Clinical outcome in patients with venous thromboembolism and hidden cancer: findings from the RIETE Registry

Abstract

To cite this article: Trujillo-Santos J, Prandoni P, Rivron-Guillot K, Romá n P, Sá nchez R, Tiberio G, Monreal M, the RIETE Investigators. Clinical outcome in patients with venous thromboembolism and hidden cancer: findings from the RIETE Registry. J Thromb Haemost 2008; 6: 251-5.See also Sørensen HT, Johnsen SP. Venous thromboembolism and subsequent short-term risk of an occult cancer. This issue, pp 249-50.Summary. Introduction: Although extensive screening in patients with venous thromboembolism (VTE) may result in early identification of hidden cancer, it is unknown whether the prognosis of these patients may be favorably influenced. Patients and methods: RIETE is an ongoing, prospective registry of consecutive patients with objectively confirmed, symptomatic, acute VTE. We compared the 3-month outcome of patients with hidden cancer with that in patients in whom no symptoms of cancer were noted. Results: Of 17 475 patients with acute VTE, 2852 (16%) had cancer diagnosed before VTE or during admission. Hidden cancer was detected in 178 (1.2%) of the remaining 14 623 patients. The most common sites were lung, prostate, colorectum, or hematologic, and 51% had metastases. As compared with patients in whom no symptoms of cancer were noted, those with hidden cancer had an increased incidence of recurrent VTE (11.4% vs. 2.1%; P < 0.001), major bleeding (5.1% vs. 2.1%; P = 0.007), and mortality (20% vs. 5.4%; P < 0.001). In the multivariate analysis, patients aged 60-75 years [odds ratio 1.8; 95% CI 1.2-2.7], with idiopathic VTE (odds ratio 3.0; 95% CI 2.2-4.2), with bilateral thrombosis (odds ratio 2.3; 95% CI 1.3-4.1) or with anemia (odds ratio 1.9; 95% CI 1.4-2.6) were at an increased risk for hidden cancer. Conclusions: VTE patients with hidden cancer have an increased incidence of recurrences, major bleeding or death during the first 3 months of therapy. With four simple, easily obtainable variables, it is possible to identify a subgroup of VTE patients with a higher risk for hidden cancer.

White blood cell count and mortality in patients with acute pulmonary embolism

“…Our findings are consistent with a retrospective study reporting an independent association between an elevated WBC count (>11.0 3 10 9 /L) and 30-day mortality in 150 patients with PE [19]. Similarly, data from the RIETE registry showed that an elevated WBC is significantly associated with adverse outcomes in patients with acute venous thromboembolism who have cancer [24].…”

Begrenset malignitetsutredning ved idiopatisk venøs trombose

“…As we did not find any differences between men and women either, both genders should be screened to the same extent. Earlier studies have indicated that the location of the thrombosis has a bearing on the the probability of underlying malignancy (22,23) and that certain types of cancer are more strongly associated with venous thromboembolism than others (4,21,24). We found no evidence of this in our material.…”

“…In contrast to the findings of a number of other studies, we found no difference in age distribution between those who developed cancer during the first year and those who did not. This indicates that malignancy screening should not only be carried out for the over 60s age group, as some have proposed (6,21,22). As we did not find any differences between men and women either, both genders should be screened to the same extent.…”

Biomarkers for prediction of venous thromboembolism in cancer

“…7 In the Registro Informatizado de la Enfermedad Trombo-Embólica (RIETE) registry that included 3805 cancer patients with acute VTE, those with leukocytosis had a 1.6-fold increased risk of recurrent VTE. 8 The exact causative role of leukocytosis in cancer-related VTE remains to be elucidated. It was shown that tumors release inflammatory cytokines into the circulation that activate tissue factor expressed on monocytes and endothelial cells.…”