1
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Alikhan R, Gomez K, Maraveyas A, Noble S, Young A, Thomas M. Cancer-associated venous thrombosis in adults (second edition): A British Society for Haematology Guideline. Br J Haematol 2024; 205:71-87. [PMID: 38664942 DOI: 10.1111/bjh.19414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 07/13/2024]
Abstract
A shared decision on the most appropriate agent for the treatment of cancer-associated thrombosis should consider the following factors, which should be reassessed as patients continue along their cancer care pathway: risk of bleeding; tumour site; suitability of oral medications; potential for drug-drug interactions; and patient preference and values regarding choice of drug. Continuing anticoagulation beyond 6 months in patients with cancer-associated venous thromboembolism and active cancer is recommended.
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Affiliation(s)
- Raza Alikhan
- University Hospital of Wales, Cardiff, UK
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Keith Gomez
- Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
| | - Anthony Maraveyas
- Centre for Clinical Sciences, The Hull York Medical School, York, UK
| | - Simon Noble
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Annie Young
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Mari Thomas
- University College London Hospitals NHS Foundation Trust, London, UK
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2
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Walker CA, Edwards C, McIntire D, Makepeace L, Holloway SB, Kakadiaris E, Spirtos AN, Miller DS, Lea JS. Predicting VTE and utility of thromboprophylaxis in metastatic and recurrent cervical cancer. Gynecol Oncol 2024; 188:22-26. [PMID: 38875744 DOI: 10.1016/j.ygyno.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 05/25/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE Patients with cervical cancer who are diagnosed with venous thromboembolism (VTE) have worse outcomes compared to those not affected. There has yet to be a reliable method to predict or prevent VTE in cervical cancer patients. Our objective is to describe the incidence of VTE in patients with recurrent and metastatic (r/mCC) and determine risk factors that may predict VTE in this setting. METHODS We performed an observational cohort study of 386 patients with r/mCC who received at least one line of systemic chemotherapy. We collected demographic, clinical, histologic data and Khorana scores for all patients. Inclusion and exclusion criteria were applied before analysis. Statistical analysis was performed using Pearson chi-square, Student's t-test, and Wilcoxon rank-sum. RESULTS 232 patients were included for evaluation. Mean age was 49 years (range 20-83). The majority (167, 72%) of patients had squamous cell histology. 169 (72.8%) patients received treatment for recurrent disease and 63 (27.2%) for metastatic, stage IVB disease. 180 (78%) patients received prior radiation and 134 (58%) received bevacizumab. VTE was diagnosed in 89 (38%) patients. There were no statistically significant differences amongst clinical and pathologic characteristics between patients who developed VTE and those who did not. There was no significant association between BMI, Khorana score, radiation, bevacizumab, or immunotherapy and the development of VTE. CONCLUSION Approximately 40% of patients with r/mCC experienced a new VTE. There were no independent risk factors that could predict VTE in this population. Due to the overwhelmingly high incidence of VTE, prophylactic anticoagulation could be strongly considered in patients with r/mCC.
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Affiliation(s)
- Christopher A Walker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Carson Edwards
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Don McIntire
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Lydia Makepeace
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Steven Blaine Holloway
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Ev Kakadiaris
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Alexandra N Spirtos
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - David S Miller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Jayanthi S Lea
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
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3
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Roy DC, Wang TF, Lun R, Zahrai A, Mallick R, Burger D, Zitikyte G, Hawken S, Wells P. Circulating Blood Biomarkers and Risk of Venous Thromboembolism in Cancer Patients: A Systematic Review and Meta-Analysis. Thromb Haemost 2024. [PMID: 38768631 DOI: 10.1055/a-2330-1371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Cancer patients have an increased risk of venous thromboembolism (VTE). Currently, the availability of highly discriminatory prediction models for VTE in cancer patients is limited. The implementation of biomarkers in prediction models might lead to refined VTE risk prediction. In this systematic review and meta-analysis, we aimed to evaluate candidate biomarkers and their association with cancer-associated VTE. METHODS We searched Medline, EMBASE, and Cochrane Central for studies that evaluated biomarkers in adult cancer patients from inception to September 2022. We included studies reporting on VTE after a cancer diagnosis with biomarker measurements performed at a defined time point. Median/mean differences (for continuous measures) and odds ratios (for dichotomous measures) with 95% confidence intervals were estimated and pooled using random-effects models. RESULTS We included 113 studies in the systematic review. Of these, 50 studies were included in the meta-analysis. We identified two biomarkers at cancer diagnosis (factor VIII and time to peak thrombin), three biomarkers pre-chemotherapy (D-dimer, fibrinogen, and mean platelet volume), and one biomarker preoperatively (platelet count) that had significant median or mean differences. Additionally, we found that hemoglobin <100 g/L and white blood count >11 × 109/L were significantly associated with future VTE risk only when measured at cancer diagnosis. Pre-chemotherapy neutrophil-to-lymphocyte ratio ≥3 and preoperative platelet count ≥400 × 109/L were also found to be associated with future VTE risk. CONCLUSION In conclusion, this study identified nine candidate blood biomarkers that may help in optimizing VTE prediction in cancer patients that should be further explored in future studies.
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Affiliation(s)
- Danielle Carole Roy
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Tzu-Fei Wang
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ronda Lun
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Vascular Neurology, Stanford Healthcare, Palo Alto, California, United States
| | - Amin Zahrai
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Dylan Burger
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gabriele Zitikyte
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Steven Hawken
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Philip Wells
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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4
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Li R, Chen S, Xia J, Zhou H, Shen Q, Li Q, Dong Q. Predictive modeling of deep vein thrombosis risk in hospitalized patients: A Q-learning enhanced feature selection model. Comput Biol Med 2024; 175:108447. [PMID: 38691912 DOI: 10.1016/j.compbiomed.2024.108447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/23/2024] [Accepted: 04/07/2024] [Indexed: 05/03/2024]
Abstract
Deep vein thrombosis (DVT) represents a critical health concern due to its potential to lead to pulmonary embolism, a life-threatening complication. Early identification and prediction of DVT are crucial to prevent thromboembolic events and implement timely prophylactic measures in high-risk individuals. This study aims to examine the risk determinants associated with acute lower extremity DVT in hospitalized individuals. Additionally, it introduces an innovative approach by integrating Q-learning augmented colony predation search ant colony optimizer (QL-CPSACO) into the analysis. This algorithm, then combined with support vector machines (SVM), forms a bQL-CPSACO-SVM feature selection model dedicated to crafting a clinical risk prognostication model for DVT. The effectiveness of the proposed algorithm's optimization and the model's accuracy are assessed through experiments utilizing the CEC 2017 benchmark functions and predictive analyses on the DVT dataset. The experimental results reveal that the proposed model achieves an outstanding accuracy of 95.90% in predicting DVT. Key parameters such as D-dimer, normal plasma prothrombin time, prothrombin percentage activity, age, previously documented DVT, leukocyte count, and thrombocyte count demonstrate significant value in the prognostication of DVT. The proposed method provides a basis for risk assessment at the time of patient admission and offers substantial guidance to physicians in making therapeutic decisions.
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Affiliation(s)
- Rizeng Li
- Department of General Surgery, The Second Affiliated Hospital of Shanghai University (Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, China.
| | - Sunmeng Chen
- Department of General Surgery, The Second Affiliated Hospital of Shanghai University (Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, China.
| | - Jianfu Xia
- Department of General Surgery, The Second Affiliated Hospital of Shanghai University (Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, China.
| | - Hong Zhou
- Department of General Surgery, The Second Affiliated Hospital of Shanghai University (Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, China.
| | - Qingzheng Shen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
| | - Qiang Li
- School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China.
| | - Qiantong Dong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
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Tsantes AG, Petrou E, Tsante KA, Sokou R, Frantzeskaki F, Domouchtsidou A, Chaldoupis AE, Fortis SP, Piovani D, Nikolopoulos GK, Iacovidou N, Bonovas S, Samonis G, Tsantes AE. Cancer-Associated Thrombosis: Pathophysiology, Laboratory Assessment, and Current Guidelines. Cancers (Basel) 2024; 16:2082. [PMID: 38893201 PMCID: PMC11171168 DOI: 10.3390/cancers16112082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Dysregulated hemostasis in cancer patients is associated with various clinical conditions, from thromboembolic complications to disseminated intravascular coagulation. Despite the well-established association between cancer and thromboembolic complications, the mechanisms involved are not completely elucidated. There are several predisposing factors in cancer for increased thrombus generation, such as immobilization and chemotherapy. The term cancer-associated thrombosis (CAT) has been introduced to describe the close bidirectional relationship between cancer and thromboembolic events. Conventional coagulation tests (PT/aPTT) are more accurate in detecting a hypocoagulable rather than a hypercoagulable state; thus, their contribution to CAT management is limited. Traditionally, D-dimer levels have been the most common laboratory study for the evaluation of thrombotic risk. However, D-dimer levels only display a snapshot of the coagulation cascade, and they cannot provide a dynamic evaluation of evolving clot formation. Non-conventional assays, such as viscoelastic methods and microparticle formation are promising tools for the identification of patients at risk for developing CAT. Recent guidelines from the American Society of Clinical Oncology counsel against the estimation of thrombotic risk through a single test and recommend the use of scoring systems that take into account several risk factors. The present review outlines the current insights into the pathophysiological mechanisms of CAT and provides a comprehensive review of the latest advances in the laboratory assessment of CAT and the recent guidelines for the management of patients at risk for developing thromboembolic complications.
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Affiliation(s)
- Andreas G. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.P.); (K.A.T.); (A.E.C.); (A.E.T.)
- Microbiology Department, “Saint Savvas” Oncology Hospital, 11522 Athens, Greece;
| | - Eleni Petrou
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.P.); (K.A.T.); (A.E.C.); (A.E.T.)
| | - Konstantina A. Tsante
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.P.); (K.A.T.); (A.E.C.); (A.E.T.)
| | - Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 18454 Piraeus, Greece;
| | - Frantzeska Frantzeskaki
- 2nd Department of Critical Care, Attikon Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Aglaia Domouchtsidou
- Microbiology Department, “Saint Savvas” Oncology Hospital, 11522 Athens, Greece;
| | - Anastasios E. Chaldoupis
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.P.); (K.A.T.); (A.E.C.); (A.E.T.)
| | - Sotirios P. Fortis
- Laboratory of Reliability and Quality Control in Laboratory Hematology (HemQcR), Department of Biomedical Sciences, Section of Medical Laboratories, School of Health & Caring Sciences, University of West Attica (UniWA), 12243 Egaleo, Greece;
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | | | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - George Samonis
- Department of Medicine, University of Crete, 71500 Heraklion, Greece;
- Department of Oncology, Metropolitan Hospital, 18547 Athens, Greece
| | - Argyrios E. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.P.); (K.A.T.); (A.E.C.); (A.E.T.)
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Turizo MJF, Patell R, Zwicker JI. Identifying novel biomarkers using proteomics to predict cancer-associated thrombosis. BLEEDING, THROMBOSIS AND VASCULAR BIOLOGY 2024; 3:120. [PMID: 38828226 PMCID: PMC11143428 DOI: 10.4081/btvb.2024.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/08/2024] [Indexed: 06/05/2024]
Abstract
Comprehensive protein analyses of plasma are made possible by high-throughput proteomic screens, which may help find new therapeutic targets and diagnostic biomarkers. Patients with cancer are frequently affected by venous thromboembolism (VTE). The limited predictive accuracy of current VTE risk assessment tools highlights the need for new, more targeted biomarkers. Although coagulation biomarkers for the diagnosis, prognosis, and treatment of VTE have been investigated, none of them have the necessary clinical validation or diagnostic accuracy. Proteomics holds the potential to uncover new biomarkers and thrombotic pathways that impact the risk of thrombosis. This review explores the fundamental methods used in proteomics and focuses on particular biomarkers found in VTE and cancer-associated thrombosis.
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Affiliation(s)
- Maria J Fernandez Turizo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Rushad Patell
- Division of Medical Oncology and Hematology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jeffrey I Zwicker
- Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weil Cornell Medical College, New York, NY, United States
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7
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Ji Y, Qin Y, Tan Q, Qiu Y, Han S, Qi X. Development of a chemiluminescence assay for tissue plasminogen activator inhibitor complex and its applicability to gastric cancer. BMC Biotechnol 2024; 24:30. [PMID: 38720310 PMCID: PMC11080135 DOI: 10.1186/s12896-024-00850-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/17/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Venous thromboembolism (VTE), is a noteworthy complication in individuals with gastric cancer, but the current diagnosis and treatment methods lack accuracy. In this study, we developed a t-PAIC chemiluminescence kit and employed chemiluminescence to detect the tissue plasminogen activator inhibitor complex (t-PAIC), thrombin-antithrombin III complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC) and thrombomodulin (TM), combined with D-dimer and fibrin degradation products (FDP), to investigate their diagnostic potential for venous thrombosis in gastric cancer patients. The study assessed variations in six indicators among gastric cancer patients at different stages. RESULTS The t-PAIC reagent showed LOD is 1.2 ng/mL and a linear factor R greater than 0.99. The reagents demonstrated accurate results, with all accuracy deviations being within 5%. The intra-batch and inter-batch CVs for the t-PAIC reagent were both within 8%. The correlation coefficient R between this method and Sysmex was 0.979. Gastric cancer patients exhibited elevated levels of TAT, PIC, TM, D-D, FDP compared to the healthy population, while no significant difference was observed in t-PAIC. In the staging of gastric cancer, patients in III-IV stages exhibit higher levels of the six markers compared to those in I-II stages. The ROC curve indicates an enhancement in sensitivity and specificity of the combined diagnosis of four or six indicators. CONCLUSION Our chemiluminescence assay performs comparably to Sysmex's method and at a reduced cost. The use of multiple markers, including t-PAIC, TM, TAT, PIC, D-D, and FDP, is superior to the use of single markers for diagnosing VTE in patients with malignant tumors. Gastric cancer patients should be screened for the six markers to facilitate proactive prophylaxis, determine the most appropriate treatment timing, ameliorate their prognosis, decrease the occurrence of venous thrombosis and mortality, and extend their survival.
