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.
Keywords
venous thrombosis - deep vein thrombosis - pulmonary embolism - cancer
