Risk factors of catheter-related thrombosis in early-stage breast cancer patients: a single-center retrospective study

Figures & data

Table 1 Patients’ characteristics

Variable	N (%)
Age (years)
<40	50 (23.9)
40–60	144 (68.9)
≥60	15 (7.2)
BMI*
<23.9	131 (62.68)
≥23.9	78 (37.32)
Pathology
IDC	180 (86.5)
ILC	8 (3.8)
DCIS	4 (1.9)
Other types	16 (7.8)
Tumor size
≤2 cm	72 (34.45)
>2 cm	137 (65.55)
LN metastasis
No	92 (44.02)
Yes	117 (55.98)
Distant metastasis
No	204 (97.67)
Yes	5 (2.39)
HR status
Negative	16 (7.7)
Positive	193 (92.3)
HER-2 status
Negative	141 (67.46)
Positive	68 (32.54)
Surgery
BCS	104 (49.76)
Mastectomy	105 (50.24)
NAC
No	166 (80.2)
Yes	41 (19.8)

Note: *Risk factors involved and classified according to the cutoff in Khorana score.

Abbreviations: BMI, body mass index; BCS, breast-conserving surgery; IDC, invasive ductal carcinoma; ILC, invasive lobular carcinoma; DCIS, ductal carcinoma in situ; HBsAg, hepatitis B surface antigen; LN, lymph node.

Figure 1 Ultrasound images of right internal jugular veins. (A) Before TIVAD implantation and (B) before TIVAD removal with chemotherapy completed in a breast cancer patient. Size of catheter-related thrombosis was listed at the bottom of the image.

Table 2 Treatment to patients with catheter-related thrombosis

Patients	Size of thrombosis (mm)	Baseline D-dimer (mg/L)	D-dimer before anticoagulation (mg/L)	Time of TIVAD removal	Anticoagulation therapy	Duration of anticoagulation (days)	D-dimer after anticoagulation (mg/L)
1	9.4×2	0.51	0.42	Directly removal	No	–	NA
2	7.3×2.9	0.23	NA	Directly removal	No	–	NA
3	7.1×4.2	NA	2.37	Directly removal	No	–	NA
4	NR	0.11	NA	Directly removal	No	–	NA
5	NR	NA	NA	Directly removal	No	–	NA
6	NR	0.25	NA	Directly removal	No	–	NA
7	NR	0.39	NA	Directly removal	No	–	NA
8	NR	0.29	1.4↑	Directly removal	No	–	NA
9	NR	0.28	NA	Directly removal	No	–	NA
10	NR	0.37	NA	Directly removal	No	–	NA
11	0.8×0.5	0.1	0.75↑	Directly removal	No	–	NA
12	10×4	0.21	3.19↑	Directly removal	No	–	NA
13	NR	0.3	NA	Directly removal	No	–	NA
14	NR	1.59	2.05↑	Directly removal	No	–	NA
15	NR	0.39	NA	Directly removal	No	–	NA
16	NR	0.16	0.14	Directly removal	No	–	NA
17	NR	0.48	0.66↑	Directly removal	No	–	NA
18	NR	0.34	2.23↑	Directly removal	No	–	NA
19	NR	NA	NA	Directly removal	No	–	NA
20	NR	0.36	0.6↑	After anticoagulation therapy	Rivaroxaban 10 mg bid	3	NA
21	NR	0.11	0.34↑	After anticoagulation therapy	Rivaroxaban 10 mg qd	3	NA
22	NR	0.98	0.35	After anticoagulation therapy	Rivaroxaban 10 mg qd	3	NA
23	8.9×3.4	0.39	2.26↑	After anticoagulation therapy	Rivaroxaban 10 mg qd	5	0.77↓
24	NR	0.25	1.1↑	After anticoagulation therapy	Rivaroxaban 10 mg qd	7	NA
25	NR	0.6	NA	After anticoagulation therapy	Rivaroxaban 10 mg qd	7	NA
26	NR	0.11	NA	After anticoagulation therapy	Rivaroxaban 10 mg bid	7	NA
28	16×6.1	0.32	1.23↑	After anticoagulation therapy	Rivaroxaban 10 mg qd	10	NA
29	NR	1.22	0.42	After anticoagulation therapy	Rivaroxaban 10 mg qd	14	NA
30	14.3×7	0.47	NA	After anticoagulation therapy	Rivaroxaban 10 mg qd	30	NA
31	18×1.9	2.43	NA	After anticoagulation therapy	Rivaroxaban 10 mg qd	30	NA
32	NR	0.22	NA	After anticoagulation therapy	Enoxaparin	Once	0.23

Note: Reference range of D-dimer: 0.00–0.55 mg/L FEU.

