Clinical significance of glycemic parameters on venous thromboembolism risk prediction in gastrointestinal cancer

摘要

AIM To investigate the possible predictive role of routinely used glycemic parameters for a first venous thromboembolism(VTE) episode in gastrointestinal(GI) cancer ambulatory patients-with or without clinically diagnosed type 2 diabetes(T2D) or obesity-treated with chemotherapy.METHODS Pre-treatment fasting blood glucose,insulin,glycated hemoglobin(Hb A1c) and homeostasis model of risk assessment(HOMA) were retrospectively evaluated in a cohort study of 342 GI cancer patients. Surgery was performed in 142(42%) patients with primary cancer,30(21%) and 112(79%) of whom received neoadjuvant and adjuvant therapies,respectively. Firstline chemotherapy was administered in 200(58%) patients with metastatic disease. The study outcome was defined as the occurrence of a first symptomatic or asymptomatic VTE episode during active treatment.RESULTS Impaired glucose tolerance(IGT) or T2 D were diagnosed in 30% of GI cancer patients,while overweight/obesity had an incidence of 41%. VTE occurred in 9.4% of patients(7% of non-diabetic non-obese),especially in those with a high ECOG score(P = 0.025). No significant association was found between VTE incidence and T2 D,obesity,different tumor types,metastatic disease,Khorana class of risk,or different anti-cancer drugs,although VTE rates were substantially higher in patients receiving bevacizumab(17% vs 8%,P = 0.044). Conversely,all glucose metabolic indexes were associated with increased VTE risk at ROC analysis. Multivariate Cox proportional analyses confirmed that HOMA index(HR = 4.13,95%CI: 1.63-10.5) or fasting blood glucose(HR = 3.56,95%CI: 1.51-8.39) were independent predictors of VTE occurrence during chemotherapy.CONCLUSION The results here reported demonstrate that evaluating glucose metabolic asset may allow for VTE risk stratification in GI cancer,helping to identify chemotherapy-treated patients who might benefit from thromboprophylaxis. Further multicenter prospective studies involving a larger number of patients are presently needed.