Derivation and Validation of a Clinical Risk Assessment Model for Cancer-Associated Thrombosis in Two Unique US Health Care Systems

作者：Ang Li, Jennifer La, Sarah May, Danielle Guffey, Wilson Luiz da Costa, Christopher Ian Amos, Raka Bandyo, Emily M. Milner, Karen M. Kurian, Daniel C. R. Chen, Nhan Do, Carolina Granada, Nimrah Riaz, Mary T. Brophy, Vipul Chimanlal Chitalia, J. Michael Gaziano, David García, Marc Carrier, Christopher R. Flowers, Neil A. Zakai, Nathanael R. Fillmore · 发表于：Journal of Clinical Oncology · 年份：2023 · DOI：10.1200/jco.22.01542 · 被引用次数：73 · 研究领域：Venous Thromboembolism Diagnosis and Management、Chemotherapy-induced cardiotoxicity and mitigation、Cardiac tumors and thrombi

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 ...