Simple, Effective and Validated. VTE CASE Risk Assessment Score for Venous Thromboembolism in Metastatic Germ Cell Tumour Patients Before First‐Line Chemotherapy

Abstract

ABSTRACT Background Venous thromboembolism (VTE) may jeopardise excellent treatment results of germ cell tumours (GCT). We previously constructed a VTE risk score for GCT patients qualified for first‐line chemotherapy (CTH), including vein compression, clinical stage (CS) and haemoglobin concentration. Aim Validating our score in a separate cohort and establishing the cut‐off point for the score. Re‐assessing the numerical score in the training cohort. Materials and Methods We retrospectively analysed a new cohort of GCT patients staged IS–IIIC. Area under the curve of receiver‐operating characteristic (AUC‐ROC) was calculated for the developed score, Khorana Risk Score (KRS) and Padua Prediction Score (PPS). AUC‐ROC of the integer score was calculated for the training cohort. Cut‐off point was established by Youden's and Liu's indices. Results Among 336 eligible patients in the validation cohort, VTE occurred in 41 (12.2%). AUC‐ROC for our score, KRS and PPS were 0.818 (95% confidence interval (CI): 0.746–0.891), 0.608 (0.529–0.688) and 0.634 (0.547–0.720), respectively, p < 0.001. The optimal cut‐off point for a low/high risk was 6 (≤ 6 vs. ≥ 7). In the training cohort, 369 patients had complete data on vein compression. AUC‐ROC for our score, KRS and PPS were 0.819 (95% CI: 0.758–0.879), 0.710 (0.637–0.782) and 0.725 (0.651–0.800), p ≤ 0.001 and 0.015, respectively. Positive and negative predictive values were 30.8% and 96.5%, respectively. Conclusions Our VTE risk score is a handy tool for GCT patients before first‐line CTH for metastatic disease. Outperforming KRS and PPS, it has a good discriminatory value, especially for identifying low‐risk patients.

Keywords

• deep vein thrombosis
• germ cell tumour
• pulmonary embolism
• risk assessment score
• venous thromboembolism