Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
Department of Internal Medicine, Tergooi Hospitals, Hilversum, The Netherlands.
J Thromb Haemost. 2020 Oct;18(10):2622-2628. doi: 10.1111/jth.15001. Epub 2020 Aug 4.
The Registro Informatizado de Pacientes con Enfermedad TromboEmbólica (RIETE) score and the Screening for Occult Malignancy in Patients with Idiopathic Venous Thromboembolism (SOME) risk scores aim to identify patients with acute unprovoked venous thromboembolism (VTE) at high risk of occult cancer, but their predictive performance is unclear.
The scores were evaluated in an individual patient data meta-analysis. Studies were eligible if enrolling consecutive adults with unprovoked VTE who underwent protocol-mandated screening for cancer. The primary outcome was a cancer diagnosis between 30 days and 2 years of follow-up. The discriminatory performance was evaluated by computing the area under the receiver (ROC) curve in random-effects meta-analyses.
The RIETE score could be calculated in 1753 patients, of whom 63 (3.6%) were diagnosed with cancer. The pooled area under the ROC curve was 0.59 (95% confidence interval [CI], 0.52-0.66; I = 0%). Of the 427 patients (24%) classified as high risk, 25 (5.9%) were diagnosed with cancer compared with 38 of 1326 (2.9%) low-risk patients (hazard ratio [HR], 2.0; 95% CI, 1.3-3.4). The SOME score was calculated in 925 patients, of whom 37 (4.0%) were diagnosed with cancer. The pooled area under the ROC curve was 0.56 (95% CI, 0.46-0.65; I = 46%). Of the 161 patients (17%) classified as high risk (≥2 points), eight (5.0%) were diagnosed with cancer compared with 29 of 764 (3.8%) low-risk patients (HR, 1.2; 95% CI, 0.55-2.7).
The predictive discriminatory performance of both scores is poor. When used dichotomously, the RIETE score is able to discriminate between low- and high-risk patients. Because this is largely driven by advanced age, these results do not support the use of these scores in daily clinical practice.
Registro Informatizado de Pacientes con Enfermedad TromboEmbólica（RIETE）评分和Screening for Occult Malignancy in Patients with Idiopathic Venous Thromboembolism（SOME）风险评分旨在识别急性无诱因静脉血栓栓塞症（VTE）患者中存在隐匿性癌症的高风险患者，但它们的预测性能尚不清楚。
该评分在个体患者数据荟萃分析中进行了评估。符合条件的研究为连续纳入无诱因 VTE 成年患者，并进行了癌症筛查。主要结局为 30 天至 2 年随访期间的癌症诊断。通过计算随机效应荟萃分析中的接收器（ROC）曲线下面积来评估判别性能。
RIETE 评分可用于 1753 例患者，其中 63 例（3.6%）被诊断为癌症。ROC 曲线下面积的合并值为 0.59（95%置信区间[CI]，0.52-0.66；I=0%）。在 427 例（24%）被归类为高危的患者中，有 25 例（5.9%）被诊断为癌症，而在 1326 例（2.9%）低危患者中，有 38 例被诊断为癌症（危险比[HR]，2.0；95%CI，1.3-3.4）。SOME 评分可用于 925 例患者，其中 37 例（4.0%）被诊断为癌症。ROC 曲线下面积的合并值为 0.56（95%置信区间[CI]，0.46-0.65；I=46%）。在 161 例（17%）被归类为高危（≥2 分）的患者中，有 8 例（5.0%）被诊断为癌症，而在 764 例低危患者中，有 29 例（3.8%）被诊断为癌症（HR，1.2；95%CI，0.55-2.7）。
两种评分的预测判别性能均较差。当使用二分法时，RIETE 评分能够区分低危和高危患者。由于这主要是由高龄驱动的，因此这些结果不支持在日常临床实践中使用这些评分。
