Cancer searching after unprovoked Thromboembolism – still a clinical controversy
Resumo
Introduction: Several trials failed to demonstrate the benefits of extensive
screening for the diagnosis of cancer after unprovoked venous thromboembolism
(VTE). The RIETE investigators recently proposed a score aimed to identify a subgroup
of patients at higher risk of occult cancer in this setting, that would benefit
from more extensive workup.
Methods: We performed a prospective and observational clinical study, that
aimed to validate the RIETE score in patients with unprovoked VTE. We calculated
the RIETE score to all patients, and the high-risk patients performed a CT
scan of the thorax, abdomen and pelvis, an upper gastrointestinal endoscopy and
a colonoscopy. All patients had clinical visits every three months for one year.
Results: We included 34 patients between November 2020 and April 2022.
Eight patients (23,5%) had a high-risk RIETE score. After a median follow-up of
21 months no cancer diagnosis was found.
Discussion and Conclusion: These results do not allow us to conclude about
the RIETE score power to distinguish high from low-risk patients of having a cancer
diagnosis after VTE, and further research is needed.
Key-words: Thromboembolism; cancer; RIETE score.
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Referências
R. Ihaddadene, D.J. Corsi, A. Lazo-Langner, et al., Risk factors predictive of occult cancer detection in patients with unprovoked venous thromboembolism, Blood 127 (16) (2016) 2035–2037, https://doi.org/10.1182/blood-2015-11-682963
N. van Es, C. Ay, L. Jara-Palomares, Screening for occult cancer in patients with venous thromboembolism: past, present, and future, Hamostaseologie 40 (3) (2020) 270–279, https://doi.org/10.1055/a-1150-2286
A. Piccioli, A.W.A. Lensing, M.H. Prins, et al., Extensive screening for occult malignant disease in idiopathic venous thromboembolism: a prospective randomized clinical trial, J. Thromb. Haemost. 2 (6) (2004) 884–889, https://doi.org/10.1111/j.1538-7836.2004.00720.x
M. Carrier, A. Lazo-Langner, S. Shivakumar, et al., Screening for occult cancer in unprovoked venous thromboembolism, N. Engl. J. Med. 373 (8) (2015) 697–704, https://doi.org/10.1056/NEJMoa1506623
P. Robin, P.Y. Le Roux, B. Planquette, et al., Limited screening with versus without 18F-fluorodeoxyglucose PET/CT for occult malignancy in unprovoked venous thromboembolism: an open-label randomised controlled trial, The Lancet Oncology 17 (2) (2016) 193–199, https://doi.org/10.1016/S1470-2045(15) 00480-5
L. Jara-Palomares, R. Otero, D. Jimenez, et al., Development of a risk prediction score for occult cancer in patients with VTE, Chest 151 (3) (2017) 564–571, https://doi.org/10.1016/j.chest.2016.10.025
L. Jara-Palomares, R. Otero, D. Jimenez, et al., Validation of a prognostic score for hidden cancer in unprovoked venous thromboembolism, PLoS One 13 (3) (2018) 1–11, https://doi.org/10.1371/journal.pone.0194673
L. Bertoletti, P. Robin, L. Jara-Palomares, et al., Predicting the risk of cancer after unprovoked venous thromboembolism: external validation of the RIETE score, J. Thromb. Haemost. 15 (11) (2017) 2184–2187, https://doi.org/10.1111/ jth.13842
A. Rosell, S. Lundstrom, N. Mackman, et al., A clinical practice-based evaluation of the RIETE score in predicting occult cancer in patients with venous thromboembolism, J. Thromb. Thrombolysis 48 (1) (2019) 111–118, https://doi.org/ 10.1007/s11239-019-01822-z
J.C. Mendonça, J. Martins, C. Fernandes, et al., Cancer risk after a venous thrombotic event - RIETE score, Thrombosis Research 202 (2021) 43–44, https://doi.org/10.1016/j.thromres.2021.02.036
