Venous Thromboembolism Risk in Head and Neck Cancer: Significance of the Preoperative Platelet-to-Lymphocyte Ratio

Abstract

Abstract (250 limit)O_ST_ABSObjectiveC_ST_ABSWe aimed to investigate the association between the preoperative platelet-to-lymphocyte ratio (PLR) and venous thromboembolism (VTE) in head and neck cancer (HNC) patients undergoing major surgery.\n\nStudy DesignRetrospective cohort study\n\nSettingAcademic tertiary hospital from 2011 to 2017\n\nSubjects and MethodsPatients with confirmed HNC undergoing major surgery were included in this study. The preoperative PLR was recorded for all patients. Known VTE risk factors, including age, sex, smoking, BMI, prior VTE, and anticoagulation were also recorded. Risk factors were screened in univariate analysis using Wilcoxons rank sum test and {chi}2 test (Bonferroni corrected). Significant covariates were subsequently included in a multivariate regression model. Bootstrap techniques were used to obtain credible confidence intervals (CI).\n\nResultsThere were 306 patients enrolled with 7 cases of VTE (6 DVTs and 1 PE). On univariate analysis, length of stay (p = 0.0026), length of surgery (p = 0.0029), and PLR (p = 0.0002) were founded to have significant associations with VTE. A Receiver Operator Characteristic (ROC) curve was constructed, that yielded an AUROC of 0.905 (95% CI: 0.82 - 0.98). Using an optimized cutoff, the multivariate model showed that length of surgery ({beta} 95% CI: 0.0001 - 0.0006; p = 0.0056), and PLR ({beta} 95% CI: 5.3256 - 5.3868; p < 0.0001) were significant independent predictors of VTE.\n\nConclusionThis exploratory pilot study has shown that PLR offers a potentially accurate risk stratification measure as an adjunct to current tools in VTE risk prediction, without additional cost to health systems.\n\nOral PresentationThis data was presented as an oral presentation at the Annual American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNSF) Meeting, 13th September 2017