Preventing Venous Thromboembolism in Ambulatory Cancer Patients: The ONKOTEV Study
Preventing Venous Thromboembolism in Ambulatory Cancer Patients: The ONKOTEV Study
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DOI：
10.1634/theoncologist.2016-0246
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发表时间：
2017-01-01
期刊：
影响因子：
5.8
通讯作者：
De Placido, Sabino
中科院分区：
文献类型：
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作者：
Cella, Chiara Alessandra;Di Minno, Giovanni;De Placido, Sabino
背景风险模型评分预测门诊癌症患者静脉血栓栓塞（VTE）的有效性正在调查中，旨在根据个体风险对癌症人群的子集进行分层，这些癌症人群可能主要受益于初级血栓预防。我们前瞻性评估了843例活动性癌症患者，收集了临床和实验室数据。我们用双功能超声（B型成像和多普勒波形分析）对所有患者的上肢和下肢进行筛查，以评估VTE（无症状和有症状）的正确发生率。我们还在我们的人群中探索了现有Khorana风险模型预防VTE的有效性。分析了与静脉血栓栓塞相关的几个危险因素，从而构建了一个风险模型。在新模型的推导过程中，采用精细灰色模型将死亡作为一种竞争风险考虑。在单变量分析中与VTE显著相关的风险因素，在Bootstrap验证后，在多变量分析中进一步证实，是转移性疾病的存在，肿瘤压迫血管/淋巴结构，既往VTE病史和Khorana评分>2。时间依赖性受试者工作特征（ROC）曲线分析显示，在3个月（71.9% vs. 57.9%，p= 0.001）、6个月（75.4% vs. 58.6%，p= 0.001）、6个月（75.4% vs.
Background. The efficacy of risk model scores to predict venous thromboembolism (VTE) in ambulatory cancer patients is under investigation, aiming to stratify on an individual risk basis the subset of the cancer population that could mostly benefit from primary thromboprophylaxis.Materials and Methods. We prospectively assessed 843 patients with active cancers, collecting clinical and laboratory data. We screened all the patients with a duplex ultrasound (B-mode imaging and Doppler waveform analysis) of the upper and lower limbs to evaluate the right incidence of VTE (both asymptomatic and symptomatic). The efficacy of the existing Khorana risk model in preventing VTE was also explored in our population. Several risk factors associated with VTE were analyzed, leading to the construction of a risk model. The Fine and Gray model was used to account for death as a competing risk in the derivation of the new model.Results. The risk factors significantly associated with VTE at univariate analysis and further confirmed in the multivariate analysis, after bootstrap validation, were the presence of metastatic disease, the compression of vascular/lymphatic structures by tumor, a history of previous VTE, and a Khorana score >2. Time-dependent receiving operating characteristic (ROC) curve analysis showed a significant improvement in the area under the curve of the new score over the Khorana model at 3 months (71.9% vs. 57.9%, p=.001), 6 months (75.4% vs. 58.6%, p