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Chest. 2017 Mar;151(3):564-571. doi: 10.1016/j.chest.2016.10.025. Epub 2016 Nov 1.

Development of a Risk Prediction Score for Occult Cancer in Patients With VTE.

Collaborators (162)

Monreal M, Decousus H, Prandoni P, Brenner B, Barba R, Di Micco P, Bertoletti L, Tzoran I, Reis A, Bosevski M, Bounameaux H, Malý R, Wells P, Papadakis M, Aibar MA, Alfonso M, Asensio-Cruz MI, Auguet T, Arcelus JI, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Bueso T, Cañas I, Ceausu A, Chic N, Culla A, Del Pozo R, Del Toro J, Díaz-Pedroche MC, Díaz-Peromingo JA, Duffort M, Elias-Hernández T, Falgá C, Fernández-Aracil C, Fernández-Capitán C, Fidalgo MA, Font C, Font L, Gallego P, García MA, García-Bragado F, García-Rodenas M, Gómez V, González J, Grau E, Grimón A, Guijarro R, Guirado L, Gutiérrez J, Hernández-Comes G, Hernández-Blasco L, Hernando-López E, Jara-Palomares L, Jaras MJ, Jiménez D, Joya MD, Llamas P, Lecumberri R, Lobo JL, López-Jiménez L, López-Reyes R, López-Sáez JB, Lorente MA, Lorenzo A, Maestre A, Marchena PJ, Martín M, Martín-Martos F, Monreal M, Nieto JA, Nieto S, Núñez A, Núñez MJ, Odriozola M, Otalora S, Otero R, Ovejero A, Pedrajas JM, Pérez G, Pérez-Ductor C, Peris ML, Porras JA, Reig O, Riera-Mestre A, Riesco D, Rivas A, Rodríguez-Dávila MA, Rosa V, Ruiz-Artacho P, Ruiz-Giménez N, Sahuquillo JC, Sala-Sainz MC, Sampériz A, Sánchez R, Sanz O, Soler S, Sopeña B, Suriñach JM, Tolosa C, Trujillo-Santos J, Uresandi F, Valero B, Valle R, Vela J, Vicente P, Vidal G, Villalobos A, Villalta J, Vanassche T, Verhamme P, Wells P, Hirmerova J, Malý R, Salgado E, Bertoletti L, Bura-Riviere A, Farge-Bancel D, Hij A, Mahé I, Merah A, Moustafa F, Papadakis M, Braester A, Brenner B, Tzoran I, Antonucci G, Barillari G, Bertone A, Bilora F, Bortoluzzi C, Ciammaichella M, Di Girolamo C, Di Micco P, Duce R, Ferrazzi P, Giorgi-Pierfranceschi M, Grandone E, Lodigiani C, Maida R, Mastroiacovo D, Pace F, Pesavento R, Pinelli M, Poggio R, Prandoni P, Rota L, Tiraferri E, Tonello D, Tufano A, Visonà A, Zalunardo B, Drucka E, Kigitovica D, Skride A, Sousa MS, Bosevski M, Zdraveska M, Bounameaux H, Mazzolai L.

Author information

1
Medical Surgical Unit of Respiratory Diseases, Virgen del Rocio Hospital, Seville, Spain; Instituto de Biomedicina de Sevilla (IBiS), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Seville, Spain. Electronic address: luisoneumo@hotmail.com.
2
Medical Surgical Unit of Respiratory Diseases, Virgen del Rocio Hospital, Seville, Spain; Instituto de Biomedicina de Sevilla (IBiS), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Seville, Spain.
3
Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain.
4
Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
5
Thrombosis and Hemostasis Unit, Department of Hematology and Bone Marrow Transplantation Rambam Medical Center, Haifa, Israel.
6
Department of Medical Oncology, Hospital Universitari Germans Trias i Pujol de Badalona, Barcelona, Spain.
7
Statistics, Methodology and Research Evaluation Unit, Andalusian Public Foundation for Health Research Management, Hospital Virgen del Rocío, Seville, Spain.
8
Atherosclerosis and Thrombosis Unit, Casa Sollievo della Sofferenza, Foggia, Italy.
9
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol de Badalona, Barcelona, Universidad Católica de Murcia, Guadalupe, Spain.

Abstract

BACKGROUND:

The benefits of a diagnostic workup for occult cancer in patients with VTE are controversial. Our aim was to provide and validate a risk score for occult cancer in patients with VTE.

METHODS:

We designed a nested case-control study in a cohort of patients with VTE included in the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry from 2001 to 2014. Cases included cancer detected beyond the first 30 days and up to 24 months after VTE. Control subjects were defined as patients with VTE with no cancer in the same period.

RESULTS:

Of 5,863 eligible patients, 444 (7.6%; 95% CI, 6.8%-8.2%) were diagnosed with occult cancer. On multivariable analysis, variables selected were male sex, age > 70 years, chronic lung disease, anemia, elevated platelet count, prior VTE, and recent surgery. We built a risk score assigning points to each variable. Internal validity was confirmed using bootstrap analysis. The proportion of patients with cancer who scored ≤ 2 points was 5.8% (241 of 4,150) and that proportion in those who scored ≥ 3 points was 12% (203 of 1,713). We also identified scores divided by sex and age subgroups.

CONCLUSIONS:

This is the first risk score that has identified patients with VTE who are at increased risk for occult cancer. Our score needs to be externally validated.

KEYWORDS:

neoplasm; pulmonary embolism; risk; screening; venous thromboembolism

PMID:
27815153
DOI:
10.1016/j.chest.2016.10.025
[Indexed for MEDLINE]

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