Predictive score for estimating cancer after venous thromboembolism: a cohort study.

FERREYRO BL; ANGRIMAN F; DIEGO GIUNTA; MARIA LOURDES POSADAS MARTINEZ; FERNANDO VAZQUEZ; FERNAN GONZALEZ BERNALDO DE QUIROS; ANDRE AMARAL; DAMON SCALES

BMC CANCER

BIOMED CENTRAL LTD

Lugar: Londres; Año: 2013

1471-2407

Background: Venous thromboembolism (VTE) has been associated with a higher risk of developing malignancy13 and mortality, and patients with VTE may therefore benefit from increased surveillance. We aimed to construct a14 clinical predictive score that could classify patients with VTE according to their risk for developing these outcomes.15 Methods: Observational cohort study using an existing clinical registry in a tertiary academic teaching hospital in Buenos16 Aires, Argentina. 1264 adult patients greater than 17 years of age presented new VTE between June 2006 and December17 2011 and were included in the registry. We excluded patients with previous or incident cancer, those who died during18 the first month, and those with less than one year of follow up (< 5%). 540 patients were included. Primary outcome was19 new cancer diagnosis during one year of follow-up, secondary composite outcome was any new cancer diagnosis or20 death. The score was developed using a multivariable logistic regression model to predict cancer or death.21 Results: During follow-up, one-quarter (26.4%) of patients developed cancer (9.2%) or died (23.7%). Patients with the22 primary outcome had more comorbidities, were more likely to have previous thromboembolism and less likely to have23 recent surgery. The final score developed for predicting cancer alone included previous episode of VTE, recent surgery24 and comorbidity (Charlson comorbidity score), [AUC of 0.75 (95% CI 0.66-0.84) and 0.79 (95% CI 0.63-0.95) in the25 derivation and validation cohorts, respectively]. The version of this score developed to predict cancer or death included26 age, albumin level, comorbidity, previous episode of VTE, and recent surgery [AUC = 0.72 (95% CI 0.66-0.78) and 0.7127 (95% CI 0.63-0.79) in the derivation and validation cohorts, respectively].28 Conclusions: A simple clinical predictive score accurately estimates patients? risk of developing cancer or death following29 newly diagnosed VTE. This tool could be used to help reassure low risk patients, or to identify high-risk patients that30 might benefit from closer surveillance and additional investigations.