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

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

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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 (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. 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 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 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.

Original languageEnglish (US)
Pages (from-to)5187-5195
Number of pages9
JournalWorld Journal of Gastroenterology
Volume23
Issue number28
DOIs
StatePublished - Jul 28 2017
Externally publishedYes

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Gastrointestinal Neoplasms
Venous Thromboembolism
Type 2 Diabetes Mellitus
Drug Therapy
Obesity
Blood Glucose
Fasting
Homeostasis
Glucose
Neoplasms
Neoadjuvant Therapy
Glucose Intolerance
Incidence
Glycosylated Hemoglobin A
ROC Curve
Multicenter Studies
Cohort Studies
Outcome Assessment (Health Care)
Prospective Studies
Insulin

Keywords

  • Chemotherapy
  • Gastrointestinal cancer
  • Insulin resistance
  • Type 2 Diabetes
  • Venous thromboembolism

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Guadagni, F., RionDino, S., Formica, V., Del Monte, G., Morelli, A. M., Lucchetti, J., ... Roselli, M. (2017). Clinical significance of glycemic parameters on venous thromboembolism risk preDiction in gastrointestinal cancer. World Journal of Gastroenterology, 23(28), 5187-5195. https://doi.org/10.3748/wjg.v23.i28.5187

Clinical significance of glycemic parameters on venous thromboembolism risk preDiction in gastrointestinal cancer. / Guadagni, Fiorella; RionDino, Silvia; Formica, Vincenzo; Del Monte, Girolamo; Morelli, Anna Maria; Lucchetti, Jessica; Spila, Antonella; D'Alessandro, Roberta; Della Morte, David; Ferroni, Patrizia; Roselli, Mario.

In: World Journal of Gastroenterology, Vol. 23, No. 28, 28.07.2017, p. 5187-5195.

Research output: Contribution to journalArticle

Guadagni, F, RionDino, S, Formica, V, Del Monte, G, Morelli, AM, Lucchetti, J, Spila, A, D'Alessandro, R, Della Morte, D, Ferroni, P & Roselli, M 2017, 'Clinical significance of glycemic parameters on venous thromboembolism risk preDiction in gastrointestinal cancer', World Journal of Gastroenterology, vol. 23, no. 28, pp. 5187-5195. https://doi.org/10.3748/wjg.v23.i28.5187
Guadagni, Fiorella ; RionDino, Silvia ; Formica, Vincenzo ; Del Monte, Girolamo ; Morelli, Anna Maria ; Lucchetti, Jessica ; Spila, Antonella ; D'Alessandro, Roberta ; Della Morte, David ; Ferroni, Patrizia ; Roselli, Mario. / Clinical significance of glycemic parameters on venous thromboembolism risk preDiction in gastrointestinal cancer. In: World Journal of Gastroenterology. 2017 ; Vol. 23, No. 28. pp. 5187-5195.
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abstract = "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 (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. 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 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 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.",
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AU - Morelli, Anna Maria

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AU - Spila, Antonella

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N2 - 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 (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. 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 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 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.

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