Development and Validation of a Risk Score for Prediction of Venous Thromboembolism in Patients With Lung Cancer

Abstract

This study aimed to develop and validate a risk score for early prediction of venous thromboembolism (VTE) in patients with lung cancer. A total of 827 patients with lung cancer from February 2013 to February 2018 in our hospital were retrospectively analyzed. Demographic and clinicopathological variables independently correlated to VTE were applied to develop the risk score in the development group while examined in the validation group. The regression coefficients of multivariable logistic regression test were applied to assign a risk score system. The incidence of VTE was 12.3%, 12.7%, and 11.8% in all patients, in the development and validation groups, respectively. The 496 patients in the development group were classified into 3 groups: low risk (scores ≤3), moderate risk (scores 4-5), and high risk (scores ≥6). The risk of VTE was significantly and positively related to the risk scores in both development and validation groups. The risk score system aided proper stratification of patients with either high or low risk of VTE in the development and validation groups ( c statistic = 0.819 and 0.827, respectively). This risk score system based on the factors with most significant correlation showed good predictive ability and is potentially useful for predicting VTE in patients with lung cancer. However, it was developed and validated by a retrospective analysis and has significant limitations, and a prospective validation with all the classic variables assessing the thrombotic risk is needed for a solid conclusion.

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).…”

“…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.…”

Risk Factors and Prediction Models for Venous Thromboembolism in Ambulatory Patients with Lung Cancer

“…Smoking [ 25 ] and recent hospitalisation [ 23 , 24 ] also raise the risk of VTE. It is believed that the Asian race has a lower risk than other races [ 26 ]. Factor V Leiden and prothrombin 20210A mutations are relatively common in Caucasians whereas they are very rare in Asians [ 27 , 28 ].…”

“…Cancer treatment is a strong risk factor for VTE, and commonly used chemotherapy drugs can increase the risk of this clinical condition [ 25 , 26 , 36 ]. For example, gemcitabine-based chemotherapy increases the risk of VTE, with a reported odds ratio of 3.37 (95% CI 1.09–10.39) [ 23 ].…”

“…In addition, VTE was more likely to occur within the first six months of the commencement of standard chemotherapy [ 24 ]. In terms of the mechanisms involved, they are probably related to vascular endothelial damage caused by chemotherapy, especially in patients who receive the medications through central venous catheterisation over a long period [ 25 , 26 , 36 ].…”