Cella Chiara Alessandra, Di Minno Giovanni, Carlomagno Chiara, Arcopinto Michele, Cerbone Anna Maria, Matano Elide, Tufano Antonella, Lordick Florian, De Simone Biagio, Muehlberg Katja Sibylle, Bruzzese Dario, Attademo Laura, Arturo Claudia, Sodano Marta, Moretto Roberto, La Fata Ersilia, De Placido Sabino
Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
University Cancer Center Leipzig (UCCL), University Medicine, Leipzig, Germany.
Oncologist. 2017 May;22(5):601-608. doi: 10.1634/theoncologist.2016-0246. Epub 2017 Apr 19.
The efficacy of risk model scores to predict venous thromboembolism (VTE) in ambulatory cancer patients is under investigation, aiming to stratify on an individual risk basis the subset of the cancer population that could mostly benefit from primary thromboprophylaxis.
We prospectively assessed 843 patients with active cancers, collecting clinical and laboratory data. We screened all the patients with a duplex ultrasound (B-mode imaging and Doppler waveform analysis) of the upper and lower limbs to evaluate the right incidence of VTE (both asymptomatic and symptomatic). The efficacy of the existing Khorana risk model in preventing VTE was also explored in our population. Several risk factors associated with VTE were analyzed, leading to the construction of a risk model. The Fine and Gray model was used to account for death as a competing risk in the derivation of the new model.
The risk factors significantly associated with VTE at univariate analysis and further confirmed in the multivariate analysis, after bootstrap validation, were the presence of metastatic disease, the compression of vascular/lymphatic structures by tumor, a history of previous VTE, and a Khorana score >2. Time-dependent receiving operating characteristic (ROC) curve analysis showed a significant improvement in the area under the curve of the new score over the Khorana model at 3 months (71.9% vs. 57.9%, = .001), 6 months (75.4% vs. 58.6%, < .001), and 12 months (69.8% vs. 58.3%, = .014).
ONKOTEV score steps into history of cancer-related-VTE as a promising tool to drive the decision about primary prophylaxis in cancer outpatients. The validation represents the goal of the prospective ONKOTEV-2 study, endorsed and approved by the European Organization for Research and Treatment of Cancer Young Investigators Program. 2017;22:601-608 IMPLICATIONS FOR PRACTICE: Preventing venous thromboembolism in cancer outpatients with a risk model score will drive physicians' decision of starting thromboprophylaxis in high-risk patients.
正在研究风险模型评分预测门诊癌症患者静脉血栓栓塞（VTE）的疗效，旨在根据个体风险对最能从一级血栓预防中获益的癌症患者亚组进行分层。
我们前瞻性评估了843例活动性癌症患者，收集临床和实验室数据。我们对所有患者进行了上下肢双功超声检查（B型成像和多普勒波形分析），以评估VTE的实际发生率（包括无症状和有症状的）。我们还在我们的人群中探讨了现有Khorana风险模型预防VTE的疗效。分析了与VTE相关的几个风险因素，从而构建了一个风险模型。在推导新模型时，使用Fine和Gray模型将死亡作为竞争风险进行考量。
单因素分析中与VTE显著相关且在多因素分析中经自抽样验证后进一步得到证实的风险因素包括存在转移性疾病、肿瘤对血管/淋巴管结构的压迫、既往VTE病史以及Khorana评分>2。时间依赖性接受者操作特征（ROC）曲线分析显示，新评分在3个月时曲线下面积较Khorana模型有显著改善（71.9%对57.9%，P = 0.001），6个月时（75.4%对58.6%，P < 0.001），以及12个月时（69.8%对58.3%，P = 0.014）。
ONKOTEV评分作为一种有前景的工具进入了癌症相关VTE的历史，可用于指导癌症门诊患者一级预防的决策。该验证是前瞻性ONKOTEV - 2研究的目标，该研究得到了欧洲癌症研究与治疗组织青年研究者计划的认可和批准。2017；22：601 - 608对实践的启示：使用风险模型评分预防癌症门诊患者的静脉血栓栓塞将推动医生对高危患者启动血栓预防的决策。
