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

BRUNO L FERREYRO; FEDERICO ANGRIMAN; DIEGO GIUNTA; POSADAS-MARTÍNEZ, LOURDES; FERNANDO VAZQUEZ

BMC CANCER

BIOMED CENTRAL LTD

Lugar: Londres; Año: 2013 vol. 13

1471-2407

Background: Venous thromboembolism (VTE) has been associated with a higher risk of developing malignancyand mortality, and patients with VTE may therefore benefit from increased surveillance. We aimed to construct aclinical predictive score that could classify patients with VTE according to their risk for developing these outcomes.Methods: Observational cohort study using an existing clinical registry in a tertiary academic teaching hospital in BuenosAires, Argentina. 1264 adult patients greater than 17 years of age presented new VTE between June 2006 and December2011 and were included in the registry. We excluded patients with previous or incident cancer, those who died duringthe first month, and those with less than one year of follow up (< 5%). 540 patients were included. Primary outcome wasnew cancer diagnosis during one year of follow-up, secondary composite outcome was any new cancer diagnosis ordeath. The score was developed using a multivariable logistic regression model to predict cancer or death.Results: During follow-up, one-quarter (26.4%) of patients developed cancer (9.2%) or died (23.7%). Patients with theprimary outcome had more comorbidities, were more likely to have previous thromboembolism and less likely to haverecent surgery. The final score developed for predicting cancer alone included previous episode of VTE, recent surgeryand comorbidity (Charlson comorbidity score), [AUC of 0.75 (95% CI 0.66-0.84) and 0.79 (95% CI 0.63-0.95) in thederivation and validation cohorts, respectively]. The version of this score developed to predict cancer or death includedage, albumin level, comorbidity, previous episode of VTE, and recent surgery [AUC = 0.72 (95% CI 0.66-0.78) and 0.71(95% CI 0.63-0.79) in the derivation and validation cohorts, respectively].Conclusions: A simple clinical predictive score accurately estimates patients? risk of developing cancer or death followingnewly diagnosed VTE. This tool could be used to help reassure low risk patients, or to identify high-risk patients thatmight benefit from closer surveillance and additional investigations.