Derivation and Validation of a Clinical Risk Assessment Model for Cancer-Associated Thrombosis in Two Unique US Health Care Systems.
Derivation and Validation of a Clinical Risk Assessment Model for Cancer-Associated Thrombosis in Two Unique US Health Care Systems.
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DOI：
10.1200/jco.22.01542
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发表时间：
2023-06-01
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静脉血栓栓塞症(VTE)，特别是肺栓塞(PE)和下肢深静脉血栓形成(LE-DVT)，是接受系统治疗的癌症患者的严重和潜在的可预防的并发症。使用2011-2020年被诊断为癌症的患者的回顾数据，我们从Harris Health System(HHS，n=9,769)中使用最小绝对收缩和选择算子回归推导出简约性风险评估模型(RAM)，并使用退伍军人事务部(VA)医疗保健系统(n=79,517)进行外部验证。使用自举c统计量和校准曲线来评估外部模型的区分度和拟合度。建立了使用整数评分的二分法风险层，并与Khorana评分(KS)进行了比较。6个月时发生VTE和PE/LE-DVT的HHS患者分别为590例(6.2%)和437例(4.6%)，VA医疗系统为4027例(5.1%)和3331例(4.2%)。在系统治疗开始时进行评估，新的随机存取存储器包括KS的组成部分，包括改良的癌症亚型、癌症分期、系统治疗类别、静脉血栓栓塞史、瘫痪/静止病史、最近住院和亚洲/太平洋岛民种族。卫生保健系统和退伍军人保健系统的c统计量分别为0.71和0.68(而KS分别为0.65和0.60)。此外，新的随机存取存储器适当地对28%的患者进行了重新分类，并在验证数据集中将高危组的VTE比例从37%增加到68%。新的RAM将癌症患者分层为高危组，6个月时VTE累积发生率为8%-10%，PE/LE-DVT为7%(低危组分别为3%和2%)。该模型改进了原始KS的性能，并使高风险层中的VTE事件数量翻了一番。我们鼓励来自前瞻性研究的更多外部验证。
Venous thromboembolism (VTE), especially pulmonary embolism (PE) and lower extremity deep vein thrombosis (LE-DVT), is a serious and potentially preventable complication for patients with cancer undergoing systemic therapy. Using retrospective data from patients diagnosed with incident cancer from 2011-2020, we derived a parsimonious risk assessment model (RAM) using least absolute shrinkage and selection operator regression from the Harris Health System (HHS, n = 9,769) and externally validated it using the Veterans Affairs (VA) health care system (n = 79,517). Bootstrapped c statistics and calibration curves were used to assess external model discrimination and fit. Dichotomized risk strata using integer scores were created and compared against the Khorana score (KS). Incident VTE and PE/LE-DVT at 6 months occurred in 590 (6.2%) and 437 (4.6%) patients in HHS and 4,027 (5.1%) and 3,331 (4.2%) patients in the VA health care system. Assessed at the time of systemic therapy initiation, the new RAM included components of the KS with the modified cancer subtype, cancer staging, systemic therapy class, history of VTE, history of paralysis/immobility, recent hospitalization, and Asian/Pacific Islander race. The c statistic was 0.71 in HHS and 0.68 in the VA health care system (compared with 0.65 and 0.60, respectively, for KS). Furthermore, the new RAM appropriately reclassified 28% of patients and increased the proportion of VTEs in the high-risk group from 37% to 68% in the validation data set. The novel RAM stratified patients with cancer into a high-risk group with 8%-10% cumulative incidence of VTE and 7% PE/LE-DVT at 6 months (v 3% and 2%, respectively, in the low-risk group). The model had improved performance over the original KS and doubled the number of VTE events in the high-risk stratum. We encourage additional external validation from prospective studies.