Background Cancer patients have an increased risk of venous thromboembolism (VTE). Currently, the availability of highly discriminatory prediction models for VTE in cancer patients is limited. The implementation of biomarkers in prediction models might lead to refined VTE risk prediction. In this systematic review and meta-analysis, we aimed to evaluate candidate biomarkers and their association with cancer-associated VTE.

Methods We searched Medline, EMBASE, and Cochrane Central for studies that evaluated biomarkers in adult cancer patients from inception to September 2022. We included studies reporting on VTE after a cancer diagnosis with biomarker measurements performed at a defined time point. Median/mean differences (for continuous measures) and odds ratios (for dichotomous measures) with 95% confidence intervals were estimated and pooled using random-effects models.

Results We included 113 studies in the systematic review. Of these, 50 studies were included in the meta-analysis. We identified two biomarkers at cancer diagnosis (factor VIII and time to peak thrombin), three biomarkers pre-chemotherapy (D-dimer, fibrinogen, and mean platelet volume), and one biomarker preoperatively (platelet count) that had significant median or mean differences. Additionally, we found that hemoglobin <100 g/L and white blood count >11 × 10⁹/L were significantly associated with future VTE risk only when measured at cancer diagnosis. Pre-chemotherapy neutrophil-to-lymphocyte ratio ≥3 and preoperative platelet count ≥400 × 10⁹/L were also found to be associated with future VTE risk.

Conclusion In conclusion, this study identified nine candidate blood biomarkers that may help in optimizing VTE prediction in cancer patients that should be further explored in future studies.

背景癌症患者发生静脉血栓栓塞（VTE）的风险增加。目前，癌症患者 VTE 的高度辨别性预测模型的可用性有限。在预测模型中应用生物标志物可能会导致更精细的 VTE 风险预测。在本次系统评价和荟萃分析中，我们旨在评估候选生物标志物及其与癌症相关 VTE 的关联。

方法我们检索了 Medline、EMBASE 和 Cochrane Central 来评估从开始到 2022 年 9 月期间成年癌症患者的生物标志物。我们纳入了报告癌症诊断后 VTE 的研究，并在规定的时间点进行了生物标志物测量。使用随机效应模型估计并汇总具有 95% 置信区间的中值/均值差异（对于连续测量）和优势比（对于二分测量）。

结果我们在系统评价中纳入了 113 项研究。其中，荟萃分析纳入了 50 项研究。我们确定了癌症诊断时的两种生物标志物（因子 VIII 和凝血酶峰值时间）、化疗前的三种生物标志物（D-二聚体、纤维蛋白原和平均血小板体积）以及术前具有显着中值或平均差异的一种生物标志物（血小板计数） 。此外，我们发现只有在癌症诊断时测量血红蛋白<100 id=3>11 × 10 ⁹ /L 才与未来 VTE 风险显着相关。化疗前中性粒细胞与淋巴细胞比率≥3和术前血小板计数≥400×10 ⁹ /L也被发现与未来VTE风险相关。

结论总之，本研究确定了九种候选血液生物标志物，可能有助于优化癌症患者的 VTE 预测，应在未来的研究中进一步探索。