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Original Research |

Development of a risk prediction score for occult cancer in patients with venous thromboembolism

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

Summary conflict of interest statements: MM received educational grants from Sanofi and Bayer; ROC received: Board membership: Leo-Pharma, Bayer Healthcare, MSD; Grants: Leo-Pharma, Bayer Healthcare. Payment for lectures including service on speaker’s bureaus: Leo-Pharma, Sanofi, Bayer Healthcare, Rovi SL; LJP, DJ, IT, BB, MM, JMPF, and EG declare no competing financial interests.

1Pulmonologist. Medical Surgical Unit of Respiratory Diseases. Virgen del Rocio Hospital. Seville, Spain

2Instituto de Biomedicina de Sevilla (IBiS). Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Seville, Spain

3Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain

4Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

5Thrombosis and Hemostasis Unit, Department of Hematology and Bone Marrow Transplantation, Rambam Medical Center, Haifa, Israel

6Department of Medical Oncology, Hospital Universitari Germans Trias i Pujol de Badalona, Barcelona. Spain

7Statistics, Methodology and Research Evaluation Unit. Andalusian Public Foundation for Health Research Management. Hospital Virgen del Rocío, Seville, Spain

8Atherosclerosis and Thrombosis Unit, Casa Sollievo della Sofferenza, Foggia, Italy

9Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol de Badalona. Barcelona. Universidad Católica de Murcia. Spain

Corresponding author: Dr. Luis Jara Palomares, Institution: Pulmonologist, Medical Surgical Unit of Respiratory Diseases. Hospital Virgen del Rocío. CIBERES. Seville. Spain. Address: Av. Manuel Siurot s/n, Seville, Spain. CP: 41013.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.10.025
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Abstract

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

Methods  We designed a nested case-control study within a cohort of VTE patients included in the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry from 2001-2014. Cases: cancer detected beyond the first 30 days after VTE and up for 24 months. Controls: VTE patients with no cancer in the same period.

Results  Of 5,863 eligible patients, 444 (7.6%; (95%CI: 6.8 to 8.2%) were diagnosed with occult cancer. On multivariable analysis, variables selected were: male gender, age>70 years, chronic lung disease, anaemia, raised platelet count, prior VTE and recent surgery. We built a risk score assigning points to each variable. Internal validity was confirmed using bootstrap analysis. Proportion of patients scoring ≤2 points who had cancer was 5.8% (241/4,150) and in those scoring ≥3 points of 12% (203/1,713). We also identified score dividing by gender and age subgroups.

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


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