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Affiliation(s)
- Yu Ji
- Department of Pathology, Affiliated Hospital of Jiangnan University, No.1000, Hefeng Road, Wuxi, 214122, Jiangsu, China
- Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China
| | - Yan Qin
- Department of Pathology, Affiliated Hospital of Jiangnan University, No.1000, Hefeng Road, Wuxi, 214122, Jiangsu, China
- Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China
| | - Qi Tan
- Department of Pathology, Affiliated Hospital of Jiangnan University, No.1000, Hefeng Road, Wuxi, 214122, Jiangsu, China
- Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China
| | - Yanru Qiu
- Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China
| | - Shuang Han
- Department of Pathology, Affiliated Hospital of Jiangnan University, No.1000, Hefeng Road, Wuxi, 214122, Jiangsu, China.
- Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China.
| | - Xiaowei Qi
- Department of Pathology, Affiliated Hospital of Jiangnan University, No.1000, Hefeng Road, Wuxi, 214122, Jiangsu, China.
- Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China.
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8
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Roberts LN, Arya R, Hunt BJ. Advances and current research in primary thromboprophylaxis to prevent hospital-associated venous thromboembolism. Br J Haematol 2024; 204:1635-1648. [PMID: 38577829 DOI: 10.1111/bjh.19424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
Hospital-associated venous thromboembolism (VTE) is defined as any case of VTE occurring during hospital admission and for up to 90 days post discharge. It accounts for over 50% of all cases of VTE internationally; indeed, there are an estimated 10 million cases of hospital-associated VTE annually. Over the last decade, there has been increasing interest in improving VTE risk assessment and thromboprophylaxis. This review summarises all the recent and ongoing major research studies and future challenges in the different areas, including medical, surgical and obstetric patients, as well as special areas such as lower limb immobilisation. We include sections on both pharmacological and mechanical thromboprophylaxis.
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Affiliation(s)
- Lara N Roberts
- Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Roopen Arya
- Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Beverley J Hunt
- Thrombosis & Haemophilia Centre, St Thomas' Hospital, London, UK
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9
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Tatsumi K. The pathogenesis of cancer-associated thrombosis. Int J Hematol 2024; 119:495-504. [PMID: 38421488 DOI: 10.1007/s12185-024-03735-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/02/2024]
Abstract
Patients with cancer have a higher risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), compared to the general population. Cancer-associated thrombosis (CAT) is a thrombotic event that occurs as a complication of cancer or cancer therapy. Major factors determining VTE risk in cancer patients include not only treatment history and patient characteristics, but also cancer type and site. Cancer types can be broadly divided into three groups based on VTE risk: high risk (pancreatic, ovarian, brain, stomach, gynecologic, and hematologic), intermediate risk (colon and lung), and low risk (breast and prostate). This implies that the mechanism of VTE differs between cancer types and that specific VTE pathways may exist for different cancer types. This review summarizes the specific pathways that contribute to VTE in cancer patients, with a particular focus on leukocytosis, neutrophil extracellular traps (NETs), tissue factor (TF), thrombocytosis, podoplanin (PDPN), plasminogen activator inhibitor-1 (PAI-1), the intrinsic coagulation pathway, and von Willebrand factor (VWF).
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Affiliation(s)
- Kohei Tatsumi
- Advanced Medical Science of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
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10
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Seki Y. Clinical guidelines for prevention and treatment of CAT in Japan and other countries. Int J Hematol 2024; 119:505-515. [PMID: 38558108 DOI: 10.1007/s12185-024-03736-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 04/04/2024]
Abstract
Cancer-associated thrombosis (CAT) is an important prognostic factor for an increasing number of cancer patients. Understanding of CAT among cancer care providers has grown in recent years, and guidelines for the prevention and treatment of CAT have been published in Japan and around the world. In this article, we introduce these major guidelines and discuss differences we identified between the Japanese guidelines and those of other countries, with a focus on problems and issues. Insurance coverage of low-molecular-weight heparin and indications for primary prevention with direct oral anticoagulants in particular require urgent consideration.
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Affiliation(s)
- Yoshinobu Seki
- Department of Hematology, Niigata University Medical and Dental Hospital, Chuoku Asahimachi-Dori 1, Niigata, 951-8520, Japan.
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11
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Erhart F, Widhalm G, Kiesel B, Hackl M, Diendorfer A, Preusser M, Rössler K, Thaler J, Pabinger I, Ay C, Riedl J. The plasma miRNome and venous thromboembolism in high-grade glioma: miRNA Sequencing of a nested case-control cohort. J Cell Mol Med 2024; 28:e18149. [PMID: 38613361 PMCID: PMC11015389 DOI: 10.1111/jcmm.18149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/31/2023] [Accepted: 01/05/2024] [Indexed: 04/14/2024] Open
Abstract
Patients with high-grade gliomas are at high risk of venous thromboembolism (VTE). MicroRNAs (miRNAs) are small non-coding RNAs with multiple roles in tumour biology, haemostasis and platelet function. Their association with VTE risk in high-grade glioma has not been comprehensively mapped so far. We thus conducted a nested case-control study within 152 patients with WHO grade IV glioma that had been part of a prospective cohort study on VTE risk factors. At inclusion a single blood draw was taken, and patients were thereafter followed for a maximum of 2 years. During that time, 24 patients (16%) developed VTE. Of the other 128 patients, we randomly selected 24 age- and sex-matched controls. After quality control, the final group size was 21 patients with VTE during follow-up and 23 without VTE. Small RNA next-generation sequencing of plasma was performed. We observed that hsa-miR-451a was globally the most abundant miRNA. Notably, 51% of all miRNAs showed a correlation with platelet count. The analysis of miRNAs differentially regulated in VTE patients-with and without platelet adjustment-identified potential VTE biomarker candidates such as has-miR-221-3p. Therewith, we here provide one of the largest and deepest peripheral blood miRNA datasets of high-grade glioma patients so far, in which we identified first VTE biomarker candidates that can serve as the starting point for future research.
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Affiliation(s)
- Friedrich Erhart
- Department of NeurosurgeryMedical University of ViennaViennaAustria
| | - Georg Widhalm
- Department of NeurosurgeryMedical University of ViennaViennaAustria
| | - Barbara Kiesel
- Department of NeurosurgeryMedical University of ViennaViennaAustria
| | | | | | - Matthias Preusser
- Clinical Division of OncologyDepartment of Medicine IMedical University of ViennaViennaAustria
| | - Karl Rössler
- Department of NeurosurgeryMedical University of ViennaViennaAustria
| | - Johannes Thaler
- Clinical Division of Haematology and HaemostaseologyDepartment of Medicine IMedical University of ViennaViennaAustria
| | - Ingrid Pabinger
- Clinical Division of Haematology and HaemostaseologyDepartment of Medicine IMedical University of ViennaViennaAustria
| | - Cihan Ay
- Clinical Division of Haematology and HaemostaseologyDepartment of Medicine IMedical University of ViennaViennaAustria
| | - Julia Riedl
- Clinical Division of Haematology and HaemostaseologyDepartment of Medicine IMedical University of ViennaViennaAustria
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Betts MB, Liu X, Junqueira DR, Fahrbach K, Neupane B, Ronnebaum S, Dhamane AD. Risk of Venous Thromboembolism by Cancer Type: A Network Meta-Analysis. Semin Thromb Hemost 2024; 50:328-341. [PMID: 38395064 DOI: 10.1055/s-0044-1779672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Patients with cancer have an increased risk of venous thromboembolism (VTE). Comparing tumor-specific VTE risk is complicated by factors such as surgery, disease stage, and chemotherapy. Network meta-analysis (NMA) using cancer types as network nodes enabled us to estimate VTE rates by leveraging comparisons across cancer types while adjusting for baseline VTE risk in individual studies. This study was conducted to estimate the risk of VTE by cancer type and factors influencing VTE risk. The Embase, MEDLINE, and Cochrane Library repositories were systematically searched to identify clinical trials and observational studies published from 2005 to 2022 that assessed the risk of primary cancer-related VTE among two or more distinct cancer types. Studies with similar cancer populations and study methods reporting VTE occurring within 1 year of diagnosis were included in the NMA. Relative VTE rates across cancer types were estimated with random-effects Bayesian NMAs. Absolute VTE rates were calculated from these estimates using the average VTE incidence in lung cancer (the most frequently reported type) as the "anchor." From 2,603 records reviewed, 30 studies were included in this NMA. The general network described 3,948,752 patients and 18 cancer types: 3.1% experienced VTE within 1 year of diagnosis, with cancer-specific rates ranging from 0.7 to 7.4%. Consistent with existing VTE risk prediction tools, pancreatic cancer was associated with higher-than-average VTE risk. Other cancer types with high VTE risk were brain and ovarian cancers. The relative rankings of VTE risk for certain cancers changed based on disease stage and/or receipt of chemotherapy or surgery.
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Affiliation(s)
| | - Xuejun Liu
- Bristol Myers Squibb Company, Lawrenceville, New Jersey
- Department of Health Policy and Management, Gillings School of Public Health, UNC-Chapel Hill, Chapel Hill, North Carolina
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Nakamura M, Sakon M, Sasako M, Okusaka T, Mukai H, Fujiwara K, Kunitoh H, Oba MS, Wada H, Hosokawa J, Takita A, Ikeda M. Association of D-dimer level with thrombotic events, bleeding, and mortality in Japanese patients with solid tumors: a Cancer-VTE Registry subanalysis. Int J Clin Oncol 2024; 29:407-416. [PMID: 38430303 DOI: 10.1007/s10147-024-02475-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/10/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND The D-dimer test is a simple test frequently used in routine clinical screening for venous thromboembolism (VTE). The Cancer-VTE Registry was a large-scale, multicenter, prospective, observational study in Japanese patients with cancer. This study aimed to clarify the relationship between D-dimer level at cancer diagnosis (baseline) and the incidence of events during cancer treatment (1-year follow-up period). METHODS This was a post hoc sub-analysis of patients from the Cancer-VTE Registry whose D-dimer levels were measured at baseline. The incidence of events during the 1-year follow-up period was evaluated stratified by baseline D-dimer level. Adjusted hazard ratios for D-dimer level and events during the follow-up period were evaluated. RESULTS Among the total enrolled patients, baseline D-dimer level was measured in 9020 patients. The mean ± standard deviation baseline D-dimer level was 1.57 ± 3.94 µg/mL. During the follow-up period, the incidence of VTE, cerebral infarction/transient ischemic attack (TIA)/systemic embolic events (SEE), bleeding, and all-cause death increased with increasing baseline D-dimer level. The incidence of all-cause death increased with increasing D-dimer level regardless of cancer stage. The adjusted hazard ratio of all-cause death was 1.03 (95% confidence interval: 1.02-1.03) per 1.0-µg/mL increase in baseline D-dimer level. CONCLUSIONS Increases in D-dimer levels were associated with a higher risk of thrombotic events, such as VTE and cerebral infarction/TIA/SEE, during cancer treatment. Furthermore, higher D-dimer levels at cancer diagnosis were associated with a higher mortality rate, regardless of cancer stage.
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Affiliation(s)
- Mashio Nakamura
- Nakamura Medical Clinic, 7-1510, Hidamarinooka, Kuwana, Mie, 511-0867, Japan.
| | - Masato Sakon
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Chuo-Ku, Osaka, Japan
| | - Mitsuru Sasako
- Department of Surgery, Yodogawa Christian Hospital, Higashi Yodogawa-Ku, Osaka, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan
| | - Hirofumi Mukai
- Division of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Keiichi Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hideo Kunitoh
- Department of Medical Oncology, Japanese Red Cross Medical Center, Shibuya-Ku, Tokyo, Japan
| | - Mari S Oba
- Department of Medical Statistics, Toho University, Ota-Ku, Tokyo, Japan
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Hideo Wada
- Department of General and Laboratory Medicine, Mie Prefectural General Medical Center, Yokkaichi, Mie, Japan
| | - Jun Hosokawa
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd, Chuo-Ku, Tokyo, Japan
| | - Atsushi Takita
- Data Intelligence Department, Daiichi Sankyo Co., Ltd, Shinagawa-Ku, Tokyo, Japan
| | - Masataka Ikeda
- Division of Lower Gastrointestinal Surgery, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
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Pamulapati S, Conroy M, Madireddy S, Kamaraju S, Cortina C, Moore H, Hartmann J. Applications of Viscoelastic Testing in Breast Cancer Patients: A Systematic Review Focusing on Hypercoagulability and Free Flap Thrombosis. Semin Thromb Hemost 2024; 50:413-422. [PMID: 37327882 DOI: 10.1055/s-0043-1769937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Viscoelastic testing is a clinically available method to assess hypercoagulability. This systematic review aims to provide a comprehensive overview of the existing literature and the potential use of such testing in patients with breast cancer. A systematic literature search for studies investigating the application of viscoelastic testing for patients with breast cancer was conducted. Studies were included as long as they were original, peer-reviewed, and in the English language. Studies were excluded if they were review articles, did not include breast cancer patients, or if the full text was unavailable. This review identified 10 articles that met the inclusion criteria. Two of the studies utilized rotational thromboelastometry, and an additional four studies used thromboelastography, to assess hypercoagulability in patients with breast cancer. Three of the identified articles discussed the use of thromboelastometry in free flap breast reconstruction for patients with breast cancer. One study was a retrospective chart review looking at thromboelastography and microsurgical breast reconstruction. Current literature regarding the application of viscoelastic testing in breast cancer and free flap breast reconstruction is limited, with no randomized trials thus far. However, some studies suggest that there may be potential utility in viscoelastic testing to assess risk for thromboembolism in breast cancer patients, and future research in this area is warranted.
