A new risk-assessment tool for venous thromboembolism in advanced lung cancer: a prospective, observational study

Abstract

Management of cancer-associated venous thromboembolism (VTE) is essential in treatment selection and cancer prognosis. However, to date, there is no method to assess the risk of VTE specifically associated with advanced lung cancer. Our aim was to create a new risk assessment scoring system that can predict the concomitant or incidence of VTE in advanced lung cancer. We used the dataset of 1008 patients with lung cancer in the Rising-VTE/NEJ037 study, of which 100 (9.9%) developed VTE. The items extracted in the multivariate analysis included female sex, adenocarcinoma, performance status, N factor, lymphocyte count, platelet count, prothrombin fragment 1 + 2, and diastolic blood pressure. This model had a maximum score of 8 points, with ≥ 5 points indicating a high risk of VTE. This simple risk-assessment model for VTE complications with advanced lung cancer could help identify cases that required monitoring for VTE.

Derivation, validation and assessment of a novel nomogram-based risk assessment model for venous thromboembolism in hospitalized patients with lung cancer: A retrospective case control study

“…Based on our analysis, the results showed that patients with adenocarcinoma have an approximately 3-fold higher risk of developing VTE than that of non-adenocarcinom apopulation. This result is consistent with the findings of previous studies (19,21,35). There is also clear evidence that patients with adenocarcinoma was associated with a markedly higher risk of VTE compared with other pathological types (8,35).…”

“…According to the results of the logistic regression analyses, we established a simplified eleven-variables nomogram model, which contains four clinical variables(BMI, histology, clinical stage and CVC history), four biomarkers(D-dimer, PT, Fbg and TG), oncogenic abnormalities(ROS-1 rearrangement) and history of previous radiotherapy and chemotherapy treatment. Many of the risk factors of cancer-associated VTE identified in this analysis, particularly in lung cancer, were mostly consistent with those of the previous literatures (18)(19)(20)(21). Among the numerous risk factors, it is widely accepted that higher BMI were patient-related risk factors related to VTE.…”

“…There is also clear evidence that patients with adenocarcinoma was associated with a markedly higher risk of VTE compared with other pathological types (8,35). Another recent studies by Tsubata et al (19) and Li et al (21) has demonstrated that adenocarcinoma was one of the most powerful predictors for VTE development in the predictive scoring system. These studies led to widespread belief that adenocarcinoma plays a critical role in activating procoagulants factors by secreting mucin that may result in thrombus formation.…”

“…score system (19)(20)(21). However, few studies have been performed for the development of novel nomograms for the prediction of VTE in lung cancer patients, particularly given other factors influencing cancer-associated VTE such as genetic and therapeutic factors (31).Therefore, with a specific focus on both genetic and therapeutic factors, we developed and validated a simple yet highly discriminating, well-calibrated, and parsimonious nomogram prediction model for the occurrence of VTE in hospitalized lung cancer patients in this study, which can provide a theoretical basis for clinical decision-making on Decision curve analysis (DCA) for assessment of the clinical utility for thromboprophylaxis.…”

Cancer Histology and Natural History of Patients with Lung Cancer and Venous Thromboembolism

“…However, the histology of lung cancer was not considered. A number of studies in the literature suggest that patients with adenocarcinoma (with or without VTE) may have a worse outcome than those with squamous or other types of lung cancer [ 1 , 3 , 13 , 14 , 15 , 16 ]. Better knowledge of the potential impact of lung cancer histology on outcome might likely help to design better therapeutic strategies for patients with lung cancer.…”