肺癌发生静脉血栓栓塞的风险评估模型的研究进展
Research Progress on Risk Assessment Model for Venous Thromboembolism in Lung Cancer
摘要: 肺癌是VTE发病率最高的恶性肿瘤之一，VTE的发生是一个重要的医疗问题，具有多种不良后果，为了更有效预测血栓栓塞事件，国内外已经开发了癌症患者的风险评估工具。这些评估工具在肺癌患者VTE中有不同程度的预测价值。KRS被相关指南推荐用于评估癌症门诊患者VTE的风险，且预测价值可观。但在肺癌患者中虽然有较高特异性，却缺乏鉴别能力，对于VTE风险分层能力欠佳。新一代KRS的提出在癌症患者中在一定程度上提高了预测准确性，但在识别VTE高风险肺癌患者方面的表现较差。COMPASS-CAT不仅在实体器官恶性肿瘤验证研究中表现出色，还是肺恶性肿瘤患者VTE发病率的最精确预测因子，适用于肺癌患者VTE风险筛查及监测。ROADMAP-CAT RAM风险因子中含有不易测得的生物标志物，不适合临床应用。本综述总结既往研究，概述了肺癌发生静脉血栓栓塞的多种风险评估工具。效能好的RAM为临床医生识别患者潜在VTE风险的最佳工具，有助于识别符合血栓预防条件的高危患者，做到早预防早治疗。
Abstract: Lung cancer is one of the malignancies with the highest incidence of venous thromboembolism (VTE). The occurrence of VTE is a significant medical issue associated with a variety of adverse consequences. To more effectively predict thromboembolic events, risk assessment tools for cancer patients have been developed both domestically and internationally. These assessment tools have varying degrees of predictive value in VTE in lung cancer patients. KRS is recommended by relevant guidelines to assess the risk of VTE in cancer outpatients and has considerable predictive value. However, although it has high specificity in lung cancer patients, it lacks the ability to distinguish and has a poor ability to stratify the risk of VTE. The proposal of a new generation of KRS has improved the prediction accuracy to a certain extent in cancer patients, but it has performed poorly in identifying lung cancer patients with a high risk of VTE. COMPASS-CAT not only performs well in validation studies of solid organ malignancies, but also serves as the most accurate predictor of VTE incidence in patients with lung malignancies. COMPASS-CAT is suitable for VTE risk screening and monitoring in lung cancer patients. The ROADMAP-CAT RAM risk factor contains biomarkers that are not easily measurable and are not suitable for clinical use. This review summarizes previous studies and outlines a variety of risk assessment tools for venous thromboembolism in lung cancer. RAM is the best tool for clinicians to identify the potential risk of VTE in patients. It is also helpful to identify high-risk patients who are eligible for thromboprophylaxis so as to achieve early prevention and early treatment.
文章引用：郭佳琪, 徐磊. 肺癌发生静脉血栓栓塞的风险评估模型的研究进展[J]. 临床医学进展, 2025, 15(1): 1856-1863. https://doi.org/10.12677/acm.2025.151247

参考文献

[1] Canonico, M.E., Santoro, C., Avvedimento, M., Giugliano, G., Mandoli, G.E., Prastaro, M., et al. (2022) Venous Thromboembolism and Cancer: A Comprehensive Review from Pathophysiology to Novel Treatment. Biomolecules, 12, Article 259. [Google Scholar] [CrossRef] [PubMed]
[2] Timp, J.F., Braekkan, S.K., Versteeg, H.H. and Cannegieter, S.C. (2013) Epidemiology of Cancer-Associated Venous Thrombosis. Blood, 122, 1712-1723. [Google Scholar] [CrossRef] [PubMed]
[3] 苏俐玫, 毛溪悦, 阳丽梅. 肺癌患者静脉血栓栓塞预防的疗效与安全性的meta分析(英文) [J]. 中国药学, 2023, 32(10): 852-860.
