预测癌症相关静脉血栓栓塞的维也纳CATScore：多时间点的外部验证
The Vienna CATScore for predicting cancer-associated venous thromboembolism: an external validation across multiple time points.
作者信息
Englisch C, Nopp S, Moik F, Starzer A M, Quehenberger P, Preusser M, Berghoff A S, Ay C, Pabinger I
机构信息
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
出版信息
ESMO Open. 2025 Feb;10(2):104130. doi: 10.1016/j.esmoop.2024.104130. Epub 2025 Jan 31.
BACKGROUND
Patients with cancer undergoing systemic therapies have a high risk for venous thromboembolism (VTE). Risk assessment models were developed to select high-risk subgroups that might benefit from primary thromboprophylaxis, yet currently available models reportedly underperform in contemporary cancer treatment populations and risk models across multiple time points throughout therapy are not available.
PATIENTS AND METHODS
We, therefore, aimed to validate the Vienna CATScore, a nomogram-based model including tumor type and continuous D-dimer levels, in a prospective cohort study of patients initiating contemporary systemic anticancer therapies. The validity of the model was tested at study inclusion, 3 weeks, and 3 months after start of therapy.
RESULTS
Overall, 598 patients were included [49% women, median age 62 years (interquartile range 53-70 years)]. Most patients had stage IV disease (68.2%). The 6-month cumulative incidence of VTE was 9.2% [95% confidence interval (CI) 6.8% to 11.5%]. The Vienna CATScore demonstrated good discriminatory ability (c-statistics: 0.69, 95% CI 0.61-0.76) at study baseline and across all evaluated time points (c-statistics: 0.68, 95% CI 0.63-0.73). Applying a 6-month predicted VTE risk threshold of 8%, the CATScore effectively distinguished between low- and high-risk groups at study inclusion (7.1% versus 15.1% observed VTE risk, P = 0.004) and across all three time points (6.3% versus 13.6% observed VTE risk, P < 0.001). Assuming a 50% risk reduction with thromboprophylaxis, this threshold resulted in a number needed to treat (NNT) of 13 and 15, respectively, in the high-risk group, while the NNT was 28 and 32, respectively, in the low-risk group.
CONCLUSIONS
This external validation of the Vienna CATScore confirms its effectiveness in predicting VTE risk in the initial months of state-of-the-art systemic anticancer therapies and across multiple time points.
背景
接受全身治疗的癌症患者发生静脉血栓栓塞（VTE）的风险很高。已开发出风险评估模型来选择可能从一级血栓预防中获益的高危亚组，但据报道，目前可用的模型在当代癌症治疗人群中的表现不佳，且在整个治疗过程中的多个时间点均没有可用的风险模型。
患者与方法
因此，我们旨在对Vienna CATScore进行验证，这是一种基于列线图的模型，包括肿瘤类型和连续D-二聚体水平，该验证在一项针对开始当代全身抗癌治疗的患者的前瞻性队列研究中进行。在研究纳入时、治疗开始后3周和3个月对该模型的有效性进行测试。
结果
总体而言，纳入了598例患者[49%为女性，中位年龄62岁（四分位间距53 - 70岁）]。大多数患者患有IV期疾病（68.2%）。VTE的6个月累积发病率为9.2%[95%置信区间（CI）6.8%至11.5%]。Vienna CATScore在研究基线时以及所有评估时间点均显示出良好的区分能力（c统计量：0.69，95%CI 0.61 - 0.76）（c统计量：0.68，95%CI 0.63 - 0.73）。应用6个月预测VTE风险阈值8%，CATScore在研究纳入时有效地区分了低风险组和高风险组（观察到的VTE风险分别为7.1%和15.1%，P = 0.004），并且在所有三个时间点均如此（观察到的VTE风险分别为6.3%和13.6%，P < 0.001）。假设血栓预防可使风险降低50%，该阈值导致高危组的治疗所需人数（NNT）分别为13和15，而低危组的NNT分别为28和32。
结论
对Vienna CATScore的这项外部验证证实了其在预测最新全身抗癌治疗最初几个月以及多个时间点的VTE风险方面的有效性。
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