Development and validation of a predictive model for chemotherapy-associated thrombosis
Development and validation of a predictive model for chemotherapy-associated thrombosis
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DOI：
10.1182/blood-2007-10-116327
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发表时间：
2008-05-15
期刊：
影响因子：
20.3
通讯作者：
Francis, Charles W.
中科院分区：
文献类型：
--
作者：
Khorana, Alok A.;Kuderer, Nicole M.;Francis, Charles W.
静脉血栓栓塞（VTE）的风险在癌症中升高，但个体风险因素不能识别出足够高风险的门诊患者进行血栓预防。我们开发了一个简单的模型，预测化疗相关的静脉血栓栓塞使用基线临床和实验室变量。在一项前瞻性观察性研究的2701例癌症门诊患者的衍生队列中，描述了VTE与多个变量的相关性。在同一研究的1365例患者的独立队列中推导并验证了风险模型。在多变量模型中确定了五个预测变量：癌症部位（极高危部位2分，高危部位1分），血小板计数≥ 350 × 10（9）/L，血红蛋白<100 g/L（10 g/dL）和/或使用红细胞生成刺激剂，白细胞计数≥ 11 × 10（9）/L，体重指数35 kg/m2或以上（各1分）。在中位数2.5个月内，推导和验证队列中的VTE发生率分别为0.8%和0.3%（低风险（评分= 0）），1.8%和2%（中风险（评分= 1-2）），7.1%和6.7%（高风险（评分>= 3））（两个队列的C统计量= 0.7）。该模型可以识别出有症状性静脉血栓栓塞短期风险接近7%的患者，并可用于选择癌症门诊患者进行血栓预防研究。
Risk of venous thromboembolism (VTE) is elevated in cancer, but individual risk factors cannot identify a sufficiently high-risk group of outpatients for thromboprophylaxis. We developed a simple model for predicting chemotherapy-associated VTE using baseline clinical and laboratory variables. The association of VTE with multiple variables was characterized in a derivation cohort of 2701 cancer outpatients from a prospective observational study. A risk model was derived and validated in an independent cohort of 1365 patients from the same study. Five predictive variables were identified in a multivariate model: site of cancer (2 points for very high-risk site, 1 point for high-risk site), platelet count of 350 x 10(9)/L or more, hemoglobin less than 100 g/L (10 g/dL) and/or use of erythropoiesis-stimulating agents, leukocyte count more than 11 x 10(9)/L, and body mass index of 35 kg/m(2) or more (1 point each). Rates of VTE in the derivation and validation cohorts, respectively, were 0.8% and 0.3% in low-risk (score = 0), 1.8% and 2% in intermediate-risk (score = 1-2), and 7.1% and 6.7% in high-risk (score >= 3) category over a median of 2.5 months (C-statistic = 0.7 for both cohorts). This model can identify patients with a nearly 7% short-term risk of symptomatic VTE and may be used to select cancer outpatients for studies of thromboprophylaxis.