Derivation and Validation of a Clinical Risk Assessment Model for Cancer-Associated Thrombosis in Two Unique US Health Care Systems

被引：35

作者：

Li, Ang ^{[1
,12
]}

La, Jennifer ^{[2
]}

May, Sarah B. ^{[3
]}

Guffey, Danielle ^{[3
]}

da Costa, Wilson L., Jr. ^{[4
]}

Amos, Christopher I. ^{[3
,4
]}

Bandyo, Raka ^{[5
]}

Milner, Emily M. ^{[6
]}

Kurian, Karen M. ^{[6
]}

Chen, Daniel C. R. ^{[2
,7
]}

Do, Nhan V. ^{[2
,7
]}

Granada, Carolina ^{[1
]}

Riaz, Nimrah ^{[1
]}

Brophy, Mary T. ^{[2
,8
]}

Chitalia, Vipul ^{[2
,9
,10
]}

Gaziano, J. Michael ^{[2
]}

Garcia, David A.

Carrier, Marc

Flowers, Christopher R.

Zakai, Neil A. ^{[11
]}

Fillmore, Nathanael R. ^{[2
,8
]}

机构：

[1] Baylor Coll Med, Sect Hematol Oncol, Houston, TX 77030 USA

[2] VA Boston Healthcare Syst, Massachusetts Vet Epidemiol Res & Informat Ctr, Boston, MA USA

[3] Baylor Coll Med, Inst Clin & Translat Res, Houston, TX 77030 USA

[4] Baylor Coll Med, Sect Epidemiol & Populat Sci, Houston, TX 77030 USA

[5] Harris Hlth Syst, Houston, TX USA

[6] Baylor Coll Med, Sch Med, Houston, TX 77030 USA

[7] Boston Univ, Sch Med, Sect Gen Internal Med, Boston, MA USA

[8] Boston Univ, Sch Med, Sect Hematol & Med Oncol, Boston, MA USA

[9] Boston Univ, Sch Med, Dept Med, Renal Sect, Boston, MA USA

[10] MIT, Inst Med Engn & Sci, Cambridge, MA USA

[11] Univ Vermont, Larner Coll Med, Dept Pathol & Lab Med, Burlington, VT USA

[12] Baylor Coll Med, One Baylor Plaza,011DF, Houston, TX 77030 USA

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2023年 / 41卷 / 16期

关键词：

PATIENTS RECEIVING CHEMOTHERAPY; VENOUS THROMBOEMBOLISM; PREDICTION; THROMBOPROPHYLAXIS; SCORE;

D O I：

10.1200/JCO.22.01542

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

PURPOSE Venous thromboembolism (VTE), especially pulmonary embolism (PE) and lower extremity deep vein thrombosis (LE-DVT), is a serious and potentially preventable complication for patients with cancer undergoing systemic therapy. METHODS Using retrospective data from patients diagnosed with incident cancer from 2011-2020, we derived a parsimonious risk assessment model (RAM) using least absolute shrinkage and selection operator regression from the Harris Health System (HHS, n59,769) and externally validated it using the Veterans Affairs (VA) health care system (n 5 79,517). Bootstrapped c statistics and calibration curves were used to assess external model discrimination and fit. Dichotomized risk strata using integer scores were created and compared against the Khorana score (KS). RESULTS Incident VTE and PE/LE-DVT at 6 months occurred in 590 (6.2%) and 437 (4.6%) patients in HHS and 4,027 (5.1%) and 3,331 (4.2%) patients in the VA health care system. Assessed at the time of systemic therapy initiation, the new RAM included components of the KS with the modified cancer subtype, cancer staging, systemic therapy class, history of VTE, history of paralysis/immobility, recent hospitalization, and Asian/Pacific Islander race. The c statistic was 0.71 in HHS and 0.68 in the VA health care system (compared with 0.65 and 0.60, respectively, for KS). Furthermore, the new RAM appropriately reclassified 28% of patients and increased the proportion of VTEs in the high-risk group from 37% to 68% in the validation data set. CONCLUSION The novel RAM stratified patients with cancer into a high-risk group with 8%-10% cumulative incidence of VTE and 7% PE/LE-DVT at 6 months (v 3% and 2%, respectively, in the low-risk group). The model had improved performance over the original KS and doubled the number of VTE events in the high-risk stratum. We encourage additional external validation from prospective studies.

引用

页码：2926 / +

页数：14

共 21 条

[21] Construction of a TAN-associated risk score model with integrated multi-omics data analysis and clinical validation in gastric cancer [J].

Xu, Zhangdi ;

Zhang, Lan ;

Wang, Xiaping ;

Pan, Bihui ;

Zhu, Mingxia ;

Wang, Tongshan ;

Xu, Wei ;

Li, Lin ;

Wei, Yong ;

Wu, Jiazhu ;

Zhou, Xin .

LIFE SCIENCES, 2024, 349

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