A Clinical-Genetic Risk Score for Predicting Cancer-Associated Venous Thromboembolism : A Development and Validation Study Involving Two Independent Prospective Cohorts
Muñoz Martin, Andrés (Sociedad Española de Oncología Médica)
Ay, Cihan (I.M. Sechenov First Moscow State Medical University (Sechenov University))
Grilz, Ella (Medical University of Vienna)
López, Sonia (Institut d'Investigació Biomèdica Sant Pau)
Font, C (Hospital Clínic i Provincial de Barcelona)
Pachón, Vanesa (Hospital Universitario Ramón y Cajal (Madrid))
Castellón, Victoria (Complejo Hospitalario Torrecárdenas (Almeria))
Martínez-Marín, Virginia (Hospital Universitario La Paz (Madrid))
Salgado, Mercedes (Complexo Hospitalario Universitario de Ourense - CHUO)
Martínez, Eva (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Calzas, Julia (Hospital Universitario de Fuenlabrada ( Madrid))
Ortega Morán, Laura (Sociedad Española de Oncología Médica)
Rupérez, Ana (Hospital Universitario Fundación Jiménez Díaz)
Salas, Eduardo (Gendiag.exe)
Pabinger, Ingrid (Medical University of Vienna)
Soria Fernández, José Manuel (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Fecha:	2023
Resumen:	Venous thromboembolism (VTE) is a leading cause of death among patients with cancer. The Khorana score was developed for assessing the risk of VTE in outpatients with cancer receiving chemotherapy, but its accuracy in identifying patients at high risk has been questioned. The aim of this study was to develop and validate a clinical-genetic score that improves the assessment of VTE risk in oncology outpatients within 6 months of diagnosis. The new score was developed using the data of 364 outpatients belonging to the Spanish ONCOTHROMB 12-01 population. In this cohort, clinical data associated with the risk of VTE were collected at the time of diagnosis, including the Khorana score. These patients were also genotyped for the 51 genetic variants known to be associated with VTE. Multivariate logistic regression was performed to determine the weight of each genetic and clinical variable in relation to VTE risk, allowing a clinical-genetic risk score (the ONCOTHROMB score) to be developed. The Khorana and the ONCOTHROMB scores were then compared via the area under the receiver operating characteristic curve (AUC), calibration, and the number of patients needed to treat. The new score was then validated in a study of 263 patients in the Vienna Cancer and Thrombosis Study population. RESULTSNine genetic variants, tumor site, TNM stage, and a body mass index of > 25 kg/m2 were found to be associated with VTE and were used to build the ONCOTHROMB score, which better predicted the overall risk of VTE than did the Khorana score (AUC, 0. 781 v 0. 580; P <. 001). Similar AUC results were recorded in the validation study the Vienna Cancer and Thrombosis Study cohort involving patients with the same type of tumor (AUC for the ONCOTHROMB score v the Khorana score: 0. 686 v 0. 577; P <. 001) and with all type of tumors (AUC for the ONCOTHROMB score v the Khorana score: 0. 720 v 0. 561; P <. 0001). The ONCOTHROMB score for VTE risk in outpatients with cancer, which takes into account both clinical and genetic variables, better identifies patients who might benefit from primary thromboprophylaxis than does the Khorana score.
Ayudas:	Instituto de Salud Carlos III PI/20/00325
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Anticoagulants ; Humans ; Neoplasms ; Prospective Studies ; Risk Assessment ; Risk Factors ; Thrombosis ; Venous Thromboembolism
Publicado en:	Journal of clinical oncology, Vol. 41 Núm. 16 (january 2023) , p. 2911-2925, ISSN 1527-7755

DOI: 10.1200/JCO.22.00255
PMID: 36730884

16 p, 531.8 KB

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