Risk scores for occult cancer in patients with unprovoked venous thromboembolism: results from an individual patient data meta-analysis

Link to article at PubMed

Mulder F, et al. J Thromb Haemost 2020.


BACKGROUND: The RIETE and SOME risk scores aim to identify patients with acute unprovoked venous thromboembolism (VTE) at high risk of occult cancer, but their predictive performance is unclear.

METHODS: The scores were evaluated in an individual-patient data meta-analysis. Studies were eligible if enrolling consecutive adults with unprovoked VTE who underwent protocol-mandated screening for cancer. The primary outcome was a cancer diagnosis between 30 days and 2 years of follow-up. The discriminatory performance was evaluated by computing the area under the receiver (ROC)-curve in random-effects meta-analyses.

RESULTS: The RIETE score could be calculated in 1,753 patients, of whom 63 (3.6%) were diagnosed with cancer. The pooled area under the ROC-curve was 0.59 (95% CI, 0.52-0.66, I2 =0%). Of the 427 patients (24%) classified as 'high-risk', 25 (5.9%) were diagnosed with cancer compared to 38 of 1,326 (2.9%) low-risk patients (hazard ratio [HR] 2.0; 95% CI, 1.3-3.4). The SOME score was calculated in 925 patients, of whom 37 (4.0%) were diagnosed with cancer. The pooled area under the ROC-curve was 0.56 (95% CI, 0.46-0.65; I2 =46%). Of the 161 patients (17%) classified as 'high-risk' (≥2 points), eight (5.0%) were diagnosed with cancer compared to 29 of 764 (3.8%) low-risk patients (HR 1.2; 95% CI, 0.55-2.7).

CONCLUSIONS: The predictive discriminatory performance of both scores is poor. When used dichotomously, the RIETE score is able to discriminate between low- and high-risk patients. Since this is largely driven by advanced age, these results do not support the use of these scores in daily clinical practice.

PMID:32654348 | DOI:10.1111/jth.15001

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