Thromb Haemost 2018; 118(07): 1270-1278
DOI: 10.1055/s-0038-1649523
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Risk Scores for Occult Cancer in Patients with Venous Thromboembolism: A Post Hoc Analysis of the Hokusai-VTE Study

Noémie Kraaijpoel
1  Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
,
Nick van Es
1  Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
,
Gary E. Raskob
2  College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Harry R. Büller
1  Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
,
Marc Carrier
3  Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, Ontario, Canada
,
George Zhang
4  Daiichi Sankyo Inc., Basking Ridge, New Jersey, United States
,
Min Lin
4  Daiichi Sankyo Inc., Basking Ridge, New Jersey, United States
,
Michael A. Grosso
4  Daiichi Sankyo Inc., Basking Ridge, New Jersey, United States
,
Marcello Di Nisio
1  Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
5  Department of Medicine and Ageing Sciences, G. D'Annunzio University, Chieti, Italy
› Author Affiliations
Further Information

Publication History

31 January 2018

07 April 2018

Publication Date:
04 June 2018 (eFirst)

Abstract

Venous thromboembolism (VTE) may be the first sign of an undiagnosed cancer. In patients with unprovoked VTE, the risk is approximately 5% in the year following VTE diagnosis. Cancer-specific screening is therefore often considered in these patients, but the optimal screening strategy remains controversial. Recently, two risk classification scores have been proposed that may help in identifying patients at high risk of occult cancer in whom extensive screening may be warranted. In the present post hoc analysis of the Hokusai-VTE study, we evaluated the performance of the Registro Informatizado de Pacientes con Enfermedad TromboEmbólica (RIETE) and Screening for Occult Malignancy in Patients with Idiopathic Venous Thromboembolism (SOME) scores for occult cancer in patients with acute VTE. A total of 8,032 patients were included in the analysis of whom 218 (2.7%; 95% confidence interval [CI], 2.4–3.1) developed cancer between 30-day and 12-month follow-up. The c-statistics of the RIETE and SOME scores were 0.62 (95% CI, 0.57–0.66) and 0.59 (95% CI, 0.55–0.62), respectively. In patients classified as ‘high risk’, the cumulative incidence of cancer diagnosis during follow-up was 2.9% (95% CI, 2.1–3.9) for the RIETE score and 2.7% (95% CI, 1.9–3.7) for the SOME score, corresponding to hazard ratios of 1.8 (95% CI, 1.3–2.5) and 1.5 (95% CI, 1.04–2.2), respectively. In conclusion, the performance of both scores was poor. When used dichotomously, the scores were able to identify a group of patients with a significantly higher risk of occult cancer, although it remains unknown whether this translates into improved clinical important outcomes.

Authors' Contributions

Study conception and design: N. Kraaijpoel, N. van Es, H.R. Büller, M. Di Nisio.


Data acquisition: N. Kraaijpoel, N. van Es, G. Zhang, M. Lin, M. Di Nisio.


Statistical analysis: G. Zhang, M. Lin.


Interpretation of the data: N. Kraaijpoel, N. van Es, G. E. Raskob, H.R. Büller, M. Carrier, G. Zhang, M. Lin, M.A. Grosso, M. Di Nisio.


Drafting of the manuscript: N. Kraaijpoel, N. van Es, M. Di Nisio.


Critical revision of the manuscript for important intellectual content: N. Kraaijpoel, N. van Es, G.E. Raskob, H.R. Büller, M. Carrier, G. Zhang, M. Lin, M.A. Grosso, M. Di Nisio.


Final approval of the manuscript: N. Kraaijpoel, N. van Es, G. E. Raskob, H.R. Büller, M. Carrier, G. Zhang, M. Lin, M.A. Grosso, M. Di Nisio.


Supplementary Material