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Affiliation(s)
| | | | | | - Sailaja Kamaraju
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Chandler Cortina
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hunter Moore
- Division of Surgery-Transplant, University of Colorado School of Medicine, Aurora, Colorado
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15
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Malte AL, Højbjerg JA, Larsen JB. Platelet Parameters as Biomarkers for Thrombosis Risk in Cancer: A Systematic Review and Meta-analysis. Semin Thromb Hemost 2024; 50:360-383. [PMID: 36921613 DOI: 10.1055/s-0043-1764381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Cancer-associated thrombosis (CAT) is a major cause of both morbidity and mortality in cancer patients. Platelet count has been investigated as a predictor of CAT in various settings while knowledge on platelet activation parameters is sparse. This report provides a systematic review and meta-analysis on available literature on associations between platelet count and/or function and arterial and venous thrombosis in adult cancer patients. The review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed and Embase were searched up to March 2022. The National Heart, Lung, and Blood Institute's tools were used for quality assessment. In total, 100 studies were included which investigated the association between CAT and platelet count (n = 90), platelet indices (n = 19), and platelet function/activation markers (n = 13) in patients with solid cancers (n = 61), hematological cancers (n = 17), or mixed cancer types (n = 22). Eighty-one studies had venous thrombosis as their outcome measure, while 4 had arterial thrombosis and 15 studies had both. We found significantly elevated odds ratio of 1.50 (95% confidence interval: 1.19-1.88) for thrombosis with higher platelet counts. We saw a tendency toward an association between markers of platelet activation in forms of mean platelet volume and soluble P selectin and both arterial and venous thrombosis. Only one study investigated dynamic platelet function using flow cytometry. In conclusion, platelet count is associated with CAT across different cancer types and settings. Platelet function or activation marker analysis may be valuable in assisting thrombosis risk assessment in cancer patients but is sparsely investigated so far.
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Affiliation(s)
- Anne Lind Malte
- Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Johanne Andersen Højbjerg
- Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Julie Brogaard Larsen
- Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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16
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Gyldenholm T, Hvas AM, Christensen TD, Larsen JB. Thrombin Generation Markers as Predictors of Cancer-Associated Venous Thromboembolism: A Systematic Review. Semin Thromb Hemost 2024; 50:384-401. [PMID: 37813372 DOI: 10.1055/s-0043-1775856] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Venous thromboembolism (VTE) is a main contributor to morbidity and mortality in cancer patients. Biomarkers with the potential to predict cancer-associated VTE are continually sought. Of these, markers of thrombin generation present a likely option. The present systematic review examines the ability of three widely used biomarkers of thrombin generation: prothrombin fragment 1.2 (F1.2), thrombin-antithrombin complex (TAT), and ex vivo thrombin generation, to predict VTE in both solid and hematologic adult cancer patients. Relevant studies were identified in the PubMed and Embase databases, and the review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Each study was evaluated using the quality assessment tool from the National Heart, Lung, and Blood Institute. The review protocol was published on PROSPERO with identifier CRD42022362339. In total, 24 papers were included in the review: 11 reporting data on F1.2, 9 on TAT, and 12 on ex vivo thrombin generation. The quality ratings of the included studies varied from good (n = 13), fair (n = 8), to poor (n = 3) with a high heterogenicity. However, F1.2, TAT complex, and ex vivo thrombin generation were all found to be associated with the development of VTE. This association was most pronounced for F1.2. Furthermore, the determination of F1.2 was able to improve the precision of several established risk assessment scores. In conclusion, markers of thrombin generation were found to be elevated in cancer patients with VTE, and particularly, F1.2 was found to be a promising predictor of cancer-associated VTE.
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Affiliation(s)
- Tua Gyldenholm
- Department of Clinical Biochemistry, Thrombosis and Haemostasis Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Thomas Decker Christensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Julie Brogaard Larsen
- Department of Clinical Biochemistry, Thrombosis and Haemostasis Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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17
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Buijs JT, van Beijnum R, Anijs RJS, Laghmani EH, Sensuk L, Minderhoud C, Ünlü B, Klok FA, Kuppen PJK, Cannegieter SC, Versteeg HH. The association of tumor-expressed REG4, SPINK4 and alpha-1 antitrypsin with cancer-associated thrombosis in colorectal cancer. J Thromb Thrombolysis 2024; 57:370-380. [PMID: 38066386 PMCID: PMC10961291 DOI: 10.1007/s11239-023-02907-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 03/26/2024]
Abstract
Novel biomarkers are needed to improve current imperfect risk prediction models for cancer-associated thrombosis (CAT). We recently identified an RNA-sequencing profile that associates with CAT in colorectal cancer (CRC) patients, with REG4, SPINK4, and SERPINA1 as the top-3 upregulated genes at mRNA level. In the current study, we investigated whether protein expression of REG4, SPINK4 and alpha-1 antitrypsin (A1AT, encoded by SERPINA1) in the tumor associated with CAT in an independent cohort of CRC patients. From 418 patients with resected CRC, 18 patients who developed CAT were age, sex, and tumor stage-matched to 18 CRC patients without CAT. Protein expression was detected by immunohistochemical staining and scored blindly by assessing the H-score (percentage positive cells*scoring intensity). The association with CAT was assessed by means of logistic regression, using patients with an H-score below 33 as reference group. The odds ratios (ORs) for developing CAT for patients with A1AThigh, REG4high, SPINK4high tumors were 3.5 (95%CI 0.8-14.5), 2.0 (95%CI 0.5-7.6) and 2.0 (95%CI 0.5-7.4) when compared to A1ATlow, REG4low, SPINK4low, respectively. The OR was increased to 24.0 (95%CI 1.1-505.1) when two proteins were combined (A1AThigh/REG4high). This nested case-control study shows that combined protein expression of A1AT and REG4 associate with CAT in patients with colorectal cancer. Therefore, REG4/A1AT are potential biomarkers to improve the identification of patients with CRC who may benefit from thromboprophylaxis.
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Affiliation(s)
- Jeroen T Buijs
- Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Thrombosis and Hemostasis, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
- Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Thrombosis and Hemostasis, Department of Internal Medicine, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Robin van Beijnum
- Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Thrombosis and Hemostasis, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Rayna J S Anijs
- Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Thrombosis and Hemostasis, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - El Houari Laghmani
- Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Thrombosis and Hemostasis, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Lily Sensuk
- Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Thrombosis and Hemostasis, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Cas Minderhoud
- Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Thrombosis and Hemostasis, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Betül Ünlü
- Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Thrombosis and Hemostasis, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederikus A Klok
- Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Thrombosis and Hemostasis, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Suzanne C Cannegieter
- Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Thrombosis and Hemostasis, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, LUMC, Leiden, The Netherlands
| | - Henri H Versteeg
- Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Thrombosis and Hemostasis, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
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18
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Chen R, Mei Z, Chen J. Scrutinizing VTE risk factors in complex renal tumor patients: a comprehensive look at the VTE-RT-IVCTT study. Int J Surg 2024; 110:1813-1814. [PMID: 38051929 PMCID: PMC10942190 DOI: 10.1097/js9.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Ru Chen
- Department of Urology, Fujian Medical University Union Hospital, Gulou District, Fuzhou City, Fujian Province
| | - Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, People’s Republic of China
| | - Jianhui Chen
- Department of Urology, Fujian Medical University Union Hospital, Gulou District, Fuzhou City, Fujian Province
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19
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Yan AR, Samarawickrema I, Naunton M, Peterson GM, Yip D, Newman P, Mortazavi R. Models for predicting venous thromboembolism in ambulatory patients with lung cancer: A systematic review and meta-analysis. Thromb Res 2024; 234:120-133. [PMID: 38215613 DOI: 10.1016/j.thromres.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
AIMS The incidence of venous thromboembolism (VTE) in patients with lung cancer is relatively high, and risk stratification models are vital for the targeted application of thromboprophylaxis. We aimed to review VTE risk prediction models that have been developed in patients with lung cancer and evaluated their performance. METHODS AND RESULTS Twenty-four eligible studies involving 123,493 patients were included. The pooled incidence of VTE within 12 months was 11 % (95 % CI 8 %-14 %). With the identified four VTE risk assessment tools, meta-analyses did not show a significant discriminatory capability of stratifying VTE risk for Khorana, PROTECHT and CONKO scores. The pooled sensitivity and specificity of the Khorana score were 24 % (95 % CI 11 %-44 %) and 84 % (95 % CI 73 %-91 %) at the 3-point cut-off, and 43 % (95 % CI 35 %-52 %) and 61 % (95 % CI 52 %-69 %) at the 2-point cut-off. However, a COMPASS-CAT score of ≥ 7 points indicated a significantly high VTE risk, with a RR of 4.68 (95 % CI 1.05-20.80). CONCLUSIONS The Khorana score lacked discriminatory capability in identifying patients with lung cancer at high VTE risk, regardless of the cut-off value. The COMPASS-CAT score had better performance, but further validation is needed. The results indicate the need for robust VTE risk assessment tools specifically designed and validated for lung cancer patients. Future research should include relevant biomarkers as important predictors and consider the combined use of risk tools. PROSPERO registration number: CRD42021245907.
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Affiliation(s)
- Ann-Rong Yan
- School of Health Sciences, Faculty of Health, University of Canberra, Canberra, ACT, Australia.
| | | | - Mark Naunton
- School of Health Sciences, Faculty of Health, University of Canberra, Canberra, ACT, Australia.
| | - Gregory M Peterson
- School of Health Sciences, Faculty of Health, University of Canberra, Canberra, ACT, Australia; College of Health and Medicine, University of Tasmania, TAS, Australia.
| | - Desmond Yip
- ANU School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia; Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia.
| | - Phillip Newman
- Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, ACT, Australia.
| | - Reza Mortazavi
- School of Health Sciences, Faculty of Health, University of Canberra, Canberra, ACT, Australia.
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20
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Qin X, Gao X, Yang Y, Ou S, Luo J, Wei H, Jiang Q. Developing a risk assessment tool for cancer-related venous thrombosis in China: a modified Delphi-analytic hierarchy process study. BMC Cancer 2024; 24:120. [PMID: 38263026 PMCID: PMC10807161 DOI: 10.1186/s12885-024-11877-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/13/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE To develop a Risk Assessment Tool for Cancer-related Venous Thrombosis in China. METHODS A modified two-round Delphi method was employed to establish consensus within a field to reach an agreement via a questionnaire or by interviewing a multidisciplinary panel of experts by collecting their feedback to inform the next round, exchanging their knowledge, experience, and opinions anonymously, and resolving uncertainties. Furthermore, The AHP (Analytic Hierarchy Process) was used to determine the final quality indicators' relative importance. RESULTS The expert's positive coefficient was 85.19% in the first round and 82.61% in the second round, with authoritative coefficients of 0.89 and 0.92 in the respective surveys. The P-value of Kendall's W test was all less than 0.001 for each round, and the W-value for concordance at the end of the two rounds was 0.115. The final Risk Assessment Tool for Cancer-related Venous Thrombosis consisted of three domains, ten subdomains, and 39 indicators, with patient factors weighing 0.1976, disease factors weighing 0.4905, and therapeutic factors weighing 0.3119. CONCLUSION The tool is significantly valid and reliable with a strong authority and coordination degree, and it can be used to assess the risk of cancer-related VTE and initiate appropriate thrombophylactic interventions in China.
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Affiliation(s)
- Xiaoli Qin
- Department of Pharmacy, The Third People's Hospital of Chengdu, 610031, Chengdu, Sichuan, P.R. China
- School of Pharmacy, Chengdu Medical College, 610500, Chengdu, Sichuan, P.R. China
| | - Xiurong Gao
- School of Pharmacy, Chengdu Medical College, 610500, Chengdu, Sichuan, P.R. China
| | - Yujie Yang
- Department of Pharmacy, The Third People's Hospital of Chengdu, 610031, Chengdu, Sichuan, P.R. China
| | - Shunlong Ou
- Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, 610041, Chengdu, Sichuan, P.R. China
| | - Jing Luo
- Department of Pharmacy, The Second People's Hospital of Yibin, 644000, Yibin, Sichuan, P.R. China
| | - Hua Wei
- Department of Pharmacy, Chengdu Second People's Hospital, 610011, Chengdu, Sichuan, P.R. China
| | - Qian Jiang
- Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, 610041, Chengdu, Sichuan, P.R. China.
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21
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Drăgan A, Drăgan AŞ. Novel Insights in Venous Thromboembolism Risk Assessment Methods in Ambulatory Cancer Patients: From the Guidelines to Clinical Practice. Cancers (Basel) 2024; 16:458. [PMID: 38275899 PMCID: PMC10813930 DOI: 10.3390/cancers16020458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/07/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Many cancer patients will experience venous thromboembolism (VTE) at some stage, with the highest rate in the initial period following diagnosis. Novel cancer therapies may further enhance the risk. VTE in a cancer setting is associated with poor prognostic, a decreased quality of life, and high healthcare costs. If thromboprophylaxis in hospitalized cancer patients and perioperative settings is widely accepted in clinical practice and supported by the guidelines, it is not the same situation in ambulatory cancer patient settings. The guidelines do not recommend primary thromboprophylaxis, except in high-risk cases. However, nowadays, risk stratification is still challenging, although many tools have been developed. The Khrorana score remains the most used method, but it has many limits. This narrative review aims to present the current relevant knowledge of VTE risk assessment in ambulatory cancer patients, starting from the guideline recommendations and continuing with the specific risk assessment methods and machine learning models approaches. Biomarkers, genetic, and clinical features were tested alone or in groups. Old and new models used in VTE risk assessment are exposed, underlining their clinical utility. Imaging and biomolecular approaches to VTE screening of outpatients with cancer are also presented, which could help clinical decisions.
