Department of Clinical Sciences, Danderyd Hospital, Division of Internal Medicine, Karolinska Institutet, Stockholm, Sweden.
Palliative Care Services and R&D-unit, Stockholms Sjukhem Foundation, Stockholm, Sweden.
J Thromb Thrombolysis. 2019 Jul;48(1):111-118. doi: 10.1007/s11239-019-01822-z.
The association between venous thromboembolism (VTE) and occult cancer is well established. However, the benefit of cancer screening in all VTE patients remains controversial. The Registro Informatizado Enfermedad TromboEmbólica (RIETE) score is a recently proposed risk score to identify VTE patients at high risk of occult cancer. We evaluated the performance of the RIETE score in a routine clinical setting comprising patients presenting with VTE between January 1 and December 31, 2014, at Danderyd University hospital. Out of 488 VTE patients, 47 (9.6%) patients received a new cancer diagnosis during a 24-month follow-up. After exclusion of patients with cancer diagnosed at baseline (≤ 10 days after VTE, n = 16), 472 patients were considered eligible for cancer screening. Among these 472 patients, 31 (6.6%) received a cancer diagnosis during follow-up. The cumulative incidence was high after both unprovoked (8.5%) and provoked (4.8%) VTE. The RIETE score was evaluated in 467 of these patients. Interestingly, a high RIETE score was not significantly associated with cancer diagnosis during follow-up (OR 1.78; 95% CI 0.85-3.63), which was mainly due to a poor performance in women (OR 1.04; 95% CI 0.30-2.83). In summary, we observed a relatively high incidence of occult cancer in both unprovoked and provoked VTE. The RIETE score performed poorly in identifying patients at high risk of occult cancer in our VTE population. Additional risk assessment models are warranted to identify VTE patients who would benefit from extensive cancer screening.
静脉血栓栓塞症（VTE）与隐匿性癌症之间的关联已得到充分证实。然而，在所有 VTE 患者中进行癌症筛查的益处仍存在争议。最近提出的 RIETE 评分是一种风险评分，用于识别 VTE 患者中隐匿性癌症风险较高的患者。我们评估了 RIETE 评分在常规临床环境中的表现，该环境包括 2014 年 1 月 1 日至 12 月 31 日在 Danderyd 大学医院就诊的 VTE 患者。在 488 例 VTE 患者中，47 例（9.6%）患者在 24 个月的随访中诊断出新癌症。排除基线时诊断出癌症的患者（VTE 后≤10 天，n=16）后，472 例患者有资格进行癌症筛查。在这 472 例患者中，31 例（6.6%）在随访期间被诊断出癌症。在未诱发（8.5%）和诱发（4.8%）VTE 后，累积发生率均较高。在其中 467 例患者中评估了 RIETE 评分。有趣的是，高 RIETE 评分与随访期间的癌症诊断无显著相关性（OR 1.78；95%CI 0.85-3.63），这主要是由于女性的表现不佳（OR 1.04；95%CI 0.30-2.83）。总之，我们观察到在未诱发和诱发的 VTE 中隐匿性癌症的发生率相对较高。RIETE 评分在识别我们的 VTE 人群中隐匿性癌症风险较高的患者方面表现不佳。需要额外的风险评估模型来识别可能从广泛癌症筛查中获益的 VTE 患者。
