A risk assessment model for predicting venous thromboembolic events in chemotherapy-treated germ-cell cancer

Date

09 Oct 2016

Session

Poster display

Presenters

M. Isabel Luengo

Citation

Annals of Oncology (2016) 27 (6): 497-521. 10.1093/annonc/mdw390

Authors

M..I. Luengo1, D. Hervás2, N. Sobrevilla3, X. Garcia del Muro4, J. Guma I Padro5, D. Castellano6, J. Aparicio7, A. Sánchez Muñoz8, E. Buxo9, A. Saenz10, J.L. Aguilar3, C. Valverde Morales11, A. Fernández Aramburu12, P. Maroto13, M. Espinosa14, P. Jimenez Fonseca15, S. Ros16, M. Margeli4, J. Sastre17, E. Gonzalez-Billalabeitia18

Author affiliations

  • 1 Hematology And Clinical Oncology, Hospital Universitario Morales Meseguer, 30008 - Murcia/ES
  • 2 Bioestadística, Instituto de Investigación Sanitaria La Fe, 30008 - Valencia/ES
  • 3 Medical Oncology, Instituto Nacional de Cancerología (INCAN), MEXICO/MX
  • 4 Medical Oncology, Institut Català d'Oncologia Hospital Duran i Reynals, Barcelona/ES
  • 5 Oncology Service, University Hospital St. Joan de Reus, 43204 - Reus/ES
  • 6 Medical Oncology, University Hospital 12 De Octubre, Madrid/ES
  • 7 Medical Oncology, Hospital Universitari i Politècnic La Fe, 46026 - Valencia/ES
  • 8 Servicio De Oncología Médica, Hospital Universitario Virgen de la Victoria, Malaga/ES
  • 9 Medical Oncology, Hospital Clinic y Provincial de Barcelona, Barcelona/ES
  • 10 Clinical Oncology, Hospital Clinico Universitario Lozano Blesa, 50009 - Zaragoza/ES
  • 11 Oncologia Médica, Vall d`Hebron University Hospital Institut d'Oncologia, 08035 - Barcelona/ES
  • 12 Clinical Oncology, Complejo Hospitalario Universitario de Albacete, Albacete/ES
  • 13 Dept. Of Medical Oncology, Hospital de la Santa Creu i Sant Pau, 08026 - Barcelona/ES
  • 14 Clinical Oncology, Hospital Universitario Virgen del Rocio, 41013 - Sevilla/ES
  • 15 Medical Oncology, Hospital Universitario Central de Asturias, 33011 - Oviedo/ES
  • 16 Clinical Oncology, Hospital Universitario Virgen de la Arrixaca, Murcia/ES
  • 17 Oncology Department, Clínico San Carlos Hospital, Madrid/ES
  • 18 Hematology And Clinical Oncology, Hospital Universitario Morales Meseguer, 30007 - Murcia/ES
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Resources

Background

Germ-cell cancer patients (GCC) treated with chemotherapy are at high risk of developing venous thromboembolic events (VTE). Several single parameters have been proposed for risk prediction, but no risk assessment model (RAM) is currently available.

Methods

All previously reported variables related with venous thrombosis in GCC were included. The association of these predictors with the development of VTEs was assessed using an Elastic Net penalized logistic regression model. The selection of the penalization factor lambda for the Elastic Net analysis was performed using 10-fold cross-validation. The adjusted model was validated using an external and independent cohort. As a measure of performance of the model the AUC (area under ROC curve) was used. The training dataset consisted of all consecutive chemotherapy-treated GCC patients recruited by 13 hospitals in the Spanish Germ-Cell Cancer Group (SGCCG) registry between 2004 and 2014. The validating dataset consisted of an external and independent cohort of patients treated at 4 independent hospitals.

Results

The training subset included 513 patients, with a VTE rate of 9% (N = 44). Our penalized logistic regression model included 4 predictors: Large retroperitoneal mass (N3), presence of liver, bone or brain metastasis (LBB), IGCCC poor prognosis (IGCCCPoor) and haemoglobin basal level (HBB), which were able to predict the probability of an event following the equation: P(event) = e − 2.33 +0.16*N3+0.27*LBB+0.19*ICCCCPoor-0.003*HBB/(1 + e − 2.33+0.16*N3+ 0.27*LBB+0.19*ICCCCPoor - 0.003*HBB). This model resulted in an area under the ROC curve of 0.83 (95% CI: 0.76-0.90). The validation subset included 325 patients with a VTE rate of 13% (N = 42). The area under the curve in the validation sample was 0.73 (95% CI, 0.65, 0.83).

Conclusions

We report a risk assessment model able to predict the probability of VTE in chemotherapy-treated GCC. This model may guide patient selection in studies of thromboprophylaxis in this population.

Clinical trial identification

Legal entity responsible for the study

Spanish Germ Cell Cancer Group

Funding

Spanish Germ Cell Cancer Group

Disclosure

All authors have declared no conflicts of interest.

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