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Affiliation(s)
- Anca Drăgan
- Department of Cardiovascular Anaesthesiology and Intensive Care, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C C Iliescu”, 258 Fundeni Road, 022328 Bucharest, Romania
| | - Adrian Ştefan Drăgan
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania;
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22
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Ma’koseh M, Abufara A, Albaghdadi D, Ghalayni R, Abdel-Razeq S, Alzughali E, Abdel Rahman F, Alhalaseh Y, Halahleh K, Abdel-Razeq H. The Application of Existing Risk Assessment Models (RAMS) to Predict the Occurrence of Venous Thromboembolic Events among Patients with Classic Hodgkin Lymphoma. J Clin Med 2024; 13:436. [PMID: 38256570 PMCID: PMC10816014 DOI: 10.3390/jcm13020436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/06/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
Background: A majority of patients included in risk assessment models (RAMs) developed to predict venous thromboembolic events (VTE) in lymphoma were non-Hodgkin lymphoma. Our study aims to evaluate the incidence and predictors of VTE, utilizing different RAMs, in patients with classic Hodgkin lymphoma (cHL) treated with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD). Methods: Adult patients with cHL, treated and followed at our center, were included. Correlations between different variables, Khorana score, and thrombosis in lymphoma (ThroLy) RAMs with VTE were examined using Fisher's exact test and logistic regression analysis. Results: A total of 321 patients were included, with a median age of 29 (range: 18-83) years. Of them, 169 (52.6%) had advanced-stage disease. Combined modality treatment was given to 169 (52.6%) patients. A total of 52 (16.2%) patients had relapsed or refractory disease. VTE were reported in 15 (4.7%) patients and were mostly during the administration of first-line (n = 8, 53.3%), or salvage chemotherapy (n = 6, 40.0%). There was no correlation between a Khorana score > 2 (p = 0.689) or ThroLy score > 3 (p = 0.335) and VTE. Older age (p = 0.014) and relapsed or refractory disease (p = 0.003) significantly correlated with VTE. Conclusions: VTE are uncommon in cHL. The commonly used RAMs failed to predict VTE. However, older age and relapsed or refractory disease significantly increased this risk.
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Affiliation(s)
- Mohammad Ma’koseh
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
- School of Medicine, The University of Jordan, Amman 11942, Jordan;
| | - Alaa Abufara
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
| | - Dana Albaghdadi
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
| | - Ruba Ghalayni
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
| | | | - Eman Alzughali
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
| | - Fadwa Abdel Rahman
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan;
| | - Yazan Alhalaseh
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
| | - Khalid Halahleh
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
| | - Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
- School of Medicine, The University of Jordan, Amman 11942, Jordan;
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Wang P, He L, Yuan Q, Lu J, Ji Q, Peng A, Liu W. Risk factors for peripherally inserted central catheter-related venous thrombosis in adult patients with cancer. Thromb J 2024; 22:6. [PMID: 38178101 PMCID: PMC10768137 DOI: 10.1186/s12959-023-00574-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/25/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE The purpose of this study was to understand and analyze the risk factors of peripherally inserted central catheter (PICC)-related venous thrombosis in adult patients with cancer. METHODS This observational cohort study included adult patients with cancer who underwent color Doppler ultrasound at the Xiangya Hospital of Central South University, Hunan Provincial Maternal and Child Healthcare Hospital, and Xiangya Changde Hospital, Hunan Province, from January 1, 2017 to December 31, 2021. Univariate and multivariate logistic regression analyses were performed to determine the risk factors of PICC-related venous thrombosis. RESULTS After risk adjustment, multivariate logistic regression analysis revealed statistically significant associations between PICC-related venous thrombosis and age > 65 years old (OR: 1.791, CI: 1.343-2.389), male sex (OR: 1.398, CI: 1.057-1.849), white blood cell count > 9.5 × 109 /L (OR: 1.422, CI: 1.041-1.942), APTT < 25 s (OR: 2.006, CI: 1.431-2.811), gastrointestinal tumor (OR: 2.191, CI: 1.406-3.414), infection (OR:7.619, CI: 5.783-10.037), the use of cisplatin (OR: 2.374, CI: 1.714-3.214), vincristine (OR: 2.329, CI: 1.447-3.749), the use of polyurethane (OR: 2.449, CI: 1.863-3.219) and open-ended catheters (OR:1.660, CI: 1.131-2.439), keeping time of the catheter (days) (OR: 1.003, CI: 1.001-1.005) were associated with PICC-related venous thrombosis. CONCLUSION We identified that the presence of age > 65 years old, male sex, white blood cell count > 9.5 × 109 /L, APTT < 25 s, gastrointestinal tumor, infection, the use of cisplatin and vincristine, the use of polyurethane, open-ended catheters and keeping time of the catheter (days), were associated with PICC-related venous thrombosis.
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Affiliation(s)
- Pinghu Wang
- Breast Surgery Department, Hunan Provincial Maternal and Child Healthcare Hospital, Changsha, Hunan, People's Republic of China
| | - Lianxiang He
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Qiong Yuan
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Juan Lu
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Qingqiong Ji
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - An Peng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Wanli Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
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24
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Tavares V, Neto BV, Marques IS, Assis J, Pereira D, Medeiros R. Cancer-associated thrombosis: What about microRNAs targeting the tissue factor coagulation pathway? Biochim Biophys Acta Rev Cancer 2024; 1879:189053. [PMID: 38092078 DOI: 10.1016/j.bbcan.2023.189053] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/03/2023] [Accepted: 12/08/2023] [Indexed: 12/18/2023]
Abstract
Cancer patients are often diagnosed with venous thromboembolism (VTE), a cardiovascular disease that substantially decreases their quality of life and survival rate. Haemostasis in these patients is deregulated, which is reflected in the common presentation of a blood hypercoagulation state. Despite the inconsistent results, existing evidence suggests that the expression of microRNAs (miRNAs) is deregulated in the context of venous thrombogenesis in the general population. However, few miRNAs are known to be linked to cancer-associated VTE due to the lack of studies with oncological patients. Parallelly, coagulation factor III, also known as tissue factor (TF), tissue factor pathway inhibitor 1 (TFPI1) and tissue factor pathway inhibitor 2 (TFPI2) have been proposed to have a central role in cancer-associated VTE and tumour progression. Yet, contrary to what was expected, the role of miRNAs targeting the TF coagulation pathway (or extrinsic coagulation pathway) is poorly explored in cancer-induced thrombogenesis. In this review, in addition to miRNAs implicated in VTE, TF and TFPI1/2-targeting miRNAs were revised. Future studies should clarify the implications of these non-coding RNAs in tumour coagulome.
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Affiliation(s)
- Valéria Tavares
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/ Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; Faculty of Medicine of University of Porto (FMUP), 4200-072 Porto, Portugal; Abel Salazar Institute for the Biomedical Sciences (ICBAS), University of Porto, 4050-313 Porto, Portugal
| | - Beatriz Vieira Neto
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/ Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; Research Department, Portuguese League Against Cancer (NRNorte), 4200-172 Porto, Portugal
| | - Inês Soares Marques
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/ Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; Faculty of Sciences of University of Porto (FCUP), 4169-007 Porto, Portugal
| | - Joana Assis
- Clinical Research Unit, Research Center of IPO Porto (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
| | - Deolinda Pereira
- Oncology Department, Portuguese Institute of Oncology of Porto (IPO Porto), 4200-072 Porto, Portugal
| | - Rui Medeiros
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/ Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; Faculty of Medicine of University of Porto (FMUP), 4200-072 Porto, Portugal; Abel Salazar Institute for the Biomedical Sciences (ICBAS), University of Porto, 4050-313 Porto, Portugal; Research Department, Portuguese League Against Cancer (NRNorte), 4200-172 Porto, Portugal; Faculty of Health Sciences, Fernando Pessoa University, 4200-150 Porto, Portugal.
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25
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Shoji M, Yamashita Y, Ishii M, Inoue H, Kato H, Fujita S, Matsui K, Tajiri K, Nameki M, Muraoka N, Nonaka A, Sugino H, Kono M, Oka T, Sueta D, Komuro I, Tsujita K. A Predictive Model for Cancer-Associated Thrombosis in Japanese Cancer Patients: Findings from the J-Khorana Registry. TH OPEN 2024; 8:e9-e18. [PMID: 38197014 PMCID: PMC10774015 DOI: 10.1055/a-2207-7715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/07/2023] [Indexed: 01/11/2024] Open
Abstract
Background Although the close relationship between cancer and venous thromboembolism (VTE) has been identified, risk stratification for VTE in Japanese patients with cancer remains unclear. Objectives This study aimed to validate the Khorana VTE risk assessment score (KRS) for VTE diagnosis and establish an optimal predictive model for VTE in Japanese patients with cancer. Methods A total of 7,955 Japanese patients with cancer were subdivided into low- (0), intermediate- (1-2), and high-score (3) groups according to the KRS. Using 37 explanatory variables, a total of 2,833 patients with cancer were divided into derivation and validation cohorts (5:5). A risk model for Japanese participants was developed using the derivation cohort data. Results The prevalence of VTE in low-, intermediate-, and high-score patients was 1.2, 2.5, and 4.3%, respectively. Logistic regression analysis demonstrated that cancer stage (III-IV) and KRS ≥ 2 were independent and significant predictors of VTE onset. The risk model for VTE assigned 1 point to body mass index ≥25 kg/m 2 and 2 points each to the prevalence of osteochondral cancer and D-dimer level ≥1.47 µg/mL. The areas under the curve of the risk model were 0.763 and 0.656 in the derivation and validation cohorts, respectively. Conclusion The KRS was useful in Japanese patients, and our new predictive model may be helpful for the diagnosis of VTE in Japanese patients with cancer.
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Affiliation(s)
- Masaaki Shoji
- Department of General Internal Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Hitoki Inoue
- Department of Cardiology, National Hospital Organization (NHO) Hokkaido Cancer Center, Hokkaido, Japan
| | - Hiroshi Kato
- Division of Onco-Cardiology, Miyagi Cancer Center, Miyagi, Japan
| | - Shin Fujita
- Department of Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Kazuhiro Matsui
- Department of Internal Medicine, Onco-Cardiology Unit, Saitama Cancer Center, Saitama, Japan
| | - Kazuko Tajiri
- Department of Cardiology, National Cancer Center Hospital East, Chiba, Japan
| | - Mizuo Nameki
- Division of Cardiology, Chiba Cancer Center, Chiba, Japan
| | - Nao Muraoka
- Division of Cardiology, Shizuoka Cancer Center, Shizuoka, Japan.
| | - Akiko Nonaka
- Division of Onco-Cardiology, Hyogo Cancer Center, Hyogo, Japan
| | - Hiroshi Sugino
- Division of Cardiology, NHO Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Mihoko Kono
- Department of Onco-Cardiology, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Toru Oka
- Department of Internal Medicine, Onco-Cardiology Unit, Saitama Cancer Center, Saitama, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Issei Komuro
- Department of Frontier Cardiovascular Science, International University of Health and Welfare, Tokyo, Japan
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
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Pavlovic D, Niciforovic D, Markovic M, Papic D. Cancer-Associated Thrombosis: Epidemiology, Pathophysiological Mechanisms, Treatment, and Risk Assessment. Clin Med Insights Oncol 2023; 17:11795549231220297. [PMID: 38152726 PMCID: PMC10752082 DOI: 10.1177/11795549231220297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
Cancer patients represent a growing population with drastically difficult care and a lowered quality of life, especially due to the heightened risk of vast complications. Thus, it is well established so far that one of the most prominent complications in individuals with cancer is venous thromboembolism. Since there are various improved methods for screening and diagnosing cancer and its complications, the incidence of cancer-associated thrombosis has been on the rise in recent years. Therefore, the high mortality and morbidity rates among these patients are not a surprise. Consequently, there is an excruciating need for understanding the mechanisms behind this complex process, as well as the imperative for adequate analysis and application of the most suitable steps for cancer-associated thrombosis prevention. There are various and numerous mechanisms offering potential answers to cancer-associated thrombosis, some of which have already been elucidated in various preclinical and clinical scenarios, yet further and more elaborate studies are crucial to understanding and preventing this complex and harsh clinical entity. This article elaborates on the growing incidence, mortality, morbidity, and risk factors of cancer-associated thrombosis while emphasizing the pathophysiological mechanisms in the light of various types of cancer in patients and summarizes the most novel therapy and prevention guidelines recommendations.