[4] Sheth, R.A., Niekamp, A., Quencer, K.B., Shamoun, F., Knuttinen, M., Naidu, S., et al. (2017) Thrombosis in Cancer Patients: Etiology, Incidence, and Management. Cardiovascular Diagnosis and Therapy, 7, S178-S185. [Google Scholar] [CrossRef] [PubMed]
[5] Chew, H.K., Wun, T., Harvey, D., Zhou, H. and White, R.H. (2006) Incidence of Venous Thromboembolism and Its Effect on Survival among Patients with Common Cancers. Archives of Internal Medicine, 166, 458-464. [Google Scholar] [CrossRef] [PubMed]
[6] Patell, R., Rybicki, L., McCrae, K.R. and Khorana, A.A. (2017) Predicting Risk of Venous Thromboembolism in Hospitalized Cancer Patients: Utility of a Risk Assessment Tool. American Journal of Hematology, 92, 501-507. [Google Scholar] [CrossRef] [PubMed]
[7] Nijkeuter, M., Söhne, M., Tick, L.W., Kamphuisen, P.W., Kramer, M.H.H., Laterveer, L., et al. (2007) The Natural Course of Hemodynamically Stable Pulmonary Embolism. Chest, 131, 517-523. [Google Scholar] [CrossRef] [PubMed]
[8] Qin, X., Gao, X., Yang, Y., Ou, S., Luo, J., Wei, H., et al. (2024) Developing a Risk Assessment Tool for Cancer-Related Venous Thrombosis in China: A Modified Delphi-Analytic Hierarchy Process Study. BMC Cancer, 24, Article No. 120. [Google Scholar] [CrossRef] [PubMed]
[9] Angelini, D. and Khorana, A. (2017) Risk Assessment Scores for Cancer-Associated Venous Thromboembolic Disease. Seminars in Thrombosis and Hemostasis, 43, 469-478. [Google Scholar] [CrossRef] [PubMed]
[10] Abdel-Razeq, H., Sharaf, B., Al-Jaghbeer, M.J., Abu-Fares, H., Bater, R., Shaer, M.A., et al. (2023) COMPASS-CAT versus Khorana Risk Assessment Model for Predicting Venous Thromboembolic Events in Patients with Non-Small Cell Lung Cancer on Active Treatment with Chemotherapy and/or Immunotherapy, the CK-RAM Study. Journal of Thrombosis and Thrombolysis, 56, 447-453. [Google Scholar] [CrossRef] [PubMed]
[11] Guntupalli, S.R., Spinosa, D., Wethington, S., Eskander, R. and Khorana, A.A. (2023) Prevention of Venous Thromboembolism in Patients with Cancer. British Medical Journal, 381, e072715. [Google Scholar] [CrossRef] [PubMed]
[12] Tatsumi, K. (2024) The Pathogenesis of Cancer-Associated Thrombosis. International Journal of Hematology, 119, 495-504. [Google Scholar] [CrossRef] [PubMed]
[13] Hisada, Y. and Mackman, N. (2017) Cancer-Associated Pathways and Biomarkers of Venous Thrombosis. Blood, 130, 1499-1506. [Google Scholar] [CrossRef] [PubMed]
[14] Tesselaar, M.E. and Osanto, S. (2007) Risk of Venous Thromboembolism in Lung Cancer. Current Opinion in Pulmonary Medicine, 13, 362-367. [Google Scholar] [CrossRef] [PubMed]
[15] Chew, H.K., Davies, A.M., Wun, T., Harvey, D., Zhou, H. and White, R.H. (2008) The Incidence of Venous Thromboembolism among Patients with Primary Lung Cancer. Journal of Thrombosis and Haemostasis, 6, 601-608. [Google Scholar] [CrossRef] [PubMed]
[16] Ay, C. and Ünal, U.K. (2016) Epidemiology and Risk Factors for Venous Thromboembolism in Lung Cancer. Current Opinion in Oncology, 28, 145-149. [Google Scholar] [CrossRef] [PubMed]
[17] Mulder, F.I., Horváth-Puhó, E., van Es, N., van Laarhoven, H.W.M., Pedersen, L., Moik, F., et al. (2021) Venous Thromboembolism in Cancer Patients: A Population-Based Cohort Study. Blood, 137, 1959-1969. [Google Scholar] [CrossRef] [PubMed]
[18] Gong, C.Y., Li, Z.W., Zhou, D.X., et al. (2016) Risk Factors of Lung Cancer Complicated with Symptomatic Venous Thromboembolism. Chinese Journal of Tuberculosis and Respiratory Diseases, 39, 454-458.
[19] National Institute for Health and Care Excellence (2019) Venous Thromboembolism in over 16s: Reducing the Risk of Hospital-Acquired Deep Vein Thrombosis or Pulmonary Embolism.
