Real-Life Incidence of Cancer Following a First Unprovoked Venous Thrombosis: Results from the Epigetbo Study
Notice bibliographique
Résumé
Abstract Background: Venous thromboembolism (VTE) can be the first manifestation of cancer. Whether screening for an occult malignancy should be systematically performed in patients with unprovoked VTE is a daily challenge for clinicians. Recently, two randomized trials demonstrated that limited cancer screening in patients with a first unprovoked VTE could be the standard of care. However, the one-year incidence of occult malignancy found in these trials was unexpectedly low (4.5%) raising the hypothesis of an inclusion bias. We aimed at estimating the real-life one-year incidence of cancer following a first unprovoked VTE to inform physicians and policy makers in establishing recommendations for cancer screening in VTE patients. Methods: The EPIGETBO study is an epidemiologic study that aimed to measure the incidence of VTE in the Brest District, France1. All symptomatic VTE cases (deep vein thrombosis of the lower limb and pulmonary embolism) diagnosed between March 1st, 2013 and February 28th, 2014 among the 367,911 inhabitants of the district were recorded and validated by an adjudication committee. A systematic follow-up was planned in order to study patients' outcome. Unprovoked VTE was defined as the absence of surgical procedure, pregnancy, delivery, immobilization, admission to hospital for an acute medical illness in the 3 months preceding VTE or known active cancer. The 1-year cumulative incidence of cancer was estimated using the Kaplan-Meier method. Then, the hazard for occult cancer diagnosis associated with age>60, male sex, and current smoking was assessed by Cox regression. Results: During the study period, 576 symptomatic validated VTE events were diagnosed in 562 inhabitants of the Brest District. Five patients did not undergo follow-up (4 refusals, 1 aged<18). The VTE event at study entry was unprovoked in 310 patients (55.6%) and this was a first unprovoked VTE event in 257. Patients' mean age was 67.9 ± 2.2 years, 114 (44.3%) were men, 38 (14.8%) had a prior unprovoked VTE event. In the year following VTE, 9 of the 257 patients with a first unprovoked VTE event were diagnosed with cancer, corresponding to an overall 1-year cumulative incidence of occult cancer of 3.68% (95% CI 1.93-6.96). This incidence was 3.78% (95% CI 1.91-7.43) in the 219 patients with a first unprovoked VTE event and no prior history of provoked VTE (8 cancers). In non-smokers, the 1-year incidence rate of occult cancer was 0.81% (95% CI 0.11-5.59) as compared with 8.05% (95% CI 3.92-16.14) in smokers (p=0.004 by log-rank test). In multivariate analysis, age>60 and male sex were associated with a non significant increased risk for occult cancer diagnosis (HR 4.92; 95% CI 0.60-40.30 and 1.42; 95% CI 0.25-8.13 respectively). Conversely, current smoking was independently associated with a significant 11.8-fold increased risk for occult cancer diagnosis (HR 11.80; 95% CI 1.19-116.52). No cancer was diagnosed in patients aged≤50 years. Conclusion: In this comprehensive real-life epidemiological study, we confirmed that the one-year incidence of occult malignancy following a first episode of unprovoked VTE is low, especially in non-smokers. Current smoking was associated with a higher risk for occult cancer diagnosis; however, even in this patient subgroup, the absolute frequency was no higher than 8%. 1 Thromb Haemost 2016; Epub ahead of print DOI: 10.1160/TH16-03-0205 Disclosures No relevant conflicts of interest to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».