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Age, smoking history among predictors of occult cancer after unprovoked VTE
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Age, a prior provoked venous thromboembolism and a history of smoking appeared to predict the presence of occult cancer in patients who presented with a first unprovoked venous thromboembolism, according to an analysis of the SOME trial.
Unprovoked VTE may be the earliest indication of cancer. As many as 10% of patients who present with an unprovoked VTE will subsequently be diagnosed with cancer, with the highest risk occurring within the first year of a VTE diagnosis.
Screening for occult cancers in these patients has remained controversial; however, a subgroup of higher risk patients may benefit from a more extensive screening approach.
Marc Carrier, MD, MSc, FRCPC, associate professor of medicine in the department of medicine and scientist in the clinical epidemiology program of The Ottawa Hospital Research Institute, and colleagues conducted this post-hoc analysis of the SOME trial to assess the risk factors that are predictive of cancer detection in this population of patients.
The investigators included all 854 patients enrolled in the SOME trial as part of their analysis. Thirty-three patients (3.9%; 95% CI, 2.8-5.4) received a new cancer diagnosis at their 1-year follow-up.
Overall results showed that 55.2% of the patients had deep vein thrombosis only, 32.6% had a pulmonary embolism only and 12.2% had both.
Other characteristics included hypertension in 21.9% of the patients, previous cancer in 5.9% and a previous provoked VTE in 5.5%. Further, 15.5% were current smokers.
Age older than 60 years appeared associated with a cancer diagnosis (HR = 3.11; 95% CI, 1.41-6.89). Each additional 1 year of age was associated with an increased risk for cancer (HR = 1.06; 95% CI, 1.03-1.08).
Previous provoked VTE (HR = 3.2; 95% CI, 1.19-8.62) and current smoking (HR = 2.8; 95% CI, 1.24-6.33) also appeared associated with a higher risk for cancer at 1 year.
Due to the relatively small number of events, the researchers were limited in their ability to adjust for confounders to provide absolute estimates for each possible risk factor. Additionally, other possibly relevant risk factors, such as lab measurements, were not collected at baseline.
Finally, the results may not be generalizable because the definition of an unprovoked VTE is heterogeneous.
“Our most salient finding is that [these] simple characteristics ... are important predictors of occult cancer diagnosis among patients with VTE,” Carrier and colleagues wrote. “Our findings may help identify patients with first unprovoked VTE who are at particularly high-risk and who may benefit from closer surveillance and additional testing.” – by Anthony SanFilippo
Disclosure: Carrier reports no relevant financial disclosures. Two other researchers report honoraria from, consultant/advisory roles with and research funding from Actelion Pharmaceuticals, Alexion, Bayer, Biotie Therapies, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Daiichi Sankyo, Janssen, LEO Pharma, The Medicines Company, Novartis, Pfizer and Portola Pharmaceuticals.
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