Prediction of Occult Cancer Among Adult Patients With Acute Venous Thromboembolic Disease

Abstract

We read with interest the study by Jara-Palomares and colleagues1Jara-Palomares L. Otero R. Jimenez D. et al.RIETE investigatorsDevelopment of a risk prediction score for occult cancer in patients with VTE.Chest. 2017; 151: 564-571Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar in this issue of CHEST. The article describes a score for identifying patients at higher risk of having an occult cancer identified after first presenting with VTE. We have previously published a study describing a similar predictive score and using similar methodology.2Ferreyro B.L. Angriman F. Giunta D. et al.Predictive score for estimating cancer after venous thromboembolism: a cohort study.BMC Cancer. 2013; 13: 352Crossref PubMed Scopus (10) Google Scholar Our score was derived and internally validated using a cohort of 1,264 adult patients who presented with a new VTE to a large tertiary hospital in Buenos Aires. Our study had a shorter follow-up period of 12 months, but patients in our cohort had a similar risk (9.2%) of having an associated occult cancer identified during follow-up. Similar to the findings from Jara-Palomares and colleagues, our final predictive score included previous episode of VTE, underlying comorbidities (as measured by the Charlson comorbidity score), and recent surgery. However, our methodology also included a secondary analysis evaluating a combined outcome of cancer or death to address the possibility that death might occur before the identification of an occult cancer. In this model, additional predictive factors were age ≥ 70 years and an albumin level ≤ 2.5 mg/dL. We believe this is an important issue not addressed in the study by Jara-Palomares and colleagues,1Jara-Palomares L. Otero R. Jimenez D. et al.RIETE investigatorsDevelopment of a risk prediction score for occult cancer in patients with VTE.Chest. 2017; 151: 564-571Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar because death was frequent during our 1 year of follow-up, occurring in 72% of patients with occult cancer and 19% without cancer. Moreover, in contrast to the results recently reported in the journal, previous VTE was associated with an increased risk of occult cancer both in our study and in another recently published large cohort study.3Ihaddadene R. Corsi D.J. Lazo-Langner A. et al.Risk factors predictive of occult cancer detection in patients with unprovoked venous thromboembolism.Blood. 2016; 127: 2035-2037Crossref PubMed Scopus (45) Google Scholar Potential mechanisms to explain the differences in the observed association between occult cancer and previous VTE include the time elapsed between the VTE events, underlying characteristics of included patients (eg, age and baseline comorbidities) and whether the incident VTE was provoked or unprovoked. Development of a Risk Prediction Score for Occult Cancer in Patients With VTECHESTVol. 151Issue 3PreviewThe benefits of a diagnostic workup for occult cancer in patients with VTE are controversial. Our aim was to provide and validate a risk score for occult cancer in patients with VTE. Full-Text PDF ResponseCHESTVol. 151Issue 3PreviewWe thank Drs Ferreyro et al for their interest in our article, their insightful comments, and the opportunity to reply. Ferreyro et al published a prognostic score with a final sample of 540 patients with VTE in 2013. Of these patients, 349 (two-thirds) composed the derivation cohort and 191 patients the validation cohort.1 In the derivation cohort, there were 32 cancers (9.2%) diagnosed during 1 year of follow-up. Moreover, they included a secondary analysis evaluating a combined outcome of cancer or death to address the possibility that death might occur before the identification of an occult cancer. Full-Text PDF