Risk Factors for Thromboembolic Events and Bleeding in Patients With Stomach Cancer: A Cohort Study

BACKGROUND: Stomach cancer is associated with systemic disturbances, including impaired hemostasis, which may result in thrombosis and bleeding, significantly affecting the prognosis, quality of life, and risk of fatal outcome.

AIM: The study aimed to identify risk factors for thrombosis and bleeding in patients with stomach cancer, assess the prognostic value of existing risk scores using a retrospective analysis of our own findings, and propose ways to improve them.

METHODS: The study analyzed medical records of 178 patients with stomach cancer who were treated at Sechenov University in 2021–2023. The medical records were grouped based on two independent variables: the presence of thromboembolic events (25 patients with and 150 patients without thromboembolic events) and the presence of bleeding (23 patients with and 155 patients without bleeding). The outcomes were assessed by examining imaging findings (ultrasound and computed tomography) specified in medical records, which allowed confirming or ruling out thromboembolic events, as well as initial examination findings and discharge summaries following hospitalization for chemotherapy. Qualitative variables are presented as mean ± standard deviation, whereas categorical variables are presented as absolute values and percentages. Intergroup differences were assessed using the Mann–Whitney and Pearson’s chi-squared tests. Significant associations for thromboembolic events and bleeding were identified using multivariate regression analysis. The prognostic value of scores was assessed using ROC analysis (AUC, sensitivity, specificity). SPSS 23.0 was used for statistical analysis.

RESULTS: Patients with chronic heart failure had an 11-fold greater risk of thromboembolic events than patients without chronic heart failure (odds ratio [OR] 11.12; 95% confidence interval [CI] 3.14–38.74; p = 0.001). Chronic kidney disease was associated with more than a 5-fold greater risk (OR 5.07; 95% CI 2.02–12.71; p = 0.002), and varicose veins with more than an 8-fold greater risk (OR 8.12; 95% CI 2.87–22.94; p = 0.001). Adding these factors to the Khorana score improved its prognostic value: in ROC analysis, AUC was 0.823 compared to 0.615 at baseline. This indicates a high discriminatory capability of the modified model (AUC > 0.8). The REACH score showed a high prognostic value for assessing the risk of bleeding (AUC = 0.738).

CONCLUSION: Adding chronic heart failure, chronic kidney disease, and varicose veins to the Khorana score improves its prognostic value for assessing the risk of thromboembolic events. The REACH score was effective in predicting the risk of bleeding.