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Development of a clinical prediction tool for cancer-associated venous thromboembolism (CAT): the MD Anderson Cancer Center CAT model

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Abstract

Introduction

Cancer-associated venous thromboembolism (CAT) is a major complication of malignancy. Our goal was to develop a prediction model for VTE that better represented to the population seen at large referral cancer centers.

Materials and methods

This study was nested in a prospective cohort study at the University of Texas MD Anderson Cancer Center that evaluated adult patients during outpatient cancer-staging computed tomography to estimate the prevalence of incidental VTE. Data from patients in whom incidental VTE was not found on initial CT were collected until 24 months ± 7 days from the study inclusion date to determine the occurrence of new VTE events. Demographics, clinical data, current cancer treatment information, and the use of erythropoietin stimulating agents (ESAs) along with hematologic variables were collected in all patients and analyzed to determine differences between those who developed VTE versus those who did not. All candidate variables with significance p value (≤ 0.1) under univariate analysis were considered to enter the final multivariate model.

Results

Data of 548 patients were analyzed. The presence of metastatic disease and the use of platinum-based chemotherapy were strongly associated with CAT occurrence. The use of ESAs and specific malignancies showed trends of association with CAT, while associations were not statistically significant.Those characteristics were utilized to develop a clinical prediction model for CAT readily available and effective (c-index = 0.74).

Conclusion

Our model is effective and easy to incorporate in busy clinical settings and it does not depend on esoteric or difficult-to-obtain laboratory testing. Future external validation studies may provide further evidence for the applicability of our results.

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Data availability

We have full control of all primary data and we agree to allow the journal to review the data if requested

Abbreviations

CAT:

Cancer-associated venous thromboembolism

VTE:

Venous thromboembolism

CT:

Computed tomography

BMI:

Body mass index

ESA:

Erythropoietin-stimulating agents

Bre:

Breast cancer

Oth:

Other malignancies

GU/Kid:

Cancer of the genitourinary system

Gyn:

Cancer of the gynecologic system

GI/Pan:

Cancer of the gastrointestinal system

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Author information

Authors and Affiliations

  1. Section of Benign Hematology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1464, Houston, TX, USA

    Cristhiam M. Rojas-Hernandez

  2. Department of Pulmonary Disease and Critical Care Medicine, The University of Texas, McGovern Medical School, Houston, TX, USA

    Victoria K. Tang

  3. Department of Medical Oncology and Hematology, The University of Maryland, Baltimore, MD, USA

    Gabriela Sanchez-Petitto

  4. Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Wei Qiao

  5. Department of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Marsha Richardson

  6. Department of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Carmen Escalante

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  1. Cristhiam M. Rojas-Hernandez
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  2. Victoria K. Tang
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  4. Wei Qiao
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Corresponding author

Correspondence to Cristhiam M. Rojas-Hernandez.

Ethics declarations

The study was approved by The University of Texas MD Anderson Cancer Center Institutional Review Board.

Conflict of interest

Dr. Rojas-Hernandez has received research funding from Daichii Sankyo pharmaceuticals not related to the content of the present manuscript. The other authors have no conflicts of interest to declare.

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Preliminary data of this study have been presented during poster sessions at the International Society of Thrombosis of Haemostasis-2017 and the American Society of Hematology-2017.

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Rojas-Hernandez, C.M., Tang, V.K., Sanchez-Petitto, G. et al. Development of a clinical prediction tool for cancer-associated venous thromboembolism (CAT): the MD Anderson Cancer Center CAT model. Support Care Cancer 28, 3755–3761 (2020). https://doi.org/10.1007/s00520-019-05150-z

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