High plasma levels of soluble P-Selectin and Factor VIII predict venous thromboembolism in non-small cell lung cancer patients: The Thrombo-Nsclc risk score. Issue 196 (December 2020)

• Record Type: Journal Article
• Authors: Castellón Rubio, Victoria E.; Segura, Pedro Pérez-; Muñoz, Andrés; Farré, Antonio López; Ruiz, Liliana Canosa; Lorente, José A.
• Is Part Of: Thrombosis research. Issue 196(2020)
• Page Start: 349
• Page End: 354
• Publication Date: 2020-12
• Subjects: VTE venous thromboembolism -- NSCLC non-small cell lung cancer -- KRS Khorana score -- FVIII factor VIII -- sP-selectin soluble P-selectin -- PE pulmonary embolism -- BMI body mass index -- DVT deep venous thrombosis -- CRP C-reactive protein -- FVL factor V Leiden -- IQR interquartile range -- ROC receiver-operating characteristic -- AUC area under the curve -- PPV positive predictive value -- NPV negative predictive value -- HR hazard ratio; Carcinoma -- Non-small-cell lung -- Venous thromboembolism -- Induction chemotherapy -- Risk assessment -- P-Selectin -- Factor VIII; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2020.09.021
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: Venous thromboembolism (VTE) is common in non-small cell lung cancer (NSCLC) patients undergoing systemic chemotherapy. The usefulness of Khorana score (KRS) to predict risk in lung cancer patients is limited, and the identification of patients who would benefit most from thromboprophylaxis is challenging. We aimed to identify variables whose values before chemotherapy helped in predicting VTE occurrence, and build a model to assess VTE risk. Materials and methods: A cohort of newly diagnosed NSCLC patients to undergo outpatient chemotherapy, not under anticoagulant treatment, was recruited. Pre-chemotherapy demographic, clinical, analytical and tumor-specific variables were collected. Patients were prospectively followed-up for 12 months to record VTE events. Bivariate and multivariate analyses were performed to identify VTE-associated variables, and a prediction model was built and compared with KRS. Results: 90 patients were recruited, 18 of whom had a VTE event during follow-up. High baseline levels of factor VIII (FVIII) and, especially, soluble P-selectin (sP-selectin), were independently associated with VTE risk (hazard ratio [HR] 4.15, 95% confidence interval [CI] 1.17–14.71, and 66.40 [8.70–506.69], respectively). Our so-called Thrombo-NSCLC risk score, which assigns 1 and 3 points to high FVIII and sP-selectin values, respectively, was significantly better than KRS in predicting VTE (area under the curve [AUC] 0.93 vs. 0.55, sensitivity 94.4 vs. 35.0%, specificity 93.1 vs. 60.0%). Our prediction model showed significant discriminating capacity between high risk vs. intermediate/low risk patients, while KRS did not. Conclusions: The Thrombo-NSCLC risk score may be useful to identify those NSCLC patients who would benefit most from thromboprophylaxis. Highlights: Chemotherapy (CT) raises thrombotic risk (TR) in non-small cell lung cancer (NSCLC). Association between pre-CT variables and TR was studied in 90 NSCLC patients. Factor VIII and especially soluble P-selectin were independently associated with TR. A score built on these variables efficiently identified high TR patients.