Abstract
Limited risk assessment tool to stratify the risk of PICC-related thrombosis (PICC-RVT) in breast cancer patients. This study developed a model to assess the risk of PICC-RVT in breast cancer patients. We conducted a retrospective cohort study of 1284 breast cancer patients receiving PICC insertion from January 1, 2015, to August 31, 2019, at a cancer specialized hospital in Hunan province, China. The entire population was divided into two groups at a ratio of 3:1 which included a derivation sample (n = 978), and a validation sample (n = 284). PICC-RVT was confirmed by ultrasonography in the presence of clinical symptoms and signs. PICC-RVT occurred in 40 (4.09%) of the derivation sample patients. Multivariable analysis identified 9 variables: chronic obstructive pulmonary disease, prior central venous catheter placement, higher level of platelets, higher level of D-dimer, lower level of activated partial thromboplastin time, menopause, no prior breast surgery, upper extremity lymphedema, and endocrine therapy. Points were assigned to each variable according to regression coefficient. The model had an area under the receiver operating characteristics curve (AUC) of 0.850 (95% CI 0.776 to 0.924), The Hosmer-Lemeshow goodness-of-fit was 5.780 (p = 0.328). At a cutoff value of 3.5, the sensitivity and specificity were 75% and 83%, respectively. Several disease-specific factors of breast cancer (e.g., menopause, endocrine therapy, and upper extremity lymphedema) play important roles in the development of PICC-RVT. Patients at higher PICC-RVT risk could be candidates for close post-insertion monitoring and interventions to prevent PICC-RVT.
Highlights
Breast cancer is the most common cancer in female patients [1]
Inserted central venous catheter (PICC) is a kind of catheter inserted from peripheral vein such as basilica or brachial vein to central venous, which can effectively prevent the extravasation of chemotherapy drugs, and provide a safe ‘life access’ for breast cancer patients[3]
The variables indentified as being important predictors for Peripherally inserted central venous catheter (PICC)-RVT in breast cancer patients included: COPD, history of CVC, PLT level, APTT level, D-dimer level, menopause, breast surgery, upper limb lymphedema, endocrine therapy, all of which were objectively measurable, and the last four variables were the specific characteristic for breast cancer
Summary
Breast cancer is the most common cancer in female patients [1]. With the development of medical service, the 5-year survival rate of breast cancer is as high as 90.9%. [2] Chemotherapy is one of the main treatment methods for breast cancer. Inserted central venous catheter (PICC) is a kind of catheter inserted from peripheral vein such as basilica or brachial vein to central venous, which can effectively prevent the extravasation of chemotherapy drugs, and provide a safe ‘life access’ for breast cancer patients[3]. Despite these advantages, the application of PICC can cause some catheter-related complications, among which PICC-related thrombosis (PICC-RVT) has been the most common and detrimental complications that could cause discomfort experience such as swelling and pain in the limb, and even cause pulmonary embolism which can endanger patients’ life[4]. There is a need to develop a simple prediction rule for peripherally inserted central venous catheter-related symptomatic thrombosis (PICC-RVT) in patients with breast cancer
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