cancer Patients

摘要

目的:探讨结直肠癌患者使用完全植入式中心静脉输液港(TIVAP)发生导管相关性血栓(CRT)的危险因素。方法:回顾性分析2020年1月—2023年8月于广西医科大学附属肿瘤医院胃肠外科行输液港植入的125例结直肠癌患者,根据颈部血管彩色多普勒超声检查结果分为血栓组(n=17)与非血栓组(n=108)。纳入单因素分析中有统计学意义的指标进行多因素Logistic回归分析及受试者工作特征(ROC)曲线分析。结果:125例结直肠癌TIVPA患者中17例发生CRT(13.60%)。单因素分析结果显示,血栓组的美国东部肿瘤协作组(ECOG)体能状态评分、红细胞压积(HCT)及回肠造口比例均明显高于非血栓组(均P<0.05)。多因素Logistic分析进一步证实,ECOG评分升高(OR=2.678,95%CI:1.201,5.972)、HCT升高(OR=1.300,95%CI:1.121,1.506)和回肠造口(OR=4.082,95%CI:1.325,12.571)是CRT的独立危险因素。ROC曲线结果显示,ECOG评分升高、HCT升高和回肠造口曲线下面积(AUC)分别为0.768、0.815和0.638,联合预测的AUC为0.892,灵敏度为88.24%,特异度为83.33%。结论:ECOG评分升高、回肠造口及HCT升高是结直肠癌患者行TIVAP发生CRT的独立危险因素。

Abstract

Objective: To investigate the risk factors for catheter-related thrombosis (CRT) in colorectal cancer patients with totally implantable venous access ports (TIVAP). Methods: A retrospective analysis was conducted on 125 colorectal cancer patients who underwent TIVAP implantation in the department of gastrointestinal surgery at the Guangxi Medical University Cancer Hospital between January 2020 and August 2023. According to the results of color Doppler ultrasound examination of cervical vessels,patients were divided into the thrombosis group (n =17) and the non-thrombosis group (n =108). Indicators with statistical significance in univariate analysis were included in multivariate Logistic regression analysis and receiver operator characteristic (ROC) curve analysis. Results: Among the 125 colorectal cancer patients with TIVPA, 17 developed CRT (13.60%). Univariate analysis showed that the Eastern Cooperative Oncology Group (ECOG) performance status score, hematocrit (HCT), and proportion of ileostomy in the thrombosis group were significantly higher than those in the non-thrombosis group (all P<0.05). Multivariate Logistic regression analysis further confirmed that elevated ECOG score(OR=2.678,95%CI:1.201,5.972), elevated HCT (OR =1.300,95%CI:1.121,1.506), and ileostomy(OR =4.082,95%CI:1.325,12.571)were independent risk factors for CRT. ROC curve results showed that the areas under the curve (AUC) for elevated ECOG score, elevated HCT, and ileostomy were 0.768, 0.815, and 0.638, respectively. The combined prediction AUC was 0.892, with a sensitivity of 88.24% and a specificity of 83.33%. Conclusion: Elevated ECOG score, ileostomy, and elevated HCT are independent risk factors for CRT in colorectal cancer patients undergoing TIVAP implantation.

关键词

结直肠癌 / 完全植入式中心静脉输液港 / 导管相关性血栓 / 回肠造口

Key words

colorectal cancer / totally implantable venous access port (TIVAP) / catheter-related thrombosis (CRT) / ileostomy

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基金资助

广西壮族自治区卫生厅健康委自筹科研项目(Z-A20230755)

广西壮族自治区卫生厅健康委自筹科研项目(Z-A20240711)