Risk factors and clinical strategies for lower extremity deep vein thrombosis following breast cancer surgery

To analyze the risk factors and clinical strategies for lower extremity deep vein thrombosis (LEDVT) following breast cancer (BC) surgery.

From August 2022 to August 2025, 139 BC patients who underwent surgical treatment at The Second Affiliated Hospital of Chengdu Medical College, Nuclear Industry 416 Hospital were selected for the study. Patients were grouped into the LEDVT group (n = 56) and the non-LEDVT group (n = 83) based on the presence of postoperative LEDVT. Clinical information were collected from both groups for comparative analysis, including baseline data (age, disease duration, body mass index [BMI], menopause status, concomitant hypertension, diabetes, hyperlipidemia, and smoking status), surgery-related parameters (surgery duration, surgical approach, use of adjuvant chemotherapy, diagnostic method), and pathological data (pathological stage, pathological pattern, lymphatic tumor embolus, histological grade, D-dimer [D-D], fibrinogen [FIB], thrombomodulin [TM]). Binary logistic regression analysis was performed to identify factors influencing the occurrence of LEDVT in patients after BC surgery.

Neoadjuvant chemotherapy, lymphatic tumor thrombus, and elevated levels of D-D, FIB, and TM were closely associated with postoperative LEDVT, whereas other indicators showed no significant correlation. Multivariate analysis further confirmed that high D-D (≥ 68 ng/L), high FIB (≥ 4.84 g/L), and high TM (≥ 30.00 μg/L) were independent risk factors for LEDVT after BC surgery. A nomogram based on multivariate analysis results was constructed to identify patients at moderate-to-high risk (30-90% risk) for postoperative LEDVT. It demonstrated favorable predictive accuracy and good calibration across low- and high-risk groups. Further evaluation revealed that the area under the curve (AUC) for predicting postoperative LEDVT after BC surgery was 0.732 for D-D, 0.784 for FIB, 0.752 for TM, and 0.889 for the joint prediction of all three factors.

These findings suggest that elevated levels of D-dimer (≥ 68 ng/L), FIB (≥ 4.84 g/L), and TM (≥ 30.00 μg/L) increase the risk of LEDVT following BC surgery, and the combination of these markers demonstrates superior predictive performance for LEDVT after BC surgery.