医学
内科学
回顾性队列研究
肺栓塞
深静脉
退伍军人事务部
血栓形成
癌症
队列
危险系数
肿瘤科
外科
置信区间
作者
Shuaipeng Ma,Jennifer La,Jennifer La,Kaitlin N. Swinnerton,Danielle Guffey,Raka Bandyo,Giordana De Las Pozas,Katy M. Hanzelka,Xiangjun Xiao,Cristhiam M. Rojas‐Hernandez,Christopher I. Amos,Christopher I. Amos,Vipul C. Chitalia,Vipul C. Chitalia,Vipul C. Chitalia,Katya Ravid,Kelly W. Merriman,Christopher R. Flowers,Nathanael Fillmore,Nathanael Fillmore,Ang Li
摘要
Abstract Venous thromboembolism (VTE) poses a significant risk to cancer patients receiving systemic therapy. The generalizability of pan‐cancer models to lymphomas is limited. Currently, there are no reliable risk prediction models for thrombosis in patients with lymphoma. Our objective was to create a risk assessment model (RAM) specifically for lymphomas. We performed a retrospective cohort study to develop Fine and Gray sub‐distribution hazard model for VTE and pulmonary embolism (PE)/ lower extremity deep vein thrombosis (LE‐DVT) respectively in adult lymphoma patients from the Veterans Affairs national healthcare system (VA). External validations were performed at the Harris Health System (HHS) and the MD Anderson Cancer Center (MDACC). Time‐dependent c‐statistic and calibration curves were used to assess discrimination and fit. There were 10,313 (VA), 854 (HHS), and 1858 (MDACC) patients in the derivation and validation cohorts with diverse baseline. At 6 months, the VTE incidence was 5.8% (VA), 8.2% (HHS), and 8.8% (MDACC), respectively. The corresponding estimates for PE/LE‐DVT were 3.9% (VA), 4.5% (HHS), and 3.7% (MDACC), respectively. The variables in the final RAM included lymphoma histology, body mass index, therapy type, recent hospitalization, history of VTE, history of paralysis/immobilization, and time to treatment initiation. The RAM had c‐statistics of 0.68 in the derivation and 0.69 and 0.72 in the two external validation cohorts. The two models achieved a clear differentiation in risk stratification in each cohort. Our findings suggest that easy‐to‐implement, clinical‐based model could be used to predict personalized VTE risk for lymphoma patients.
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