0
Correspondence |

Prediction of Occult Cancer Among Adult Patients With Acute Venous Thromboembolic Disease FREE TO VIEW

Bruno L. Ferreyro, MD; Federico Angriman, MD, MPH; Andre C.K.B. Amaral, MD; Damon C. Scales, MD, PhD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aInternal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

bInterdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada

cDepartment of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada

CORRESPONDENCE TO: Bruno L. Ferreyro, MD, Internal Medicine Department of Hospital Italiano de Buenos Aires, Peron 4190, C1199, Buenos Aires, Argentina


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(3):727-728. doi:10.1016/j.chest.2016.11.032
Text Size: A A A
Published online

We read with interest the study by Jara-Palomares and colleagues in this issue of CHEST. The article describes a score for identifying patients at higher risk of having an occult cancer identified after first presenting with VTE. We have previously published a study describing a similar predictive score and using similar methodology.

Our score was derived and internally validated using a cohort of 1,264 adult patients who presented with a new VTE to a large tertiary hospital in Buenos Aires. Our study had a shorter follow-up period of 12 months, but patients in our cohort had a similar risk (9.2%) of having an associated occult cancer identified during follow-up. Similar to the findings from Jara-Palomares and colleagues, our final predictive score included previous episode of VTE, underlying comorbidities (as measured by the Charlson comorbidity score), and recent surgery. However, our methodology also included a secondary analysis evaluating a combined outcome of cancer or death to address the possibility that death might occur before the identification of an occult cancer. In this model, additional predictive factors were age ≥ 70 years and an albumin level ≤ 2.5 mg/dL. We believe this is an important issue not addressed in the study by Jara-Palomares and colleagues, because death was frequent during our 1 year of follow-up, occurring in 72% of patients with occult cancer and 19% without cancer.

Moreover, in contrast to the results recently reported in the journal, previous VTE was associated with an increased risk of occult cancer both in our study and in another recently published large cohort study. Potential mechanisms to explain the differences in the observed association between occult cancer and previous VTE include the time elapsed between the VTE events, underlying characteristics of included patients (eg, age and baseline comorbidities) and whether the incident VTE was provoked or unprovoked.

References

Jara-Palomares L. .Otero R. .Jimenez D. . RIETE investigatorset al Development of a risk prediction score for occult cancer in patients with VTE. Chest. 2017;151:564-571 [PubMed]journal
 
Ferreyro B.L. .Angriman F. .Giunta D. .et al Predictive score for estimating cancer after venous thromboembolism: a cohort study. BMC Cancer. 2013;13:352- [PubMed]journal. [CrossRef] [PubMed]
 
Ihaddadene R. .Corsi D.J. .Lazo-Langner A. .et al Risk factors predictive of occult cancer detection in patients with unprovoked venous thromboembolism. Blood. 2016;127:2035-2037 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Tables

References

Jara-Palomares L. .Otero R. .Jimenez D. . RIETE investigatorset al Development of a risk prediction score for occult cancer in patients with VTE. Chest. 2017;151:564-571 [PubMed]journal
 
Ferreyro B.L. .Angriman F. .Giunta D. .et al Predictive score for estimating cancer after venous thromboembolism: a cohort study. BMC Cancer. 2013;13:352- [PubMed]journal. [CrossRef] [PubMed]
 
Ihaddadene R. .Corsi D.J. .Lazo-Langner A. .et al Risk factors predictive of occult cancer detection in patients with unprovoked venous thromboembolism. Blood. 2016;127:2035-2037 [PubMed]journal. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543