Abbreviations: NR, not reported; NA, not available.

Table 3 Univariate and multivariate logistic regression of risk factors for catheter-related thrombosis

Variable	Thrombosis		Univariate logistic regression		Multivariate logistic regression
	Yes (%)	No (%)	OR (95% CI)	P-value	OR (95% CI)	P-value
Age (years)				0.643	Not included
<40	10 (30.3)	40 (22.7)	1
40–60	21 (63.6)	123 (69.9)	0.68 (0.29–1.57)
≥60	2 (6.1)	13 (7.4)	0.61 (0.12–3.18)
BMI*				0.149	0.262
<23.9	17 (12.98)	114 (87.02)	1		1
≥23.9	16 (20.51)	39 (79.49)	1.73 (0.82–3.66)		1.52 (0.69–3.34)
Pathology				0.423	Not included
IDC	28 (84.8)	152 (86.9)	1
ILC	0 (0)	8 (4.6)	0.00 (0.00–0.00)
DCIS	2 (6.1)	2 (1.1)	5.24 (0.71–38.71)
Other types	3 (9.1)	13 (7.4)	1.25 (0.33–4.68)
Tumor size				0.037	0.032
≤2 cm	6 (8.33)	66 (91.67)	1		1
>2 cm	27 (19.71)	110 (80.29)	2.70 (1.03–6.88)		2.73 (1.04–7.18)
LN metastasis				0.96	Not included
No	12 (13.04)	80 (86.96)	1
Yes	21 (17.95)	96 (82.05)	1.46 (0.68–3.15)
Distant metastasis				0.521	Not included
No	32 (15.69)	172 (84.31)	1
Yes	1 (20.00)	4 (80.00)	1.34 (0.15–12.42)
HR status				0.708	Not included
Negative	4 (11.43)	31 (88.57)	1
Positive	29 (16.67)	145 (83.33)	1.34 (0.29–6.19)
HER-2 status				0.743	Not included
Negative	22 (15.60)	119 (84.40)	1
Positive	11 (16.18)	57 (83.82)	1.04 (0.47–2.30)
Surgery				0.873	Not included
BCS	16 (15.38)	88 (84.62)	1
Mastectomy	17 (16.19)	88 (83.81)	1.06 (0.51–2.24)
NAC				0.486	Not included
No	26 (15.79)	143 (84.62)	1
Yes	7 (17.50)	33 (82.50)	0.86 (0.30–1.77)
Brand of TIVAD				0.711	Not included
Bards	9 (27.3)	57 (32.4)	1
Braun	11 (33.3)	47 (26.7)	1.48 (0.56–3.87)
Medicom	13 (39.4)	72 (40.9)	1.14 (0.45–2.86)
TIVAD duration				0.15	Not included
≤200 days	18 (54.5)	119 (67.6)	1
>200 days	15 (45.5)	57 (32.4)	1.74 (0.81–3.69)
HBsAg				0.023	0.047
Negative	25 (78.1)	160 (92.0)	1		1
Positive	7 (21.9)	14 (8.0)	3.20 (1.17–8.70)		2.80 (1.03–7.86)
PLT (10^9/L)*				0.581		0.085
<300	29 (16.38)	148 (83.62)	1
>350	4 (12.50)	28 (87.50)	0.72 (0.23–2.23)
Hb (g/L)*				0.751	0.831
≥100	29 (16.11)	151 (83.89)	1		1
<100	4 (13.79)	25 (86.21)	0.83 (0.27–2.57)		0.88 (0.27–2.89)
WBC (10^9/L)*					Not included
≤11	33 (16.50)	167 (83.50)	1
>11	0 (0.00)	9 (100.00)	0.00 (0.00–0.00)
PT (s)				0.563	Not included
10.7–14.4	22 (75.9)	119 (73.9)	1
<10.7	3 (10.3)	27 (16.8)	0.60 (0.16–2.15)
>14.4	4 (13.8)	15 (9.3)	1.44 (0.44–4.76)
APTT (s)				0.567	Not included
23.5–35.0	11 (33.3)	74 (43.3)	1
<23.5	1 (3.0)	4 (2.3)	1.68 (0.17–12.46)
>35.0	21 (63.7)	93 (54.4)	1.51 (0.68–3.35)
AST (U/L)				0.235	Not included
<40	29 (87.8)	164 (93.7)	1
>40	4 (12.1)	11 (6.3)	2.06 (0.61–6.90)
ALT (U/L)				0.111	Not included
<40	28 (84.8)	163 (93.1)	1
>40	5 (15.2)	12 (6.9)	2.43 (0.79–7.41)
D-dimer (mg/L FEU)				0.439	Not included
0–0.55	24 (82.8)	128 (76.2)	1
>0.55	5 (17.2)	40 (23.8)	0.67 (0.24–1.86)
HDL (mmol/L)				0.523	Not included
1.04–1.55	17 (65.4)	86 (59.7)	1
<1.04	1 (3.8)	16 (11.1)	0.32 (0.04–2.54)
>1.55	8 (30.8)	42 (29.2)	0.96 (0.38–2.41)
LDL (mmol/L)				0.039	0.04
≤3.6	20 (12.74)	137 (87.26)	1		1
>3.6	13 (25.00)	39 (75.00)	2.28 (1.04–4.99)		2.36 (1.06–5.35)
TC (mmol/L)				0.955	Not included
≤6.0	28 (15.73)	150 (84.27)	1
>6.0	5 (16.13)	26 (83.87)	1.03 (0.36–2.91)
TG (mmol/L)				0.919	Not included
≤2.3	30 (15.87)	159 (84.13)	1
>2.3	3 (15.00)	17 (85.00)	0.93 (0.25–3.39)
Hypertension				0.407	Not included
No	6 (10.71)	50 (89.29)	1
Yes	1 (25.00)	3 (75.00)	0.36 (0.03–4.03)
Diabetes				0.265	Not included
No	6 (10.53)	51 (89.47)	1
Yes	1 (33.33)	6 (10.53)	0.24 (0.18–2.99)

