A clinical practice-based evaluation of the RIETE score in predicting occult cancer in patients with venous thromboembolism

Rosell, Axel; Lundström, Staffan; Mackman, Nigel; Wallén, Håkan; Thålin, Charlotte

doi:10.1007/s11239-019-01822-z

Cited by 12 publications

(7 citation statements)

References 20 publications

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“…Following these encouraging findings, four independent studies evaluated the RIETE score in more than 10,000 patients with provoked VTE in various settings. [13][14][15]31 A random-effects meta-analysis of the performance of the dichotomized RIETE score confirms that the risk of an underlying cancer is approximately twofold higher in those with 3 points or more (in summary, RR: 2.09; 95% CI: 1.57-2.78; ►Fig. 3).…”

Section: Risk Factors For Presence Of Occult Cancer In Patients With mentioning

confidence: 87%

“…30 A history of cancer should also alert clinicians for cancer, which could be either new or recurrent disease. 30,31 Finally, D-dimer levels obtained at VTE diagnosis also appear to be positively correlated with the risk of occult cancer. 11,32 For example, in a retrospective study of 824 VTE patients, cancer was diagnosed four times more frequently in those with D-dimer levels >4,000 ng/mL than in those with levels <2,000 ng/mL.…”

Section: Risk Factors For Presence Of Occult Cancer In Patients With mentioning

confidence: 99%

“…This study will evaluate whether platelet mRNA sequencing could serve as a pan-cancer diagnostic tool, possibly enabling clinical advances in blood-based "liquid biopsies." 31 Other biomarkers that will be assessed include ctDNA and a proteomics-based approach. The study aims to include 462 patients who will be followed for 12 months.…”

Section: Ongoing Studies and Closing Remarksmentioning

confidence: 99%

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Screening for Occult Cancer in Patients with Venous Thromboembolism: Past, Present, and Future

Jara‐Palomares

2020

Hamostaseologie

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A strong link between cancer and thrombosis has been well recognized. The occurrence of venous thromboembolism (VTE) can be the first clinical sign of an undiagnosed (i.e., occult) cancer. Cancer is more often diagnosed after unprovoked compared with provoked VTE events, with a reported risk in recent studies of around 5%. Extensive, imaging-based screening strategies to detect occult cancer after unprovoked VTE do not appear to have a clear clinical benefit compared with a more limited cancer screening. To identify patients with unprovoked VTE at high risk of occult cancer, risk factors have been explored and prediction models developed. Relevant risk factors for occult cancer include male sex, age, anemia, chronic lung disease, and thrombocytosis. Studies with preselection of patients based on risk assessment and evaluation of limited versus extensive screening strategies are currently ongoing. Also, novel and promising approaches for early detection of cancer in patients with unprovoked VTE by means of liquid biopsies, which include analysis of circulating tumor cells, cell-free tumor DNA, proteomics, or platelet mRNA sequencing, are currently under investigation. In this review, we provide an overview of the risk of cancer diagnosis after VTE, discuss the studies which investigated different screening strategies for occult cancer, summarize risk factors and risk scoring models for identification of patients at high risk of cancer diagnosis after VTE, and highlight ongoing research to optimize screening and identification of patients at risk of occult cancer, which will shape the future clinical practice.

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Section: Risk Factors For Presence Of Occult Cancer In Patients With mentioning

confidence: 87%

Section: Risk Factors For Presence Of Occult Cancer In Patients With mentioning

confidence: 99%

Section: Ongoing Studies and Closing Remarksmentioning

confidence: 99%

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Screening for Occult Cancer in Patients with Venous Thromboembolism: Past, Present, and Future

Jara‐Palomares

2020

Hamostaseologie

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“…However, several studies have shown no difference between cancer incidence after provoked and unprovoked VTE: one third of occult cancers in RIETE were found in patients with provoking risk factors. In a subgroup analysis of the RIETE registry, Rossel et al found a high cumulative incidence of cancer in both unprovoked and provoked VTE cases (8.5% and 4.8%, p = 0.12) [ 30 ]. Furthermore, a similar effect was observed in the Hokusai VTE trial population, with similar cancer risks between provoked and unprovoked events (2.1% vs. 1.8%) [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

