Predicting the risk of cancer after unprovoked venous thromboembolism: external validation of the RIETE score

Bertoletti, Laurent; Robin, Philippe; Jara-Palomares, Luis; Tromeur, Cécile; Pastré, Jean; Prévôt-Bitot, Nathalie; Mouneh, T.; Gal, Grégoire Le; Salaun, Pierre–Yves; A, Armand; Boisjolly, J.M. de; Bordot, A.S.; Dambrine, S.; Delori, M.; Derrien, B.; Guillaume, Benoı̂t; Lavigne, Christian; Loison, J.; Pattier, K.; Roy, Pierre‐Marie; Barnier, Anne; Blanc, Jean-Claude; Cornily, J.-C.; Couturaud, O.; Delluc, Aurélien; Gut-Gobert, Christophe; Jaffrelot, Morgan; Lacut, Karine; Leroyer, Christophe; Hénaff, M. Le; Moigne, E. Le; Mottier, Dominique; Paleiron, Nicolas; Pasquier, Elisabeth; Pennec, Pierre-Yves; Quéré, Gilles; Roge, C.; Martin, L. de Saint; Belmont, L.; Gosset, Marie; Meyer, Guy; Mourin, G.; Planquette, Benjamin; Roux, Anne-Laure; Sanchez, Olivier; Wermert, Delphine; Accassat, Sandrine; Bost, V.; Buchmüller, Andréa; Décousus, Hervé; Décousus, M.; Merah, Adel; Rivron-Guillot, Karine; Robert, Francisco; Tardy, Bernard; Torris, P.

doi:10.1111/jth.13842

Cited by 25 publications

(19 citation statements)

References 7 publications

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“…Age, prior provoked VTE and smoking habit were identified as predictors of occult cancer in patients with first unprovoked VTE. Recently, our score was been validated in a post hoc analysis from the MVTEP study [ 9 , 19 ]. In this study, authors validated the score, but the main limitation was that they did not collect data on chronic lung disease and to obtain validation they replaced tobacco instead of chronic lung disease.…”

Section: Discussionmentioning

confidence: 99%

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Validation of a prognostic score for hidden cancer in unprovoked venous thromboembolism

et al. 2018

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The usefulness of a diagnostic workup for occult cancer in patients with venous thromboembolism (VTE) is controversial. We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) database to perform a nested case-control study to validate a prognostic score that identifies patients with unprovoked VTE at increased risk for cancer. We dichotomized patients as having low- (≤2 points) or high (≥3 points) risk for cancer, and tried to validate the score at 12 and 24 months. From January 2014 to October 2016, 11,695 VTE patients were recruited. Of these, 1,360 with unprovoked VTE (11.6%) were eligible for the study. At 12 months, 52 patients (3.8%; 95%CI: 2.9–5%) were diagnosed with cancer. Among 905 patients (67%) scoring ≤2 points, 22 (2.4%) had cancer. Among 455 scoring ≥3 points, 30 (6.6%) had cancer (hazard ratio 2.8; 95%CI 1.6–5; p<0.01). C-statistic was 0.63 (95%CI 0.55–0.71). At 24 months, 58 patients (4.3%; 95%CI: 3.3–5.5%) were diagnosed with cancer. Among 905 patients scoring ≤2 points, 26 (2.9%) had cancer. Among 455 patients scoring ≥3 points, 32 (7%) had cancer (hazard ratio 2.6; 95%CI 1.5–4.3; p<0.01). C-statistic was 0.61 (95%CI, 0.54–0.69). We validated our prognostic score at 12 and 24 months, although prospective cohort validation is needed. This may help to identify patients for whom more extensive screening workup may be required.

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Section: Discussionmentioning

confidence: 99%

“…Our score helped to identify the most common sites of cancer according to gender and age subgroups. Moreover, this score has been externally validated but only after replacing one variable, and this implies a limitation [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Validation of a prognostic score for hidden cancer in unprovoked venous thromboembolism

et al. 2018

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“…A new scoring system has been developed recently in the RIETE registry to identify patients at high risk for occult cancer 30 days to 24 months after VTE. 19,40,41 It comprises 7 items: male sex, age >70 years, chronic lung disease, anemia, elevated platelet count ≥350 000 × 1000/mm 3 , prior VTE, and recent surgery, with the last 2 items scoring negative points. Twelve percent of patients were diagnosed with cancer when the score was higher than or equal to 3 points, compared with 5.8% when it was lower than or equal to 2 points.…”

Section: Practical Implications Of Occult Cancer Screening In Patientmentioning

confidence: 99%

Occult cancer and thromboembolism: current epidemiology and its practical implication

Chao¹,

Wang²,

Kao³

2018

Polish Archives of Internal Medicine

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Venous thromboembolism (VTE) may be the first presentation of malignancy. Up to 10% of patients with unprovoked VTE are diagnosed with occult cancer within 1 year. Cancer patients with concomitant VTE have a worse outcome. While limited screening strategy (thorough medical history, physical examination, basic laboratory tests, and chest X‑ray) and extensive screening strategy (limited screening plus computed tomography scan of the abdomen/pelvis or 18F-fluorodeoxyglucose positron emission tomography-computed tomography) have a similar ability to detect early-stage cancer and improve morbidity and mortality of cancer patients with unprovoked VTE, the extensive screening strategy has been shown to diagnose occult cancer earlier. Among the risk factors for occult cancer in patients with unprovoked VTE, age is the most promising one. The risk of occult cancer detection increases with age. The newly developed RIETE score helps identify risk of occult cancer and might decrease unnecessary diagnostic procedures in lower-risk patients. Current guidelines suggest that patients with first unprovoked VTE undergo limited screening, with age- and sex-specific cancer screening, including colon, breast, cervical, and prostate cancers.

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“…Several clinical and analytical factors have revealed a predictive value for the identification of patients with uVTE at increased risk of cancer [14][15][16][17]. The Computerized Registry of Patients with Venous Thromboembolism (RIETE) score was validated for this purpose, with the highest risk being present in patients who meet three or more of the following criteria: male gender, age equal or superior to 70 years, chronic lung disease, anemia, thrombocytosis, previous VTE and recent surgery [18].…”

Section: Introductionmentioning

confidence: 99%

Cancer Screening in Patients with Unprovoked Thromboembolism: How to do it and Who Benefits?

Ferreira¹,

Pereira²,

Lynce³

et al. 2020

Cureus

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Predicting the risk of cancer after unprovoked venous thromboembolism: external validation of the RIETE score

Cited by 25 publications

References 7 publications

Validation of a prognostic score for hidden cancer in unprovoked venous thromboembolism

Validation of a prognostic score for hidden cancer in unprovoked venous thromboembolism

Occult cancer and thromboembolism: current epidemiology and its practical implication

Cancer Screening in Patients with Unprovoked Thromboembolism: How to do it and Who Benefits?

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