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Original Research: Lung Cancer |

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

Luis Jara-Palomares, MD, PhD; Remedios Otero, MD, PhD; David Jimenez, PhD; Marc Carrier, MD; Inna Tzoran, MD; Benjamin Brenner, MD; Mireia Margeli, MD; Juan Manuel Praena-Fernandez, PhD; Elvira Grandone, MD, PhD; Manuel Monreal, MD, PhD
Author and Funding Information

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aMedical Surgical Unit of Respiratory Diseases, Virgen del Rocio Hospital, Seville, Spain

bInstituto de Biomedicina de Sevilla (IBiS), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Seville, Spain

cRespiratory Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain

dThrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada

eThrombosis and Hemostasis Unit, Department of Hematology and Bone Marrow Transplantation Rambam Medical Center, Haifa, Israel

fDepartment of Medical Oncology, Hospital Universitari Germans Trias i Pujol de Badalona, Barcelona, Spain

gStatistics, Methodology and Research Evaluation Unit, Andalusian Public Foundation for Health Research Management, Hospital Virgen del Rocío, Seville, Spain

hAtherosclerosis and Thrombosis Unit, Casa Sollievo della Sofferenza, Foggia, Italy

iDepartment of Internal Medicine, Hospital Universitari Germans Trias i Pujol de Badalona, Barcelona, Universidad Católica de Murcia, Guadalupe, Spain

CORRESPONDENCE TO: Luis Jara-Palomares, MD, PhD, Medical Surgical Unit of Respiratory Diseases, Hospital Virgen del Rocío, Ciberes, Seville, Spain. Av Manuel Siurot s/n, Seville, Spain, CP: 41013


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


Chest. 2017;151(3):564-571. doi:10.1016/j.chest.2016.10.025
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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.

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