The Conundrum of Occult Cancer Screening in Venous Thromboembolism: Lessons from the REMOTEV Registry

et al. 2022

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(1) Background and Objectives: Venous thromboembolism (VTE) is strongly associated with cancer, and may be the first event revealing occult neoplasia. Nonetheless, the reasonable extent of the etiological assessment after an unprovoked VTE event remains debated. The main objective of this study was to evaluate the incidence of occult neoplasia one year after an episode of VTE, in consecutively hospitalized patients for VTE from the REMOTEV registry. The secondary objectives were to assess the performance of the various tests used for occult cancer screening in a real-life setting and analyze the risk factors associated with the discovery of cancer and the 1-year prognosis. (2) Methods: REMOTEV is a prospective, non-interventional cohort study of patients with acute VTE. Patients included in the registry from 23 October 2013 to 28 July 2018 were analyzed after a follow-up of 12 months. Cancer detection was performed according to local practices and consisted of a limited strategy to which an abdominal ultrasound was added. In the presence of suggestive clinical manifestations, further examinations were performed on an individual basis. (3) Results: A total of 993 patients were included in the study. At 1 year, the incidence of newly diagnosed cancer was low (5.3%). Half of the detected cancers were metastatic at discovery (51%) and had a poor global prognosis (32% of mortality at 1 year). Admission pulmonary CT scans as well as (thoracic)-abdomino-pelvic CT scans (when performed) were responsible for the majority of detected cancers. Age over 65 years and the concomitant presence of an unusual site and lower-limb deep vein thrombosis were the only factors associated with occult neoplasia in this cohort. After 1-year FU, mortality was higher in cancer patients (HR 6.0 (CI 95% 3.5–10.3, p < 0.0001)), and cancer evolution was the leading cause of death in the cancer group. (4) Conclusions: In REMOTEV, VTE-revealed occult cancer prevalence was low, but similar to recent reports and associated with higher age, multiple thrombotic sites and worse prognosis.

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“…14 However, another study found that a high RIETE score was not significantly associated with cancer diagnosis, a finding ascribed to poor predictive ability in women. 15 Improved clinical tools are needed to identify patients at high-risk for occult malignancy who may benefit from more aggressive screening for cancer.…”

Section: Scoring Systems For Vte Prognosticationmentioning

confidence: 99%

Screening for occult cancer after unprovoked venous thromboembolism: Assessing the current literature and future directions

Patel

Tao

McMurry

et al. 2022

European J of Haematology

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While significant evidence has established an increased rate of thrombosis in patients with cancer, the risk of occult malignancy in the setting of an unprovoked thrombosis is less clear. Despite continued interest in developing an effective screening system for occult malignancy following unprovoked venous thromboembolism (VTE), discrepancies in the literature and guideline recommendations leave providers uncertain whether to screen or perform further diagnostics for this patient population. Evidence suggests that screening for malignancy can detect cancer sooner in patients with unprovoked VTE, but there is a lack of high-quality evidence demonstrating improvements in survival who receive early detection. In the following manuscript, we summarize VTE in relation to cancer epidemiology and pathophysiology. Our literature review summarizes the spectrum of testing strategies for occult malignancy following unprovoked VTE, including biomarker detection methods and various imaging approaches. We evaluate the benefit of additional diagnostic strategies, review current guidelines on the issue, and provide guidance to the reader on the best practice for investigating undiagnosed malignancy in patients with unprovoked VTE.

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A clinical practice-based evaluation of the RIETE score in predicting occult cancer in patients with venous thromboembolism

Cited by 12 publications

References 20 publications

Screening for Occult Cancer in Patients with Venous Thromboembolism: Past, Present, and Future

Screening for Occult Cancer in Patients with Venous Thromboembolism: Past, Present, and Future

The Conundrum of Occult Cancer Screening in Venous Thromboembolism: Lessons from the REMOTEV Registry

Screening for occult cancer after unprovoked venous thromboembolism: Assessing the current literature and future directions

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