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Affiliation(s)
- Dragica Pavlovic
- Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Danijela Niciforovic
- Center for Internal Oncology, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Marina Markovic
- Center for Internal Oncology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Dragana Papic
- Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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27
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Thipbumrung S, Niprapan P, Suprasert P, Ketpueak T, Tantiworawit A, Punnachet T, Hantrakun N, Piriyakhuntorn P, Rattanathammethee T, Hantrakool S, Rattarittamrong E, Norasetthada L, Chai-Adisaksopha C. Comparison of risk prediction scores for cancer-associated thrombosis in ambulatory cancer patients not receiving thromboprophylaxis: A prospective cohort study in a South-East Asian population. Thromb Res 2023; 232:138-144. [PMID: 37979462 DOI: 10.1016/j.thromres.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION To date, there is limited data regarding the incidence and risk prediction of cancer-associated thrombosis among South-East Asian patients who do not receive thromboprophylaxis. MATERIALS AND METHODS This was a prospective cohort study conducted at a tertiary medical center from June 2020 to December 2021 in Thailand. We enrolled cancer patients aged ≥ 18 years, with ECOG score ≤ 1, scheduled to receive the first cycle of chemotherapy. We measured incidence of venous thromboembolism (VTE), all-cause mortality and performance of risk prediction scores. RESULTS A total of 457 patients were included with a mean age of 58.18 ± 12.60 years. By the end of 6 months period, VTE had occurred in 30 patients (6.56 %, 95%CI 4.36-9.21). The median time to the first thrombosis was 1.94 months (IQR 0.26-3.19). Cancer associated thrombosis incidence was 14.58 % for Khorana score ≥ 3, 6.67 % for scores 1-2 and 2.13 % for score 0. C-statistics were 0.50 (95%CI 0.41-0.60) for Khorana score cut-off ≥ 2, 0.57 (95%CI 0.49-0.65) for Khorana score ≥ 3, 0.55 (95%CI 0.46-0.65) for PROTECHT score ≥ 3, and 0.57 (95%CI 0.49-0.65) for CONKO score ≥ 3. Classifying cholangiocarcinoma as very-high-risk increased the Khorana score cut-off ≥ 3's C-statistic to 0.62 (95%CI 0.53-0.71). CONCLUSIONS A significant proportion of ambulatory South-East Asian cancer patients without thromboprophylaxis developed VTE. Further prospective studies investigating the benefit of thromboprophylaxis in high-risk patients with active cancer are warranted.
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Affiliation(s)
- Sittikul Thipbumrung
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Piangrawee Niprapan
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Prapaporn Suprasert
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thanika Ketpueak
- Division of Oncology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Adisak Tantiworawit
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Teerachat Punnachet
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nonthakorn Hantrakun
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pokpong Piriyakhuntorn
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thanawat Rattanathammethee
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sasinee Hantrakool
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ekarat Rattarittamrong
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Lalita Norasetthada
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chatree Chai-Adisaksopha
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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28
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Qin Y, Liang X, Wu H, Sun X, Yan S, Wang N, Yuan M, Wang Q, Wu D. Development and Validation of a Modified Khorana Score for Predicting Venous Thromboembolism in Newly Diagnosed Stage IV Lung Cancer. Angiology 2023:33197231213197. [PMID: 37924222 DOI: 10.1177/00033197231213197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
We aimed to establish an effective model to identify metastatic lung cancer patients at high risk of venous thromboembolism (VTE). Patients diagnosed with stage IV lung cancer from January 2011 to June 2019 were included in the development cohort; those recruited from July 2019 to June 2021 were included in the validation cohort. Univariable and multivariable analyses determined the risk factors for VTE. Then we assessed the value for predicting VTE of the Khorana score and modified Khorana score in these two cohorts; 575 patients were included in the development cohort, and 202 patients in the validation cohort. Adenocarcinoma, D-dimer, and the Khorana score were independent risk factors for VTE. In the development cohort, the area under the receiver operating characteristic curve (AUC) of the Khorana score in patients with newly diagnosed stage IV lung cancer was 0.598 (95% CI, 0.512-0.684). The AUC of the modified Khorana score was 0.747 (95% CI, 0.689-0.805). The difference was statistically significant (P <.001). The AUC of the modified Khorana score in the validation cohort was 0.763 (95% CI, 0.661-0.865). The modified Khorana score is more able to accurately predict VTE in patients with newly diagnosed stage IV lung cancer than the Khorana score.
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Affiliation(s)
- Ya Qin
- Department of Oncology, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
| | - Xiao Liang
- Department of Oncology, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
- Department of Medical Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongshuai Wu
- Department of Central Laboratory, the Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
| | - Xia Sun
- Department of Oncology, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
| | - Shuai Yan
- Department of Oncology, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
| | - Nanyao Wang
- Department of Oncology, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
| | - Ming Yuan
- Department of Oncology, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
| | - Qiong Wang
- Department of Oncology, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
| | - Dan Wu
- Department of Oncology, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
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Mankame AR, Sanders KE, Cardenas JC. TIME-DEPENDENT CHANGES IN PROINFLAMMATORY MEDIATORS ARE ASSOCIATED WITH TRAUMA-RELATED VENOUS THROMBOEMBOLISM. Shock 2023; 60:637-645. [PMID: 37647085 PMCID: PMC10841201 DOI: 10.1097/shk.0000000000002216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
ABSTRACT Background: Tissue trauma and hemorrhage result in pronounced activation of the innate immune system. Given known crosstalk between inflammation and coagulation, soluble inflammatory mediators could be associated with venous thromboembolisms (VTEs) after major trauma. Objectives : This study aimed to identify plasma inflammatory mediators that are independent predictors of VTE risk in trauma patients. Methods: We performed a secondary analysis of the Pragmatic Randomized Optimal Platelets and Plasma Ratios (PROPPR) study. Plasma levels of 27 cytokines/chemokines were measured by Bio-Plex at admission and 2, 4, 6, 12, 24, 48, and 72 h later. Patients who died from exsanguination or within 24 h were excluded. Mann-Whitney tests were performed to assess no-VTE and VTE groups at each time point. Multivariable logistic regression was used to determine the adjusted effects of inflammatory mediators on VTE risk. Results: Eighty-six of the 575 patients (15%) included developed VTE. Interleukin (IL)-1ra, IL-6, IL-8, IL-10, eotaxin, granulocyte colony-stimulating factor, interferon-γ-inducible protein, monocyte chemoattractant protein 1 (MCP-1), and chemokine ligand 5 (regulated on activation, normal T cell expressed and secreted) were all significantly increased among VTE patients. Multivariable analyses demonstrated that IL-6, IL-8, interferon-γ-inducible protein, and MCP-1 were independently associated with VTE. Cox proportional hazards modeling identified IL-6, IL-8, and MCP-1 as independent predictors of accelerated VTE development. We identified significant correlations between inflammation and markers of coagulation and endothelial activation. Conclusion: Sustained systemic inflammation is a key driver of VTE risk after major trauma. Therapeutics targeting innate immune activation should be considered for development of future multimodal strategies to augment current VTE prophylaxis.
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Affiliation(s)
- Atharwa R. Mankame
- Department of Surgery, Center for Translational Injury Research, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin St., MSB 5.204, Houston, TX, 77030, USA
| | - Kelly E. Sanders
- Department of Surgery, Center for Translational Injury Research, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin St., MSB 5.204, Houston, TX, 77030, USA
| | - Jessica C. Cardenas
- Department of Surgery, Center for Translational Injury Research, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin St., MSB 5.204, Houston, TX, 77030, USA
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30
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Sanfilippo KM, Fiala MA, Feinberg D, Tathireddy H, Girard T, Vij R, Di Paola J, Gage BF. D-dimer predicts venous thromboembolism in multiple myeloma: a nested case-control study. Res Pract Thromb Haemost 2023; 7:102235. [PMID: 38193055 PMCID: PMC10772878 DOI: 10.1016/j.rpth.2023.102235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/21/2023] [Accepted: 10/10/2023] [Indexed: 01/10/2024] Open
Abstract
Background Clinical risk assessment scores, such as IMPEDE VTE, can identify patients with multiple myeloma (MM) at high-risk of venous thromboembolism (VTE). Refinement of these scores, by including 1 or more biomarkers, could improve risk assessment. Objectives We sought to determine the association between soluble P-selectin (sP-selectin) and D-dimer with VTE in MM. Methods We identified 545 patients with newly diagnosed MM. Using a nested case-control design, we identified 38 cases of VTE within 6-months of MM treatment and 137 randomly selected controls. Using logistic regression, we examined the association between D-dimer and sP-selectin with VTE. We also analyzed the association after adjusting for IMPEDE VTE. Results Each 1-point increase in IMPEDE VTE score was associated with a 27% increase in odds of VTE (odds ratio 1.27; 95% CI 1.08-1.51; c-statistic 0.61; 95% CI 0.51-0.71). There was no association between sP-selectin and VTE. Each one increase in natural log of D-dimer was associated with a 44% increase in odds of VTE, so we assigned points (ranging from -2 to +2) to D-dimer values and incorporated them into IMPEDE VTE, forming IMPEDED VTE. There was a 30% increase in odds of VTE per each 1-point increase in IMPEDED VTE (OR 1.30; 95% CI 1.12-1.52; c-statistic 0.65; 95% CI 0.55-0.75). Conclusion Among patients with newly diagnosed MM starting chemotherapy, D-dimer was associated with increased odds of developing VTE within the subsequent 6-months. The addition of D-dimer to IMPEDE VTE-IMPEDED VTE-could improve prediction of VTE among patients with MM.
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Affiliation(s)
- Kristen M. Sanfilippo
- Department of Medicine, St. Louis Veterans Administration Health Care System, St. Louis, Missouri, USA
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mark A. Fiala
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Daniel Feinberg
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Harsha Tathireddy
- Department of Medicine, St Joseph Memorial Hospital, Southern Illinois Healthcare, Murphysboro, Illinois, USA
| | - Thomas Girard
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ravi Vij
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jorge Di Paola
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Brian F. Gage
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Alexander M, Harris S, Underhill C, Torres J, Sharma S, Lee N, Wong H, Eek R, Michael M, Tie J, Rogers J, Heriot AG, Ball D, MacManus M, Wolfe R, Solomon BJ, Burbury K. Risk-Directed Ambulatory Thromboprophylaxis in Lung and Gastrointestinal Cancers: The TARGET-TP Randomized Clinical Trial. JAMA Oncol 2023; 9:1536-1545. [PMID: 37733336 PMCID: PMC10514890 DOI: 10.1001/jamaoncol.2023.3634] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/11/2023] [Indexed: 09/22/2023]
Abstract
Importance Thromboprophylaxis for individuals receiving systemic anticancer therapies has proven to be effective. Potential to maximize benefits relies on improved risk-directed strategies, but existing risk models underperform in cohorts with lung and gastrointestinal cancers. Objective To assess clinical benefits and safety of biomarker-driven thromboprophylaxis and to externally validate a biomarker thrombosis risk assessment model for individuals with lung and gastrointestinal cancers. Design, Setting, and Participants This open-label, phase 3 randomized clinical trial (Targeted Thromboprophylaxis in Ambulatory Patients Receiving Anticancer Therapies [TARGET-TP]) conducted from June 2018 to July 2021 (with 6-month primary follow-up) included adults aged 18 years or older commencing systemic anticancer therapies for lung or gastrointestinal cancers at 1 metropolitan and 4 regional hospitals in Australia. Thromboembolism risk assessment based on fibrinogen and d-dimer levels stratified individuals into low-risk (observation) and high-risk (randomized) cohorts. Interventions High-risk patients were randomized 1:1 to receive enoxaparin, 40 mg, subcutaneously daily for 90 days (extending up to 180 days according to ongoing risk) or no thromboprophylaxis (control). Main Outcomes and Measures The primary outcome was objectively confirmed thromboembolism at 180 days. Key secondary outcomes included bleeding, survival, and risk model validation. Results Of 782 eligible adults, 328 (42%) were enrolled in the trial (median age, 65 years [range, 30-88 years]; 176 male [54%]). Of these participants, 201 (61%) had gastrointestinal cancer, 127 (39%) had lung cancer, and 132 (40%) had metastatic disease; 200 (61%) were high risk (100 in each group), and 128 (39%) were low risk. In the high-risk cohort, thromboembolism occurred in 8 individuals randomized to enoxaparin (8%) and 23 control individuals (23%) (hazard ratio [HR], 0.31; 95% CI, 0.15-0.70; P = .005; number needed to treat, 6.7). Thromboembolism occurred in 10 low-risk individuals (8%) (high-risk control vs low risk: HR, 3.33; 95% CI, 1.58-6.99; P = .002). Risk model sensitivity was 70%, and specificity was 61%. The rate of major bleeding was low, occurring in 1 participant randomized to enoxaparin (1%), 2 in the high-risk control group (2%), and 3 in the low-risk group (2%) (P = .88). Six-month mortality was 13% in the enoxaparin group vs 26% in the high-risk control group (HR, 0.48; 95% CI, 0.24-0.93; P = .03) and 7% in the low-risk group (vs high-risk control: HR, 4.71; 95% CI, 2.13-10.42; P < .001). Conclusions and Relevance In this randomized clinical trial of individuals with lung and gastrointestinal cancers who were stratified by risk score according to thrombosis risk, risk-directed thromboprophylaxis reduced thromboembolism with a desirable number needed to treat, without safety concerns, and with reduced mortality. Individuals at low risk avoided unnecessary intervention. The findings suggest that biomarker-driven, risk-directed primary thromboprophylaxis is an appropriate approach in this population. Trial Registration ANZCTR Identifier: ACTRN12618000811202.
