A New Risk Prediction Model for Venous Thromboembolism and Death in Ambulatory Lung Cancer Patients
Patricia Gómez-Rosas, Cinzia Giaccherini, Laura Russo, Cristina Verzeroli, Sara Gamba, Carmen Julia Tartari, Silvia Bolognini, Chiara Ticozzi, Francesca Schieppati, Luca Barcella, Roberta Sarmiento, Giovanna Masci, Carlo Tondini, Fausto Petrelli, Francesco Giuliani, A. D’Alessio, Mauro Minelli, Filippo de Braud, Armando Santoro, Roberto Labianca, Giampietro Gasparini, Marina Marchetti, Anna Falanga, on behalf of the HYPERCAN Investigators
Abstract
(1) Background: Venous thromboembolism (VTE) is a frequent complication in ambulatory lung cancer patients during chemotherapy and is associated with increased mortality. (2) Methods: We analyzed 568 newly diagnosed metastatic lung cancer patients prospectively enrolled in the HYPERCAN study. Blood samples collected before chemotherapy were tested for thrombin generation (TG) and a panel of hemostatic biomarkers. The Khorana risk score (KRS), new-Vienna CATS, PROTECHT, and CONKO risk assessment models (RAMs) were applied. (3) Results: Within 6 months, the cumulative incidences of VTE and mortality were 12% and 29%, respectively. Patients with VTE showed significantly increased levels of D-dimer, FVIII, prothrombin fragment 1 + 2, and TG. D-dimer and ECOG performance status were identified as independent risk factors for VTE and mortality by multivariable analysis and utilized to generate a risk score that provided a cumulative incidence of VTE of 6% vs. 25%, death of 19% vs. 55%, and in the low- vs. high-risk group, respectively (p < 0.001). While all published RAMs significantly stratified patients for risk of death, only the CATS and CONKO were able to stratify patients for VTE. (4) Conclusions: A new prediction model was generated to stratify lung cancer patients for VTE and mortality risk, where other published RAMs failed.