Development of a Risk Prediction Score for Occult Cancer in Patients With VTE.
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.
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.
Luis
L
Jara-Palomares
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.
Remedios
R
Otero
Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain.
David
D
Jimenez
Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Marc
M
Carrier
Thrombosis and Hemostasis Unit, Department of Hematology and Bone Marrow Transplantation Rambam Medical Center, Haifa, Israel.
Inna
I
Tzoran
Thrombosis and Hemostasis Unit, Department of Hematology and Bone Marrow Transplantation Rambam Medical Center, Haifa, Israel.
Benjamin
B
Brenner
Department of Medical Oncology, Hospital Universitari Germans Trias i Pujol de Badalona, Barcelona, Spain.
Mireia
M
Margeli
Statistics, Methodology and Research Evaluation Unit, Andalusian Public Foundation for Health Research Management, Hospital Virgen del Rocío, Seville, Spain.
Juan Manuel
JM
Praena-Fernandez
Atherosclerosis and Thrombosis Unit, Casa Sollievo della Sofferenza, Foggia, Italy.
Elvira
E
Grandone
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol de Badalona, Barcelona, Universidad Católica de Murcia, Guadalupe, Spain.
Manuel
M
Monreal
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000453:epidemiology*; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D013922:Thrombocytosis / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology; D020246:Venous Thrombosis / Q000453:epidemiology*
neoplasm; pulmonary embolism; risk; screening; venous thromboembolism