Fabian Wolpert1, Anna S Berghoff2, Bettina Grossenbacher3, Anna Lareida3, Raphael Löb2, Patrick Roth3, Marian C Neidert4, Nicolaus Andratschke5, Emilie Le Rhun6, Matthias Preusser2, Michael Weller3. 1. Department of Neurology, Brain Tumor Center & Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland. Electronic address: fabian.wolpert@usz.ch. 2. Division of Oncology, Department of Medicine 1, Medical University of Vienna, 18-20 Waehringer Guertel, AT-1090, Vienna, Austria. 3. Department of Neurology, Brain Tumor Center & Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland. 4. Department of Neurosurgery, Brain Tumor Center & Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland. 5. Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland. 6. Department of Neurology, Brain Tumor Center & Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland; Neuro-oncology, Department of Neurosurgery, University Hospital Lille, Salengro Hospital, Rue Emile Laine, FR-59037, Lille, France; Neurology, Department of Medical Oncology, Oscar Lambret Center, FR-59020, Lille, France; Inserm U-1192, Villeneuve d'Ascq, France.
Abstract
AIM OF STUDY: Venous thromboembolic events (VTEs) are significant complications in patients with systemic malignancies. Thrombosis risk is poorly defined for patients with brain metastasis, and available risk calculation scores are not validated for these patients. METHODS: We identified 811 patients with brain metastasis followed at our institution and reviewed electronic charts retrospectively for the occurrence of VTEs, along with candidate risk factors. Risk factors were tested in univariate and multivariate analyses and finally integrated in a score model for risk estimation. An independent cohort of 346 patients with brain metastasis was available for validation. RESULTS: VTEs were documented in 97 of 811 patients (12.0%). Primary tumours with high thrombogenicity (p = 0.02, hazard ratio 1.7, 95% confidence interval (CI) = 1.1-2.8), dexamethasone (p = 0.011, hazard ratio 2.27, 95% CI = 1.5-4.5), chemotherapy (p = 0.005, hazard ratio 3.4, 95% CI = 1.6-7.5), body mass index > 35 kg/m2 (p = 0.002, hazard ratio 3.4, 95% CI = 1.6-7.5) and immobilisation (p = 0.003, hazard ratio 2.4, 95% CI = 1.3-4.3) were confirmed to be independently associated with VTEs. We derived a score model for VTE risk estimation, the thrombogenic primary, immobilization, chemotherapy, obesity, steroid (PICOS) score (0-7 points). Receiver-operating characteristic curve analysis demonstrated its prognostic accuracy (area under the curve [AUC] = 0.71, 95% CI = 0.64-0.77), and its value for the evaluation of VTE risk was superior to that of other scores such as the Khorana (AUC = 0.51) or CONKO (AUC = 0.52) scores. The potential value of the PICOS score was confirmed in the validation cohort (AUC = 0.72, 95% CI = 0.63-0.82). CONCLUSIONS: The PICOS score may become a helpful tool for the identification of patients with brain metastasis at high risk for VTEs and for stratification in controlled studies.
AIM OF STUDY:Venous thromboembolic events (VTEs) are significant complications in patients with systemic malignancies. Thrombosis risk is poorly defined for patients with brain metastasis, and available risk calculation scores are not validated for these patients. METHODS: We identified 811 patients with brain metastasis followed at our institution and reviewed electronic charts retrospectively for the occurrence of VTEs, along with candidate risk factors. Risk factors were tested in univariate and multivariate analyses and finally integrated in a score model for risk estimation. An independent cohort of 346 patients with brain metastasis was available for validation. RESULTS: VTEs were documented in 97 of 811 patients (12.0%). Primary tumours with high thrombogenicity (p = 0.02, hazard ratio 1.7, 95% confidence interval (CI) = 1.1-2.8), dexamethasone (p = 0.011, hazard ratio 2.27, 95% CI = 1.5-4.5), chemotherapy (p = 0.005, hazard ratio 3.4, 95% CI = 1.6-7.5), body mass index > 35 kg/m2 (p = 0.002, hazard ratio 3.4, 95% CI = 1.6-7.5) and immobilisation (p = 0.003, hazard ratio 2.4, 95% CI = 1.3-4.3) were confirmed to be independently associated with VTEs. We derived a score model for VTE risk estimation, the thrombogenic primary, immobilization, chemotherapy, obesity, steroid (PICOS) score (0-7 points). Receiver-operating characteristic curve analysis demonstrated its prognostic accuracy (area under the curve [AUC] = 0.71, 95% CI = 0.64-0.77), and its value for the evaluation of VTE risk was superior to that of other scores such as the Khorana (AUC = 0.51) or CONKO (AUC = 0.52) scores. The potential value of the PICOS score was confirmed in the validation cohort (AUC = 0.72, 95% CI = 0.63-0.82). CONCLUSIONS: The PICOS score may become a helpful tool for the identification of patients with brain metastasis at high risk for VTEs and for stratification in controlled studies.
Authors: Ayal A Aizer; Nayan Lamba; Manmeet S Ahluwalia; Kenneth Aldape; Adrienne Boire; Priscilla K Brastianos; Paul D Brown; D Ross Camidge; Veronica L Chiang; Michael A Davies; Leland S Hu; Raymond Y Huang; Timothy Kaufmann; Priya Kumthekar; Keng Lam; Eudocia Q Lee; Nancy U Lin; Minesh Mehta; Michael Parsons; David A Reardon; Jason Sheehan; Riccardo Soffietti; Hussein Tawbi; Michael Weller; Patrick Y Wen Journal: Neuro Oncol Date: 2022-10-03 Impact factor: 13.029