A clinical practice-based evaluation of the RIETE score in predicting occult cancer in patients with venous thromboembolism

Axel Rosell,Charlotte Thålin,Staffan Lundström,Håkan Wallén,Nigel Mackman

doi:10.1007/s11239-019-01822-z

Axel Rosell, Charlotte Thålin + Show 3 more

Open Access

https://doi.org/10.1007/s11239-019-01822-z

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Abstract

The association between venous thromboembolism (VTE) and occult cancer is well established. However, the benefit of cancer screening in all VTE patients remains controversial. The Registro Informatizado Enfermedad TromboEmbólica (RIETE) score is a recently proposed risk score to identify VTE patients at high risk of occult cancer. We evaluated the performance of the RIETE score in a routine clinical setting comprising patients presenting with VTE between January 1 and December 31, 2014, at Danderyd University hospital. Out of 488 VTE patients, 47 (9.6%) patients received a new cancer diagnosis during a 24-month follow-up. After exclusion of patients with cancer diagnosed at baseline (≤ 10 days after VTE, n = 16), 472 patients were considered eligible for cancer screening. Among these 472 patients, 31 (6.6%) received a cancer diagnosis during follow-up. The cumulative incidence was high after both unprovoked (8.5%) and provoked (4.8%) VTE. The RIETE score was evaluated in 467 of these patients. Interestingly, a high RIETE score was not significantly associated with cancer diagnosis during follow-up (OR 1.78; 95% CI 0.85–3.63), which was mainly due to a poor performance in women (OR 1.04; 95% CI 0.30–2.83). In summary, we observed a relatively high incidence of occult cancer in both unprovoked and provoked VTE. The RIETE score performed poorly in identifying patients at high risk of occult cancer in our VTE population. Additional risk assessment models are warranted to identify VTE patients who would benefit from extensive cancer screening.

Highlights

Venous thromboembolism (VTE), i.e. deep venous thrombosis (DVT) and pulmonary embolism (PE), is a common complication of cancer—the risk of venous thromboembolism (VTE) in cancer patients is four to sixfold compared to the general population [1, 2]
Extensive screening of all patients with unprovoked VTE could lead to earlier detection of occult cancer, earlier initiation of anti-cancer treatment, and improved prognosis
Recent prospective randomized trials have failed to show that extensive screening with computed tomography (CT) of abdomen/pelvis diagnose more cancers compared to a limited screening approach [5,6,7]

Summary

Introduction

Venous thromboembolism (VTE), i.e. deep venous thrombosis (DVT) and pulmonary embolism (PE), is a common complication of cancer—the risk of VTE in cancer patients is four to sixfold compared to the general population [1, 2]. VTE may be the earliest sign of occult cancer. The incidence of occult cancer in patients with provoked VTE is less investigated, but is considered much lower [3]. The benefit and extent of screening for occult cancer in VTE patients remains controversial. Extensive screening of all patients with unprovoked VTE could lead to earlier detection of occult cancer, earlier initiation of anti-cancer treatment, and improved prognosis. Recent prospective randomized trials have failed to show that extensive screening with computed tomography (CT) of abdomen/pelvis diagnose more cancers compared to a limited screening approach [5,6,7]. The addition of 18F-Fluorodesoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) to limited diagnostic work-up has yielded promising results [8], but further studies are needed to clarify the benefit of FDG PET/ CT in occult cancer screening

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