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Affiliation(s)
- Marliese Alexander
- Department of Pharmacy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Sam Harris
- Bendigo Cancer Centre, Bendigo Health, Bendigo, Victoria, Australia
| | - Craig Underhill
- Border Medical Oncology and Haematology Research Unit, Albury Wodonga Regional Cancer Centre, Albury Wodonga, New South Wales, Australia
- University of New South Wales, Rural Medical School, Albury Campus, Sydney, New South Wales, Australia
| | - Javier Torres
- Peter Copulos Cancer and Wellness Centre, Goulburn Valley Health, Shepparton, Victoria, Australia
- Rural Clinical School–Shepparton, The University of Melbourne, Shepparton, Victoria, Australia
| | - Sharad Sharma
- Ballarat Regional Integrated Cancer Centre, Grampians Health, Ballarat, Victoria, Australia
| | - Nora Lee
- Bendigo Cancer Centre, Bendigo Health, Bendigo, Victoria, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - HuiLi Wong
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Richard Eek
- Border Medical Oncology and Haematology Research Unit, Albury Wodonga Regional Cancer Centre, Albury Wodonga, New South Wales, Australia
| | - Michael Michael
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jeanne Tie
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Jennifer Rogers
- Department of Pharmacy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alexander G. Heriot
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - David Ball
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael MacManus
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Benjamin J. Solomon
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kate Burbury
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Chen S, Sun W, Dan M, Sun Y, Jiang Y. A nomogram for predicting the risk of venous thromboembolism in patients with solid cancers. J Thromb Thrombolysis 2023; 56:414-422. [PMID: 37462901 PMCID: PMC10439043 DOI: 10.1007/s11239-023-02856-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 08/20/2023]
Abstract
Cancer patients with venous thromboembolism (VTE) are prone to poor prognoses. Thus, we aimed to develop a nomogram to predict the risk of VTE in these patients. We retrospectively analyzed 791 patients diagnosed with solid tumors between January 2017 and May 2021 at Tongji Hospital. Univariate logistic analysis and multivariate logistic regression were adopted in this study. Our results indicated that age ≥ 60 years, tumor stages III-IV, platelet distribution width (PDW) ≤ 12.6%, albumin concentration ≤ 38.8 g/L, lactate dehydrogenase (LDH) concentration ≥ 198 U/L, D-dimer concentration ≥ 1.72 µg/mL, blood hemoglobin concentration ≤ 100 g/dL or the use of erythropoiesis-stimulating agents and cancer types were independent risk factors. The nomogram prediction model was developed based on the regression coefficients of these variables. We assessed the performance of the nomogram by calibration plot and the area under the receiver operating characteristic curve and compared it with the Khorana score. The concordance index (C- index) of the nomogram was 0.852 [95% confidence interval (CI) 0.823 to 0.880], while the Khorana score was 0.681 (95% CI 0.639 to 0.723). Given its performance, this nomogram could be used to select cancer patients at high risk for VTE and guide thromboprophylaxis treatment in clinical practice, provided it is validated in an external cohort.
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Affiliation(s)
- Siyu Chen
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Wei Sun
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Min Dan
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Yue Sun
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Yongsheng Jiang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
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García Vallejo O, Aicart Bort MD, Babiano Fernández MÁ, Caballer Rodilla J, Cabrera Ferriols MÁ, Carrasco Carrasco E, Gil Gil I, Lahera García AM, Martos Cárdenas T, Piera Carbonell A. [Recommendations for thromboembolic disease in oncological processes. A view from primary care]. Semergen 2023; 49:102030. [PMID: 37487423 DOI: 10.1016/j.semerg.2023.102030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 07/26/2023]
Abstract
Venous thromboembolic disease (VTE) is a frequent complication in patients diagnosed with cancer and a cause of morbidity and mortality. Approximately 20% of thromboembolic episodes develop in association with active cancer. On the other hand, it is estimated that about 2-12% of cases, the thromboembolic episode is the first manifestation of an occult cancer, diagnosed at that time or subsequently, which offers an opportunity for early diagnosis and treatment. There are multiple factors that contribute to increase the risk of VTE in oncological patients in relation to specific characteristics of the patient, the tumor and the treatments. Knowledge of these risk factors will contribute to early diagnosis when signs of VTE appear, as well as the assessment of thromboprophylaxis if indicated. The diagnosis of VTE in patients with cancer does not differ of those who do not suffer from it. Regarding the treatment of VTE in these patients, low molecular weight heparin (LMWH), direct acting anticoagulants (DACs) and antivitamin K (VKA) are the most commonly used, although the dosing regimen and length are not clear yet. The management of these patients should be interdisciplinary and early, so the primary care physician plays a key role in this process as he/she is liaise with his/her patients. It is also necessary to update knowledge in order to improve the care of these patients. For these reasons, this document has been prepared by the Working Group on Vasculopathies of the Spanish Society of Primary Care Physicians (SEMERGEN) whose objective is to present the available information regarding the management of VTE that may appear in oncological patients, as well as the assessment of thromboprophylaxis and treatment, if appropriate, from an approach focused on a primary care field.
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Affiliation(s)
- O García Vallejo
- Medicina Familiar y Comunitaria, Centro de Salud Comillas, Madrid, España.
| | | | - M Á Babiano Fernández
- Medicina Familiar y Comunitaria, Centro de Salud Argamasilla de Calatrava, Argamasilla de Calatrava, Ciudad Real, España
| | - J Caballer Rodilla
- Medicina Familiar y Comunitaria. Centro de Salud Algete, Algete, Madrid, España
| | | | - E Carrasco Carrasco
- Medicina Familiar y Comunitaria, Centro de Salud de Abarán, Abarán, Murcia, España
| | - I Gil Gil
- Medicina Familiar y Comunitaria, Centro de Salud Vielha, Vielha, Lleida, España
| | | | | | - A Piera Carbonell
- Medicina Familiar y Comunitaria, Centro de Salud Corredoria, Oviedo, Asturias, España
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Franco-Moreno A, Madroñal-Cerezo E, Muñoz-Rivas N, Torres-Macho J, Ruiz-Giardín JM, Ancos-Aracil CL. Prediction of Venous Thromboembolism in Patients With Cancer Using Machine Learning Approaches: A Systematic Review and Meta-Analysis. JCO Clin Cancer Inform 2023; 7:e2300060. [PMID: 37616550 DOI: 10.1200/cci.23.00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/02/2023] [Accepted: 07/10/2023] [Indexed: 08/26/2023] Open
Abstract
PURPOSE Recent studies have suggested that machine learning (ML) could be used to predict venous thromboembolism (VTE) in cancer patients with high accuracy. METHODS We aimed to evaluate the performance of ML in predicting VTE events in patients with cancer. PubMed, Web of Science, and EMBASE to identify studies were searched. RESULTS Seven studies involving 12,249 patients with cancer were included. The combined results of the different ML models demonstrated good accuracy in the prediction of VTE. In the training set, the global pooled sensitivity was 0.87, the global pooled specificity was 0.87, and the AUC was 0.91, and in the test set 0.65, 0.84, and 0.80, respectively. CONCLUSION The prediction ML models showed good performance to predict VTE. External validation to determine the result's reproducibility is necessary.
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Affiliation(s)
- Anabel Franco-Moreno
- Thromboembolism Unit, Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain
| | - Elena Madroñal-Cerezo
- Thromboembolism Unit, Internal Medicine Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Nuria Muñoz-Rivas
- Thromboembolism Unit, Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain
- Medicine Department, Complutense University, Madrid, Spain
| | - Juan Torres-Macho
- Thromboembolism Unit, Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain
- Medicine Department, Complutense University, Madrid, Spain
| | - José Manuel Ruiz-Giardín
- Internal Medicine Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
- CIBERINFEC, Madrid, Spain
| | - Cristina L Ancos-Aracil
- Thromboembolism Unit, Internal Medicine Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
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Townsley SK, Basu D, Vora J, Wun T, Chuah C, Shankar PRV. Predicting venous thromboembolism (VTE) risk in cancer patients using machine learning. HEALTH CARE SCIENCE 2023; 2:205-222. [PMID: 38939521 PMCID: PMC11080820 DOI: 10.1002/hcs2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 05/14/2023] [Accepted: 05/21/2023] [Indexed: 06/29/2024]
Abstract
Background The association between cancer and venous thromboembolism (VTE) is well-established with cancer patients accounting for approximately 20% of all VTE incidents. In this paper, we have performed a comparison of machine learning (ML) methods to traditional clinical scoring models for predicting the occurrence of VTE in a cancer patient population, identified important features (clinical biomarkers) for ML model predictions, and examined how different approaches to reducing the number of features used in the model impact model performance. Methods We have developed an ML pipeline including three separate feature selection processes and applied it to routine patient care data from the electronic health records of 1910 cancer patients at the University of California Davis Medical Center. Results Our ML-based prediction model achieved an area under the receiver operating characteristic curve of 0.778 ± 0.006 (mean ± SD) when trained on a set of 15 features. This result is comparable with the model performance when trained on all features in our feature pool [0.779 ± 0.006 (mean ± SD) with 29 features]. Our result surpasses the most validated clinical scoring system for VTE risk assessment in cancer patients by 16.1%. We additionally found cancer stage information to be a useful predictor after all performed feature selection processes despite not being used in existing score-based approaches. Conclusion From these findings, we observe that ML can offer new insights and a significant improvement over the most validated clinical VTE risk scoring systems in cancer patients. The results of this study also allowed us to draw insight into our feature pool and identify the features that could have the most utility in the context of developing an efficient ML classifier. While a model trained on our entire feature pool of 29 features significantly outperformed the traditionally used clinical scoring system, we were able to achieve an equivalent performance using a subset of only 15 features through strategic feature selection methods. These results are encouraging for potential applications of ML to predicting cancer-associated VTE in clinical settings such as in bedside decision support systems where feature availability may be limited.
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Affiliation(s)
- Samir Khan Townsley
- Department of Electrical and Computer EngineeringUniversity of CaliforniaDavisCaliforniaUSA
| | - Debraj Basu
- Department of Electrical and Computer EngineeringUniversity of CaliforniaDavisCaliforniaUSA
| | - Jayneel Vora
- Department of Computer ScienceUniversity of CaliforniaDavisCaliforniaUSA
| | - Ted Wun
- School of Medicine, Davis HealthUniversity of CaliforniaSacramentoCaliforniaUSA
| | - Chen‐Nee Chuah
- Department of Electrical and Computer EngineeringUniversity of CaliforniaDavisCaliforniaUSA
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Giustozzi M, Franco L, Agnelli G, Verso M. Unmet clinical needs in the prevention and treatment of cancer-associated venous thromboembolism. Trends Cardiovasc Med 2023; 33:336-343. [PMID: 35150850 DOI: 10.1016/j.tcm.2022.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 12/11/2022]
Abstract
Venous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis, is a leading cause of morbidity and mortality in patients with cancer. Based on accumulating evidence, the prophylaxis and treatment of cancer-associated VTE have been changed over the years. Recently, the introduction in clinical practice of the direct oral anticoagulants has radically changed the management of cancer-associated VTE for their easier use and non-inferior efficacy-safety profile compared to low-molecular-weight heparins. However, the heterogeneity of the cancer population in terms of site, type and stage of the malignancy, the presence of comorbidities, and the variability in cancer treatment and prognosis represent major challenges in the management of VTE in patients with cancer. In the present review, we will discuss clinical questions that represent unsolved issues in the setting of cancer-associated VTE and provide an overview on recent evidence on this topic: primary prophylaxis in ambulatory cancer patients treated with chemotherapy and in cancer surgical patients, need of long-term anticoagulation in cancer patients, treatment of VTE in cancer patients at increased bleeding risk and in special categories such as incidental VTE, splanchnic vein thrombosis or catheter-related thrombosis.
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Affiliation(s)
- Michela Giustozzi
- Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Piazzale Menghini 1, Perugia 06129, Italy.
| | - Laura Franco
- Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Piazzale Menghini 1, Perugia 06129, Italy
| | - Giancarlo Agnelli
- Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Piazzale Menghini 1, Perugia 06129, Italy
| | - Melina Verso
- Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Piazzale Menghini 1, Perugia 06129, Italy
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Verzeroli C, Giaccherini C, Russo L, Bolognini S, Gamba S, Tartari CJ, Schieppati F, Ticozzi C, Vignoli A, Masci G, Sarmiento R, Spinelli D, Malighetti P, Tondini C, Petrelli F, Giuliani F, D'Alessio A, Gasparini G, Minelli M, De Braud F, Santoro A, Labianca R, Marchetti M, Falanga A. Utility of the Khorana and the new-Vienna CATS prediction scores in cancer patients of the HYPERCAN cohort. J Thromb Haemost 2023; 21:1869-1881. [PMID: 37054917 DOI: 10.1016/j.jtha.2023.03.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/24/2023] [Accepted: 03/16/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Risk assessment models (RAMs) are relevant approaches to identify cancer outpatients at high risk of venous thromboembolism (VTE). Among the proposed RAMs, the Khorana (KRS) and the new-Vienna CATS risk scores have been externally validated in ambulatory patients with cancer. OBJECTIVES To test KRS and new-Vienna CATS scores in 6-month VTE prediction and mortality in a large prospective cohort of metastatic cancer outpatients during chemotherapy. PATIENTS/METHODS Newly diagnosed patients with metastatic non-small cell lung, colorectal, gastric, or breast cancers were analyzed (n = 1286). The cumulative incidence of objectively confirmed VTE was estimated with death as a competing risk and multivariate Fine and Gray regression. RESULTS Within 6 months, 120 VTE events (9.7%) occurred. The KRS and the new-Vienna CATS scores showed comparable c-stat. Stratification by KRS provided VTE cumulative incidences of 6.2%, 11.4%, and 11.5% in the low-, intermediate-, and high-risk categories, respectively (p = ns), and of 8.5% vs. 11.8% (p = ns) in the low- vs. high-risk group by the single 2-point cut-off value stratification. Using a pre-defined 60-point cut-off by the new-Vienna CATS score, 6.6% and 12.2% cumulative incidences were obtained in the low- and high-risk groups, respectively (p < 0.001). Furthermore, having a KRS ≥2 = or a new-Vienna CATS score >60 points was also an independent risk factor for mortality. CONCLUSION In our cohort, the 2 RAMs showed a comparable discriminating potential; however, after the application of cut-off values, the new-Vienna CATS score provided statistically significant stratification for VTE. Both RAMs proved to be effective in identifying patients at increased risk of mortality.
