Department of Neurology, Brain Tumor Center & Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland.
Division of Oncology, Department of Medicine 1, Medical University of Vienna, 18-20 Waehringer Guertel, AT-1090, Vienna, Austria.
Eur J Cancer. 2020 Jul;134:75-85. doi: 10.1016/j.ejca.2020.04.018. Epub 2020 May 27.
Venous thromboembolic events (VTEs) are significant complications in patients with systemic malignancies. Thrombosis risk is poorly defined for patients with brain metastasis, and available risk calculation scores are not validated for these patients.
We identified 811 patients with brain metastasis followed at our institution and reviewed electronic charts retrospectively for the occurrence of VTEs, along with candidate risk factors. Risk factors were tested in univariate and multivariate analyses and finally integrated in a score model for risk estimation. An independent cohort of 346 patients with brain metastasis was available for validation.
VTEs were documented in 97 of 811 patients (12.0%). Primary tumours with high thrombogenicity (p = 0.02, hazard ratio 1.7, 95% confidence interval (CI) = 1.1-2.8), dexamethasone (p = 0.011, hazard ratio 2.27, 95% CI = 1.5-4.5), chemotherapy (p = 0.005, hazard ratio 3.4, 95% CI = 1.6-7.5), body mass index > 35 kg/m (p = 0.002, hazard ratio 3.4, 95% CI = 1.6-7.5) and immobilisation (p = 0.003, hazard ratio 2.4, 95% CI = 1.3-4.3) were confirmed to be independently associated with VTEs. We derived a score model for VTE risk estimation, the thrombogenic primary, immobilization, chemotherapy, obesity, steroid (PICOS) score (0-7 points). Receiver-operating characteristic curve analysis demonstrated its prognostic accuracy (area under the curve [AUC] = 0.71, 95% CI = 0.64-0.77), and its value for the evaluation of VTE risk was superior to that of other scores such as the Khorana (AUC = 0.51) or CONKO (AUC = 0.52) scores. The potential value of the PICOS score was confirmed in the validation cohort (AUC = 0.72, 95% CI = 0.63-0.82).
The PICOS score may become a helpful tool for the identification of patients with brain metastasis at high risk for VTEs and for stratification in controlled studies.
静脉血栓栓塞事件（VTE）是系统性恶性肿瘤患者的严重并发症。患有脑转移的患者的血栓形成风险尚未明确，且现有的风险计算评分并未针对这些患者进行验证。
我们在本机构中确定了 811 例患有脑转移的患者，并回顾性地查阅了电子病历，以了解 VTE 的发生情况以及候选风险因素。在单因素和多因素分析中测试了这些危险因素，并最终将其整合到一个风险评估评分模型中。另有 346 例脑转移患者的独立队列用于验证。
811 例患者中，97 例（12.0%）记录到 VTE。具有高血栓形成性的原发性肿瘤（p=0.02，风险比 1.7，95%置信区间（CI）=1.1-2.8）、地塞米松（p=0.011，风险比 2.27，95%CI=1.5-4.5）、化疗（p=0.005，风险比 3.4，95%CI=1.6-7.5）、体重指数（BMI）>35kg/m2（p=0.002，风险比 3.4，95%CI=1.6-7.5）和固定不动（p=0.003，风险比 2.4，95%CI=1.3-4.3）被证实与 VTE 独立相关。我们得出了一个用于 VTE 风险评估的评分模型，即血栓形成性原发性肿瘤、固定不动、化疗、肥胖、类固醇（PICOS）评分（0-7 分）。受试者工作特征曲线分析表明其具有良好的预后准确性（曲线下面积[AUC]为 0.71，95%CI=0.64-0.77），并且其评估 VTE 风险的价值优于其他评分，如 Khorana（AUC=0.51）或 CONKO（AUC=0.52）评分。在验证队列中也证实了 PICOS 评分的潜在价值（AUC=0.72，95%CI=0.63-0.82）。
PICOS 评分可能成为识别脑转移患者 VTE 高危人群并在对照研究中进行分层的有用工具。
