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

作     者：Fiorella Guadagni Silvia Riondino Vincenzo Formica Girolamo Del Monte Anna Maria Morelli Jessica Lucchetti Antonella Spila Roberta D’Alessandro David Della-Morte Patrizia Ferroni Mario Roselli 

作者机构：San Raffaele Roma Open University Interinstitutional Multidisciplinary BiobankIRCCS San Raffaele Pisana Department of Systems MedicineMedical Oncology UnitTor Vergata Clinical CenterUniversity of Rome Tor Vergata Department of Palliative CareSan Raffaele CassinoClinical Center Department of Systems MedicineUniversity of Rome Tor Vergata 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2017年第23卷第28期

页      面：5187-5195页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Gastrointestinal cancer Type 2 diabetes Venous thromboembolism Chemotherapy Insulin resistance 

摘      要：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 ***-treatment fasting blood glucose, insulin, glycated hemoglobin (HbA1c) 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. First-line 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 *** glucose tolerance (IGT) or T2D 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 T2D, 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 *** 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 involv