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Affiliation(s)
- Cristina Verzeroli
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Cinzia Giaccherini
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Russo
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Silvia Bolognini
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Sara Gamba
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Carmen J Tartari
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Schieppati
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Ticozzi
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Alfonso Vignoli
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Giovanna Masci
- Oncology Unit, Istituti di Ricovero e Cura a Carattere Scientifico Humanitas Institute, Rozzano, Italy
| | | | - Daniele Spinelli
- Department of Statistics, University of Milan Bicocca, Milan, Italy
| | - Paolo Malighetti
- Department of Management Engineering, University of Bergamo, Italy
| | - Carlo Tondini
- Oncology Unit, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Fausto Petrelli
- Oncology Unit, Hospital Treviglio-Caravaggio, Treviglio, Italy
| | - Francesco Giuliani
- Oncology Unit, Istituti di Ricovero e Cura a Carattere Scientifico Cancer Institute Giovanni Paolo II, Bari, Italy
| | - Andrea D'Alessio
- Medical Oncology and Internal Medicine, Policlinico San Marco, Gruppo San Donato Zingonia-Bergamo, Italy
| | | | - Mauro Minelli
- Oncology Unit, Hospital San Giovanni Addolorata, Rome, Italy
| | - Filippo De Braud
- Oncology Unit, Istituti di Ricovero e Cura a Carattere Scientifico National Cancer Institute, Milan, Italy
| | - Armando Santoro
- Oncology Unit, Istituti di Ricovero e Cura a Carattere Scientifico Humanitas Institute, Rozzano, Italy
| | | | - Marina Marchetti
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy; University of Milan Bicocca, School of Medicine, Milan, Italy
| | - Anna Falanga
- Immunohematology and Transfusion Medicine, Aziende Socio Sanitarie Territoriali Hospital Papa Giovanni XXIII, Bergamo, Italy; University of Milan Bicocca, School of Medicine, Milan, Italy.
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Elalamy I, Cohen-Solal A, Hanon O, Mirabel M, Mismetti P, Spano JP. Primary prevention of cancer-associated venous thrombosis: Rationale and challenges in clinical practice. Curr Res Transl Med 2023; 71:103405. [PMID: 37478777 DOI: 10.1016/j.retram.2023.103405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
Cancer-associated venous thrombosis (CAT) is a common, multifactor event known to complicate the course of cancer and jeopardize a patient's prognosis. The current guidelines regarding the prevention of CAT are sometimes considered insufficiently precise about specific situations, or are poorly applied. The expected benefits of thromboprophylaxis are balanced by the risk of major bleeding induced by anticoagulation, which implies a need to accurately identify ambulatory patients at high risk of thrombosis or hemorrhage. The Khorana score is commonly used for this, but is limited by the non-reproducibility of predicted performance across cancer types, and by the fact that antitumor treatment and cardiovascular risks are not included. The COMPASS-CAT score, which includes those two aspects, was found to be a more accurate predictor of venous thromboembolism in patients with lung cancer, and to better distinguish between patients at low or high risk of thrombosis. The frailty of patients with cancer is also a major issue, and should be taken into account when thromboprophylaxis is considered. According to current guidelines, CAT prophylaxis should be considered for hospitalized patients, those for whom surgery is scheduled, or those with pancreatic cancers. In ambulatory patients, decisions should be made according to patient, cancer and antitumoral treatment characteristics. Low molecular weight heparin is the gold standard of CAT prophylaxis. Despite increased risks of bleeding or drug-drug interactions in cancer patients, direct oral anticoagulants could be alternate options for high-risk ambulatory patients that should be accompanied by a careful global analysis of benefits, harms, and patient preferences.
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Affiliation(s)
- Ismail Elalamy
- Thrombosis Center, Hematology Department (DMU BioGeM), Assistance Publique Hôpitaux de Paris, Sorbonne University of Medicine, Paris, France; Research Group "Cancer, Haemostasis and Angiogenesis", INSERM U938, Research Centre Saint-Antoine, University Institute of Cancerology, Sorbonne University of Medicine, Paris, France; The First I.M. Sechenov Moscow State Medical University, Moscow, Russia.
| | - Alain Cohen-Solal
- Université Paris Cité, INSERM Unité 942 MASCOT, AP-HP, Département de cardiologie et maladies vasculaires, Hôpital Lariboisière, Paris, France
| | - Olivier Hanon
- Université Paris Cité, EA4468, AP-HP, hôpitaux Universitaires Paris Centre, Département de Gériatrie, Hôpital Broca, Paris, France
| | - Mariana Mirabel
- Département de Cardiologie, Institut mutualiste Montsouris, Paris, France
| | - Patrick Mismetti
- Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalier Universitaire, Saint Etienne, France
| | - Jean-Philippe Spano
- Service d'Oncologie médicale, APHP-SU, IUC, Hôpital La Pitié-Salpêtrière, Paris, France
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Mesa E, Miles D, Araguez-Ancares N, Casadesus D. Hemolysis, Elevated Liver Enzymes and Low Platelets (HELLP) Syndrome and Metastatic Breast Cancer: A Rare Overlap in a Postpartum Patient With Disseminated Intravascular Coagulation and Refractory Thrombocytopenia. Cureus 2023; 15:e42225. [PMID: 37605670 PMCID: PMC10439979 DOI: 10.7759/cureus.42225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
A middle-aged female arrived at a tertiary care hospital after a referral from her primary care physician to evaluate a left breast mass found on ultrasound concerning malignancy. The patient was also 27 weeks gestational with monochorionic diamniotic twins. During triage, she was found to have severe hypertension and lab abnormalities concerning HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome and underwent cesarean delivery of the infants. She had a biopsy of the left breast mass post-delivery, later diagnosed as invasive ductal cell carcinoma with spinal metastasis and numerous metastatic pulmonary nodules. Her hospital stay was complicated by a right lower extremity deep vein thrombosis, acute subdural hematoma, and disseminated intravascular coagulation with refractory thrombocytopenia resulting in her death.
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Affiliation(s)
- Elvis Mesa
- Internal Medicine, St. George's University School of Medicine, St. George's, USA
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Dylan Miles
- Internal Medicine, St. George's University School of Medicine, St. George's, GRD
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40
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Ha H, Ko YH, Kim K, Hong J, Lee GW, Jeong SH, Bang SM, Yoon SS. Application of the Khorana score for cancer-associated thrombosis prediction in patients of East Asian ethnicity undergoing ambulatory chemotherapy. Thromb J 2023; 21:63. [PMID: 37271814 DOI: 10.1186/s12959-023-00505-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND The Khorana score (KS) has not been well studied in East Asian cancer patients, who have different genetic backgrounds for inherited thrombophilia, body metabolism, and cancer epidemiology. METHODS By using the Common Data Model, we retrospectively collected deidentified data from 11,714 consecutive newly diagnosed cancer patients who underwent first-line chemotherapy from December 2015 to December 2021 at a single institution in Korea, and we applied the KS for cancer-associated thrombosis (CAT) prediction. Age at diagnosis, sex, and use of highly thrombogenic chemotherapeutics were additionally investigated as potential risk factors for CAT development. RESULTS By 6 months after chemotherapy initiation, 207 patients (1.77%) experienced CAT. Only 0.4% had a body mass index (BMI) ≥ 35 kg/m2 and changing the cutoff to 25 kg/m2 improved the prediction of CAT. Age ≥ 65 years and the use of highly thrombogenic chemotherapeutics were independently associated with CAT development. KS values of 1 ~ 2 and ≥ 3 accounted for 52.3% and 7.6% of all patients, respectively, and the incidence of CAT in these groups was 2.16% and 4.16%, respectively, suggesting a lower incidence of CAT in the study population than in Westerners. The KS component regarding the site of cancer showed a good association with CAT development but needed some improvement. CONCLUSION The KS was partially validated to predict CAT in Korean cancer patients undergoing modern chemotherapy. Modifying the BMI cutoff, adding other risk variables, and refining the use of cancer-site data for CAT risk prediction may improve the performance of the KS for CAT prediction in East Asian patients.
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Affiliation(s)
- Hyerim Ha
- Department of Internal Medicine, Inha University College of Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Yeh-Hee Ko
- Department of Applied Statistics, Yonsei University, Seoul, Republic of Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Department of Medicine, College of Medicine, Seoul National University Hospital, Seoul National University, 101 Daehak-ro, Jongno-gu, Adjunct, Seoul, Republic of Korea.
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Gyeong-Won Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Seong Hyun Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National Bundang Hospital, Seongnam, Republic of Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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41
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Li A, La J, May SB, Guffey D, da Costa WL, Amos CI, Bandyo R, Milner EM, Kurian KM, Chen DC, Do NV, Granada C, Riaz N, Brophy MT, Chitalia V, Gaziano JM, Garcia DA, Carrier M, Flowers CR, Zakai NA, Fillmore NR. Derivation and Validation of a Clinical Risk Assessment Model for Cancer-Associated Thrombosis in Two Unique US Health Care Systems. J Clin Oncol 2023; 41:2926-2938. [PMID: 36626707 PMCID: PMC10431461 DOI: 10.1200/jco.22.01542] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/25/2022] [Accepted: 12/01/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Venous thromboembolism (VTE), especially pulmonary embolism (PE) and lower extremity deep vein thrombosis (LE-DVT), is a serious and potentially preventable complication for patients with cancer undergoing systemic therapy. METHODS Using retrospective data from patients diagnosed with incident cancer from 2011-2020, we derived a parsimonious risk assessment model (RAM) using least absolute shrinkage and selection operator regression from the Harris Health System (HHS, n = 9,769) and externally validated it using the Veterans Affairs (VA) health care system (n = 79,517). Bootstrapped c statistics and calibration curves were used to assess external model discrimination and fit. Dichotomized risk strata using integer scores were created and compared against the Khorana score (KS). RESULTS Incident VTE and PE/LE-DVT at 6 months occurred in 590 (6.2%) and 437 (4.6%) patients in HHS and 4,027 (5.1%) and 3,331 (4.2%) patients in the VA health care system. Assessed at the time of systemic therapy initiation, the new RAM included components of the KS with the modified cancer subtype, cancer staging, systemic therapy class, history of VTE, history of paralysis/immobility, recent hospitalization, and Asian/Pacific Islander race. The c statistic was 0.71 in HHS and 0.68 in the VA health care system (compared with 0.65 and 0.60, respectively, for KS). Furthermore, the new RAM appropriately reclassified 28% of patients and increased the proportion of VTEs in the high-risk group from 37% to 68% in the validation data set. CONCLUSION The novel RAM stratified patients with cancer into a high-risk group with 8%-10% cumulative incidence of VTE and 7% PE/LE-DVT at 6 months (v 3% and 2%, respectively, in the low-risk group). The model had improved performance over the original KS and doubled the number of VTE events in the high-risk stratum. We encourage additional external validation from prospective studies.[Media: see text].
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Affiliation(s)
- Ang Li
- Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX
| | - Jennifer La
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
| | - Sarah B. May
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, TX
| | - Danielle Guffey
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, TX
| | - Wilson L. da Costa
- Section of Epidemiology and Population Science, Baylor College of Medicine, Houston, TX
| | - Christopher I. Amos
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, TX
- Section of Epidemiology and Population Science, Baylor College of Medicine, Houston, TX
| | | | | | | | - Daniel C.R. Chen
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
| | - Nhan V. Do
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
| | - Carolina Granada
- Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX
| | - Nimrah Riaz
- Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX
| | - Mary T. Brophy
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Section of Hematology & Medical Oncology, Boston University School of Medicine, Boston, MA
| | - Vipul Chitalia
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - J. Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Aging, Brigham and Women's Hospital, Boston, MA
| | - David A. Garcia
- Division of Hematology, University of Washington School of Medicine, Seattle, WA
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher R. Flowers
- Division of Cancer Medicine, Department of Lymphoma-Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Neil A. Zakai
- Departments of Medicine and Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Nathanael R. Fillmore
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Section of Hematology & Medical Oncology, Boston University School of Medicine, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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42
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Guntupalli SR, Spinosa D, Wethington S, Eskander R, Khorana AA. Prevention of venous thromboembolism in patients with cancer. BMJ 2023; 381:e072715. [PMID: 37263632 DOI: 10.1136/bmj-2022-072715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Venous thromboembolism (VTE) is a major cause of both morbidity and mortality in patients with cancer. Venous thromboembolism, which includes both deep vein thrombosis and pulmonary embolism, affects a sizable portion of patients with malignancy and can have potentially life threatening complications. Accurate assessment of risk as well as diagnosis and treatment of this process is paramount to preventing death in this high risk population. Various risk models predictive of venous thromboembolism in patients with cancer have been developed, and knowledge of these rubrics is essential for the treating oncologist. Subgroups of particular interest are inpatients receiving chemotherapy, postoperative patients after surgical debulking, and patients undergoing radiotherapy. Numerous newer drugs have become available for the prevention of venous thromboembolism in patients with cancer who are at high risk of developing the disease. These include the class of drugs called direct oral anticoagulants, (DOACs) which do not require the same monitoring that other modalities have previously required and are taken by mouth, preventing the discomfort associated with subcutaneous strategies. The appropriate risk stratification and intervention to prevent venous thromboembolism are vital to the treatment of patients with cancer.
