(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.
(1) 背景：静脉血栓栓塞（VTE）是门诊肺癌患者化疗期间的常见并发症，并与死亡率增加相关。(2) 方法：我们分析了前瞻性纳入HYPERCAN研究的568例新诊断转移性肺癌患者。在化疗前采集的血样进行了凝血酶生成（TG）和一组止血生物标志物的检测。应用了Khorana风险评分（KRS）、新维也纳CATS、PROTECHT和CONKO风险评估模型（RAMs）。(3) 结果：在6个月内，VTE和死亡的累积发生率分别为12%和29%。发生VTE的患者D-二聚体、FVIII、凝血酶原片段1+2和TG水平显著升高。通过多变量分析，D-二聚体和ECOG体能状态被确定为VTE和死亡的独立危险因素，并用于生成风险评分，该评分显示低风险组与高风险组的VTE累积发生率分别为6% vs. 25%，死亡率分别为19% vs. 55%（p < 0.001）。虽然所有已发表的RAMs均能显著对患者的死亡风险进行分层，但只有CATS和CONKO模型能够对患者的VTE风险进行分层。(4) 结论：本研究建立了一个新的预测模型，用于对肺癌患者的VTE和死亡风险进行分层，而其他已发表的RAMs未能做到这一点。
A New Risk Prediction Model for Venous Thromboembolism and Death in Ambulatory Lung Cancer Patients
肿瘤(癌症)患者之家