A New Risk Prediction Model for Venous Thromboembolism and Death in Ambulatory Lung Cancer Patients

Abstract

(1) Background: Venous thromboembolism (VTE) is a frequent complication in ambulatory lung cancer patients during chemotherapy and is associated with increased mortality. (2) Methods: We analyzed 568 newly diagnosed metastatic lung cancer patients prospectively enrolled in the HYPERCAN study. Blood samples collected before chemotherapy were tested for thrombin generation (TG) and a panel of hemostatic biomarkers. The Khorana risk score (KRS), new-Vienna CATS, PROTECHT, and CONKO risk assessment models (RAMs) were applied. (3) Results: Within 6 months, the cumulative incidences of VTE and mortality were 12% and 29%, respectively. Patients with VTE showed significantly increased levels of D-dimer, FVIII, prothrombin fragment 1 + 2, and TG. D-dimer and ECOG performance status were identified as independent risk factors for VTE and mortality by multivariable analysis and utilized to generate a risk score that provided a cumulative incidence of VTE of 6% vs. 25%, death of 19% vs. 55%, and in the low- vs. high-risk group, respectively (p < 0.001). While all published RAMs significantly stratified patients for risk of death, only the CATS and CONKO were able to stratify patients for VTE. (4) Conclusions: A new prediction model was generated to stratify lung cancer patients for VTE and mortality risk, where other published RAMs failed.

Novel Insights in Venous Thromboembolism Risk Assessment Methods in Ambulatory Cancer Patients: From the Guidelines to Clinical Practice

“…In ambulatory oncologic patients, the VTE risk stratification by CONKO was suboptimal [49,52], although in the Hispanic population the results were more encouraging [56]. HYPERSCAN study reported that CONKO scores significantly stratified patients for VTE risk, while the KRS and the PROTECHT failed in ambulatory lung cancer patients [59]. In this setting, future research is awaited.…”

“…Papinger et al proposed a modified Vienna CATS, the CATS/MICA score, that integrated the tumor site category and D-dimer level to predict the VTE risk in ambulatory patients with solid cancers [61]. The new Vienna CATS and the CONKO scores significantly stratified patients for VTE risk in lung cancer [59]. Verzeroli et al reported that a modified Vienna CATS score > 60 points was an independent risk factor for mortality in outpatients with metastatic cancer during chemotherapy [41].…”

“…In newly diagnosed NSCLC outpatients who undergo chemotherapy, Thrombo-NSCLC (FVIII and sP-selectin values) predicted VTE significantly better than the Khorana score [76]. Gomez-Rosas et al recently proposed a new risk tool, the Hypercan score, to stratify lung cancer patients for VTE and mortality risk [59]. This score contains information regarding ECOG performance and D dimer and stratifies the patients into low-and high-risk groups [59].…”

“…Gomez-Rosas et al recently proposed a new risk tool, the Hypercan score, to stratify lung cancer patients for VTE and mortality risk [59]. This score contains information regarding ECOG performance and D dimer and stratifies the patients into low-and high-risk groups [59]. Using the Hypercan score, the cumulative incidence of VTE was 6% in the low-and 25% in the high-risk group [59].…”

“…This score contains information regarding ECOG performance and D dimer and stratifies the patients into low-and high-risk groups [59]. Using the Hypercan score, the cumulative incidence of VTE was 6% in the low-and 25% in the high-risk group [59]. Li et al proposed and validated a new nomogram for VTE risk prediction in patients recently diagnosed with lung cancer [77].…”