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Affiliation(s)
- Saketh R Guntupalli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel Spinosa
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stephanie Wethington
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ramez Eskander
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology University of California School of Medicine, San Diego, CA, USA
| | - Alok A Khorana
- Department of Hematology Oncology, Taussig Cancer Institute and Case Comprehensive Cancer Center, Cleveland Clinic, Cleveland, OH, USA
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Mantha S, Chatterjee S, Singh R, Cadley J, Poon C, Chatterjee A, Kelly D, Sterpi M, Soff G, Zwicker J, Soria J, Ruiz M, Muñoz A, Arcila M. Application of Machine Learning to the Prediction of Cancer-Associated Venous Thromboembolism. RESEARCH SQUARE 2023:rs.3.rs-2870367. [PMID: 37214902 PMCID: PMC10197737 DOI: 10.21203/rs.3.rs-2870367/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Venous thromboembolism (VTE) is a common and impactful complication of cancer. Several clinical prediction rules have been devised to estimate the risk of a thrombotic event in this patient population, however they are associated with limitations. We aimed to develop a predictive model of cancer-associated VTE using machine learning as a means to better integrate all available data, improve prediction accuracy and allow applicability regardless of timing for systemic therapy administration. A retrospective cohort was used to fit and validate the models, consisting of adult patients who had next generation sequencing performed on their solid tumor for the years 2014 to 2019. A deep learning survival model limited to demographic, cancer-specific, laboratory and pharmacological predictors was selected based on results from training data for 23,800 individuals and was evaluated on an internal validation set including 5,951 individuals, yielding a time-dependent concordance index of 0.72 (95% CI = 0.70-0.74) for the first 6 months of observation. Adapted models also performed well overall compared to the Khorana Score (KS) in two external cohorts of individuals starting systemic therapy; in an external validation set of 1,250 patients, the C-index was 0.71 (95% CI = 0.65-0.77) for the deep learning model vs 0.66 (95% CI = 0.59-0.72) for the KS and in a smaller external cohort of 358 patients the C-index was 0.59 (95% CI = 0.50-0.69) for the deep learning model vs 0.56 (95% CI = 0.48-0.64) for the KS. The proportions of patients accurately reclassified by the deep learning model were 25% and 26% respectively. In this large cohort of patients with a broad range of solid malignancies and at different phases of systemic therapy, the use of deep learning resulted in improved accuracy for VTE incidence predictions. Additional studies are needed to further assess the validity of this model.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Gerald Soff
- University of Miami Health System/Sylvester Comprehensive Cancer Center
| | | | - José Soria
- Biomedical Research Institute Sant Pau (IIB-Sant Pau)
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Liz-Pimenta J, Tavares V, Neto BV, Santos JMO, Guedes CB, Araújo A, Khorana AA, Medeiros R. Thrombosis and cachexia in cancer: two partners in crime? Crit Rev Oncol Hematol 2023; 186:103989. [PMID: 37061076 DOI: 10.1016/j.critrevonc.2023.103989] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023] Open
Abstract
Among cancer patients, thrombosis and cachexia are major causes of morbidity and mortality. Although the two may occur together, little is known about their possible relationship. Thus, a literature review was conducted by screening the databases PubMed, Scopus, SciELO, Medline and Web of Science. To summarize, cancer-associated thrombosis (CAT) and cancer-associated cachexia (CAC) seem to share several patient-, tumour- and treatment-related risk factors. Inflammation alongside metabolic and endocrine derangement is the potential missing link between CAT, CAC and cancer. Many key players, including specific pro-inflammatory cytokines, immune cells and hormones, appear to be implicated in both thrombosis and cachexia, representing attractive predictive markers and potential therapeutic targets. Altogether, the current evidence suggests a link between CAT and CAC, however, epidemiological studies are required to explore this potential relationship. Given the high incidence and negative impact of both diseases, further studies are needed for the better management of cancer patients.
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Affiliation(s)
- Joana Liz-Pimenta
- Department of Medical Oncology, Centro Hospitalar de Trás-os-Montes e Alto Douro, 5000-508 Vila Real, Portugal; FMUP, Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal
| | - Valéria Tavares
- FMUP, Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal; ICBAS, Abel Salazar Institute for the Biomedical Sciences, 4050-313 Porto, Portugal; Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP) / Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
| | - Beatriz Vieira Neto
- FMUP, Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal; Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP) / Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
| | - Joana M O Santos
- FMUP, Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal; Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP) / Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
| | - Catarina Brandão Guedes
- Department of Imunohemotherapy, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - António Araújo
- Department of Medical Oncology, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Alok A Khorana
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio 44106, United States of America
| | - Rui Medeiros
- FMUP, Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal; ICBAS, Abel Salazar Institute for the Biomedical Sciences, 4050-313 Porto, Portugal; Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP) / Pathology and Laboratory Medicine Dep., Clinical Pathology SV/ RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal; Research Department, Portuguese League Against Cancer - Regional Nucleus of the North, 4200-172 Porto, Portugal; Biomedical Research Center, Faculty of Health Sciences of the Fernando Pessoa University, 4249-004 Porto, Portugal.
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45
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Connors JM. Fine Tuning Venous Thromboembolism Risk Prediction in Patients With Cancer. J Clin Oncol 2023; 41:2881-2883. [PMID: 36972498 DOI: 10.1200/jco.23.00100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Affiliation(s)
- Jean M Connors
- Hematology Division, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA
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46
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Goshua G, Lee AI. Summiting thrombotic hazards in glioma. Blood 2023; 141:1245-1246. [PMID: 36929442 DOI: 10.1182/blood.2022019020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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47
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Wang TF, Carrier M. Immune Checkpoint Inhibitors-Associated Thrombosis: Incidence, Risk Factors and Management. Curr Oncol 2023; 30:3032-3046. [PMID: 36975443 PMCID: PMC10047296 DOI: 10.3390/curroncol30030230] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) target programmed cell death (PD) 1 receptor and its ligand PD-L1, and have become an integral part of treatment regimens in many cancers including lung cancer, renal cell carcinoma, melanoma, and more. Cancer is associated with a significantly increased risk of venous thromboembolism compared to non-cancer patients, and the risks increase further with anticancer therapies including ICIs. Cancer-associated thrombosis can lead to hospitalizations, delayed cancer treatment, and mortality. While thrombosis was not reported as a major complication in initial clinical trials leading to the approval of ICIs, emerging evidence from post-marketing studies revealed concerning risks of thrombosis in patients receiving ICIs. However, results remained heterogenous given differences in study designs and populations. Recent studies also showed that C-reactive protein dynamics might be an easily accessible biomarker for thrombosis and disease response in this population. In addition, early findings indicated that a commonly used anticoagulant for cancer-associated thrombosis, factor Xa inhibitors, might have potential synergistic antitumor effects when combined with ICIs. Herein we will review the current literature on the incidence, risk factors, and management of thrombosis in patients with cancer receiving ICIs. We aim to provide valuable information for clinicians in managing these patients.
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48
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Dutra B, Garcia-Rodriguez V, Garcia R, Szafron D, Abraham F, Khurana S, Lockhart J, Amin R, Wang Y, Thomas A. Characteristics and Outcomes of Cancer Patients With Venous Thromboembolic Events After Treatment With Immune Checkpoint Inhibitors. Am J Clin Oncol 2023; 46:94-100. [PMID: 36735530 DOI: 10.1097/coc.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study aimed to describe the clinical characteristics and outcomes of patients with venous thromboembolism (VTE) after Immune checkpoint inhibitors (ICI), focusing on patients with gastrointestinal (GI) immune-related adverse events (irAE). METHODS In this retrospective, single-center study, we report the clinical outcomes of adult cancer patients who developed a VTE within 2 years of ICI initiation. Patients were excluded if alternate causes of VTE were present apart from malignancy and cancer therapy. The cohort was classified into those with GI-irAE, non-GI-irAE, and no irAE. A control group with ICI exposure without irAE and VTE was selected for comparative analysis. RESULTS Of all ICI-treated patients, 1891 (17.2%) were diagnosed with VTE. In all, 501 (4.6%) had no etiology for VTE aside from malignancy and cancer therapy. Of these, 137 patients were included and classified as: 44 GI-irAE, 42 non-GI-irAE, and 51 no irAE. Chemotherapy within 6 months of ICI therapy was associated with increased VTE risk. There was no difference in the clinical course between those exposed to chemotherapy versus ICI therapy alone, time from ICI initiation to VTE, and VTE type, recurrence, or related hospitalization. While there was no difference in VTE-related mortality, the GI-irAE group was associated with lower all-cause mortality and superior overall survival. CONCLUSION Combined ICI and chemotherapy use increased VTE risk. There is a similar disease course of VTE after ICI exposure, regardless of other irAEs. Co-existing GI-irAE with VTE is associated with superior overall survival. Prospective studies are needed to evaluate the relationship between ICI therapy and VTE and irAE impact on VTE outcomes.
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Affiliation(s)
- Barbara Dutra
- Department of Internal Medicine, The University of Texas Health Science Center
| | | | | | | | - Fiyinfoluwa Abraham
- Department of Internal Medicine, The University of Texas Health Science Center
| | - Shruti Khurana
- Department of Internal Medicine, The University of Texas Health Science Center
| | - Jonathan Lockhart
- Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX
| | - Rajan Amin
- Department of Internal Medicine, The University of Texas Health Science Center
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center
| | - Anusha Thomas
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center
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Using machine learning to predict venous thromboembolism and major bleeding events following total joint arthroplasty. Sci Rep 2023; 13:2197. [PMID: 36750656 PMCID: PMC9905066 DOI: 10.1038/s41598-022-26032-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/08/2022] [Indexed: 02/09/2023] Open
Abstract
Venous thromboembolism (VTE) and major bleeding (MBE) are feared complications that are influenced by numerous host and surgical related factors. Using machine learning on contemporary data, our aim was to develop and validate a practical, easy-to-use algorithm to predict risk for VTE and MBE following total joint arthroplasty (TJA). This was a single institutional study of 35,963 primary and revision total hip (THA) and knee arthroplasty (TKA) patients operated between 2009 and 2020. Fifty-six variables related to demographics, comorbidities, operative factors as well as chemoprophylaxis were included in the analysis. The cohort was divided to training (70%) and test (30%) sets. Four machine learning models were developed for each of the outcomes assessed (VTE and MBE). Models were created for all VTE grouped together as well as for pulmonary emboli (PE) and deep vein thrombosis (DVT) individually to examine the need for distinct algorithms. For each outcome, the model that best performed using repeated cross validation was chosen for algorithm development, and predicted versus observed incidences were evaluated. Of the 35,963 patients included, 308 (0.86%) developed VTE (170 PE's, 176 DVT's) and 293 (0.81%) developed MBE. Separate models were created for PE and DVT as they were found to outperform the prediction of VTE. Gradient boosting trees had the highest performance for both PE (AUC-ROC 0.774 [SD 0.055]) and DVT (AUC-ROC 0.759 [SD 0.039]). For MBE, least absolute shrinkage and selection operator (Lasso) analysis had the highest AUC (AUC-ROC 0.803 [SD 0.035]). An algorithm that provides the probability for PE, DVT and MBE for each specific patient was created. All 3 algorithms had good discriminatory capability and cross-validation showed similar probabilities comparing predicted and observed failures indicating high accuracy of the model. We successfully developed and validated an easy-to-use algorithm that accurately predicts VTE and MBE following TJA. This tool can be used in every-day clinical decision making and patient counseling.
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50
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Wiegers HMG, Schaafsma M, Guman NAM, Zelisse HS, Mulder FI, Middeldorp S, van Es N, Mom CH. Risk of venous thromboembolism and bleeding after major surgery for ovarian cancer: standard in-hospital versus extended duration of thromboprophylaxis. JOURNAL OF THROMBOSIS AND HAEMOSTASIS : JTH 2023; 21:294-302. [PMID: 36700503 DOI: 10.1016/j.jtha.2022.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/18/2022] [Accepted: 11/01/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a frequent complication in patients with ovarian cancer after major surgery. Based on limited data, international guidelines recommend extended thromboprophylaxis for up to 28 days. OBJECTIVES To assess the incidence of VTE and bleeding within 30 days following major surgery in patients with ovarian cancer and to evaluate the association between VTE and thromboprophylaxis duration. METHODS This was a single-center, retrospective, "before-after" cohort study in patients with ovarian cancer undergoing major surgery. Before July 2019, the local protocol mandated a standard course of thromboprophylaxis during hospital stay only. From July 2019 onward, patients received extended thromboprophylaxis for 28 days. The cumulative incidences of VTE and major bleeding within 30 days after surgery were estimated using the Kaplan-Meier method, with 95% confidence intervals (CIs). Cox regression analysis was performed to evaluate the association between thromboprophylaxis duration and VTE incidence. RESULTS Between January 2018 and December 2020, 250 women were included, of which 118 (47.2%) received extended and 132 (52.8%) standard thromboprophylaxis. During follow-up, 12 patients developed VTE (cumulative incidence, 4.8%; 95% CI, 2.1-7.4) and 2 major bleeding (cumulative incidence 0.8%; 95% CI, 0.0-1.9). Compared with standard thromboprophylaxis, VTE incidence was numerically lower with extended duration of thromboprophylaxis (5/118 [4.2%] vs 7/132 [5.3%]) but not significantly different (hazard ratio, 0.80; 95% CI, 0.25-2.52). The risk of major bleeding was similar in both groups (1/118 [0.8%] vs 1/132 [0.8%]; hazard ratio, 1.12; 95% CI, 0.07-17.89). CONCLUSIONS The cumulative VTE incidence in patients with ovarian cancer following major surgery was considerable. Extended thromboprophylaxis was safe and associated with a numerically lower risk of VTE but not significantly different.
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Affiliation(s)
- Hanke M G Wiegers
- Amsterdam UMC - location University of Amsterdam, Vascular Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, the Netherlands.
| | - Mirte Schaafsma
- Antoni van Leeuwenhoek/Netherlands Cancer Institute, Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, Amsterdam, the Netherlands; Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Noori A M Guman
- Amsterdam UMC - location University of Amsterdam, Vascular Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, the Netherlands
| | - Hein S Zelisse
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Frits I Mulder
- Amsterdam UMC - location University of Amsterdam, Vascular Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, the Netherlands; Department of Internal Medicine, Tergooi Medical Center, Hilversum, the Netherlands
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nick van Es
- Amsterdam UMC - location University of Amsterdam, Vascular Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, the Netherlands
| | - Constantijne H Mom
- Department of Gynaecological Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
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