Cancer Biology and Therapeutics, INSERM U938, Institut Universitaire de Cancérologie (IUC), Faculté de Médecine Pierre et Marie Curie, Université Pierre et Marie Curie (UPMC), Sorbonne Universités, Paris, France
Service d'Hématologie Biologique Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique Hôpitaux de Paris, Paris, France.
Oncologist. 2017 Oct;22(10):1222-1231. doi: 10.1634/theoncologist.2016-0414. Epub 2017 May 26.
The stratification of outpatients on chemotherapy for breast, colorectal, lung, and ovarian cancers at risk of venous thromboembolism (VTE) remains an unmet clinical need. The derivation of a risk assessment model (RAM) for VTE in these patients was the aim of the study "Prospective Comparison of Methods for thromboembolic risk assessment with clinical Perceptions and AwareneSS in real life patients-Cancer Associated Thrombosis" (COMPASS-CAT).
The derivation cohort consisted of 1,023 outpatients. Patients on low molecular weight heparin (LMWH) thromboprophylaxis were excluded. Documented symptomatic VTE was the endpoint of the study.
Patients had breast (61%), colorectal (17%), lung (13%), or ovarian cancer (8.6%) at localized (30%) or advanced stage (70%). In 64% of patients, cancer was diagnosed within the last 6 months prior to inclusion. Most of them were on chemotherapy when assessed. Symptomatic VTE occurred in 8.5% of patients. The COMPASS-CAT RAM includes the following variables: (a) anthracycline or antihormonal therapy, (b) time since cancer diagnosis, (c) central venous catheter, (d) stage of cancer, (e) presence of cardiovascular risk factors, (f) recent hospitalization for acute medical illness, (g) personal history of VTE, and (h) platelet count. At 6 months, patients stratified at low/intermediate and high-risk groups had VTE rates of 1.7% and 13.3%, respectively. The area under the curve of receiver operating characteristics analysis was 0.85. The sensitivity and specificity of the RAM were 88% and 52%, respectively. The negative and positive predictive values of the RAM were 98% and 13%, respectively.
The COMPASS-CAT RAM includes reliable and easily collected VTE risk predictors and, in contrast to the Khorana score, it is applicable after the initiation of anticancer treatment in patients with common solid tumors. Its robustness for stratification of patients at high and low/intermediate VTE risk needs to be externally validated.
The Prospective Comparison of Methods for thromboembolic risk assessment with clinical Perceptions and AwareneSS in real life patients-Cancer Associated Thrombosis (COMPASS-CAT) study provides a new risk assessment model (RAM) for venous thromboembolism (VTE) applicable in outpatients with breast, colorectal, lung or ovarian cancer. The COMPASS-CAT RAM is robust, applicable during chemotherapy and determines the need for VTE prévention by including reliable and easily collected VTE predictors associated with cancer status, its treatment as well as with patients' characteristics and comorbidities. An independent external validation of the RAM is indicated before its use in clinical practice.
对于有静脉血栓栓塞（VTE）风险的乳腺癌、结直肠癌、肺癌和卵巢癌患者，需要对门诊患者进行分层，但这仍然是一个未满足的临床需求。该研究“前瞻性比较血栓栓塞风险评估方法与真实患者的临床认识和意识-癌症相关血栓形成”（COMPASS-CAT）旨在为这些患者开发 VTE 风险评估模型（RAM）。
推导队列包括 1023 名门诊患者。接受低分子肝素（LMWH）血栓预防治疗的患者被排除在外。有症状的 VTE 是本研究的终点。
患者的癌症分别为局限性（30%）或晚期（70%）乳腺癌（61%）、结直肠癌（17%）、肺癌（13%）或卵巢癌（8.6%）。在 64%的患者中，癌症是在纳入前的最近 6 个月内诊断出来的。大多数患者在评估时正在接受化疗。8.5%的患者发生有症状的 VTE。COMPASS-CAT RAM 包括以下变量：（a）蒽环类药物或抗激素治疗，（b）癌症诊断后的时间，（c）中心静脉导管，（d）癌症分期，（e）心血管危险因素存在，（f）最近因急性内科疾病住院，（g）个人 VTE 病史，（h）血小板计数。在 6 个月时，低/中危和高危组患者的 VTE 发生率分别为 1.7%和 13.3%。受试者工作特征曲线下面积为 0.85。RAM 的灵敏度和特异性分别为 88%和 52%。RAM 的阴性预测值和阳性预测值分别为 98%和 13%。
COMPASS-CAT RAM 包括可靠且易于收集的 VTE 风险预测因素，与 Khorana 评分相比，它适用于接受常见实体瘤治疗的癌症患者。需要进一步的外部验证来证实该模型在高危和低/中危 VTE 风险分层中的稳健性。
前瞻性比较方法的血栓栓塞风险评估与临床认知和意识在真实患者中的应用-癌症相关血栓形成（COMPASS-CAT）研究提供了一种新的静脉血栓栓塞（VTE）风险评估模型（RAM），适用于乳腺癌、结直肠癌、肺癌或卵巢癌的门诊患者。COMPASS-CAT RAM 稳健，可在化疗期间应用，并通过纳入与癌症状态、治疗以及患者特征和合并症相关的可靠且易于收集的 VTE 预测因素来确定 VTE 预防的必要性。在临床实践中使用之前，需要对 RAM 进行独立的外部验证。