Note: *Risk factors involved and classified according to the cutoff in Khorana Score.

Abbreviations: BMI, body mass index; IDC, invasive ductal carcinoma; ILC, invasive lobular carcinoma; DCIS, ductal carcinoma in situ; LN, lymph node; HR, hormone receptor; BCS, breast-conserving surgery; NAC, neoadjuvant chemotherapy; HBsAg, hepatitis B surface antigen; PLT, platelet; Hb, hemoglobin; WBC, white blood cell; PT, prothrombin time; APTT, activated partial thromboplastin time; AST, aspartate transaminase; ALT, alanine transaminase; HDL, high-density lipoprotein; LDL, low-density lipoprotein; TC, total cholesterol; TG, triglycerides.

Table 4 Breast cancer catheter-related thrombosis risk score

Risk factor	Coefficients	Score	OR (95% CI)
Tumor size >2 cm	0.90535	1	2.735 (1.042–7.177)
HBVsAg positive	1.03930	1	2.803 (1.027–7.856)
Baseline LDL >3.6 mmol/L	1.02510	1	2.360 (1.059–5.351)

Notes: Plus the score according to patient risk factors to predict the risk of developing catheter-related thrombosis，score 0 indicates low risk, 1 indicates moderate risk, 2 to 3 indicates high risk.

Table 5 Catheter-related thrombosis stratified by CRT risk score and Khorana model

	CRT risk score N (% of total cohort)	P-value
Low risk	3 (6.25)	0.001
Moderate risk	14 (12.17)
High risk	16 (34.78)
Total	33 (15.79)

Note: CRT risk score: low (score 0), moderate (score 1) and high risk (score 2–3).

Abbreviation: CRT, catheter-related thrombosis.