[20] Chan, N.C., Gross, P.L. and Weitz, J.I. (2018) Addressing the Burden of Hospital-Related Venous Thromboembolism: The Role of Extended Anticoagulant Prophylaxis. Journal of Thrombosis and Haemostasis, 16, 413-417. [Google Scholar] [CrossRef] [PubMed]
[21] Pandor, A., Tonkins, M., Goodacre, S., Sworn, K., Clowes, M., Griffin, X.L., et al. (2021) Risk Assessment Models for Venous Thromboembolism in Hospitalised Adult Patients: A Systematic Review. BMJ Open, 11, e045672. [Google Scholar] [CrossRef] [PubMed]
[22] Khorana, A.A., Kuderer, N.M., Culakova, E., Lyman, G.H. and Francis, C.W. (2008) Development and Validation of a Predictive Model for Chemotherapy-Associated Thrombosis. Blood, 111, 4902-4907. [Google Scholar] [CrossRef] [PubMed]
[23] Key, N.S., Khorana, A.A., Kuderer, N.M., Bohlke, K., Lee, A.Y.Y., Arcelus, J.I., et al. (2023) Venous Thromboembolism Prophylaxis and Treatment in Patients with Cancer: ASCO Guideline Update. Journal of Clinical Oncology, 41, 3063-3071. [Google Scholar] [CrossRef] [PubMed]
[24] Wang, T., Zwicker, J.I., Ay, C., Pabinger, I., Falanga, A., Antic, D., et al. (2019) The Use of Direct Oral Anticoagulants for Primary Thromboprophylaxis in Ambulatory Cancer Patients: Guidance from the SSC of the Isth. Journal of Thrombosis and Haemostasis, 17, 1772-1778. [Google Scholar] [CrossRef] [PubMed]
[25] Farge, D., Frere, C., Connors, J.M., Khorana, A.A., Kakkar, A., Ay, C., et al. (2022) 2022 International Clinical Practice Guidelines for the Treatment and Prophylaxis of Venous Thromboembolism in Patients with Cancer, Including Patients with Covid-19. The Lancet Oncology, 23, e334-e347. [Google Scholar] [CrossRef] [PubMed]
[26] Gerotziafas, G.T., Mahé, I., Lefkou, E., AboElnazar, E., Abdel-Razeq, H., Taher, A., et al. (2020) Overview of Risk Assessment Models for Venous Thromboembolism in Ambulatory Patients with Cancer. Thrombosis Research, 191, S50-S57. [Google Scholar] [CrossRef] [PubMed]
[27] Kimura, H., Ota, H., Kimura, Y. and Takasawa, S. (2020) Effects of Intermittent Hypoxia on Pulmonary Vascular and Systemic Diseases. International Journal of Environmental Research and Public Health, 16, Article 3101.
[28] Parker, A., Peterson, E., Lee, A.Y.Y., de Wit, C., Carrier, M., Polley, G., et al. (2018) Risk Stratification for the Development of Venous Thromboembolism in Hospitalized Patients with Cancer. Journal of Thrombosis and Haemostasis, 16, 1321-1326. [Google Scholar] [CrossRef] [PubMed]
[29] Hu, Y., Li, X., Zhou, H., Lin, P., Zhang, J., Huang, D., et al. (2020) Comparison between the Khorana Prediction Score and Caprini Risk Assessment Models for Assessing the Risk of Venous Thromboembolism in Hospitalized Patients with Cancer: A Retrospective Case Control Study. Interactive Cardio Vascular and Thoracic Surgery, 31, 454-460. [Google Scholar] [CrossRef] [PubMed]
[30] Vathiotis, I., Dimakakos, E.P., Boura, P., Ntineri, A., Charpidou, A., Gerotziafas, G., et al. (2018) Khorana Score: Νew Predictor of Early Mortality in Patients with Lung Adenocarcinoma. Clinical and Applied Thrombosis/Hemostasis, 24, 1347-1351. [Google Scholar] [CrossRef] [PubMed]
[31] Yan, A., Samarawickrema, I., Naunton, M., Peterson, G.M., Yip, D., Newman, P., et al. (2024) Models for Predicting Venous Thromboembolism in Ambulatory Patients with Lung Cancer: A Systematic Review and Meta-Analysis. Thrombosis Research, 234, 120-133. [Google Scholar] [CrossRef] [PubMed]
[32] Dapkevičiūtė, A., Daškevičiūtė, A., Zablockis, R., Kuzaitė, A., Jonušienė, G., Diktanas, S., et al. (2019) Association between the Khorana Score and Pulmonary Embolism Risk in Patients with Advanced Stage Lung Cancer. The Clinical Respiratory Journal, 14, 3-8. [Google Scholar] [CrossRef] [PubMed]
[33] Ay, C., Dunkler, D., Marosi, C., Chiriac, A., Vormittag, R., Simanek, R., et al. (2010) Prediction of Venous Thromboembolism in Cancer Patients. Blood, 116, 5377-5382. [Google Scholar] [CrossRef] [PubMed]
[34] Pabinger, I., van Es, N., Heinze, G., Posch, F., Riedl, J., Reitter, E., et al. (2018) A Clinical Prediction Model for Cancer-Associated Venous Thromboembolism: A Development and Validation Study in Two Independent Prospective Cohorts. The Lancet Haematology, 5, e289-e298. [Google Scholar] [CrossRef] [PubMed]
[35] Verso, M., Agnelli, G., Barni, S., Gasparini, G. and LaBianca, R. (2012) A Modified Khorana Risk Assessment Score for Venous Thromboembolism in Cancer Patients Receiving Chemotherapy: The Protecht Score. Internal and Emergency Medicine, 7, 291-292. [Google Scholar] [CrossRef] [PubMed]
[36] Pelzer, U., Sinn, M., Stieler, J. and Riess, H. (2013) Primäre medikamentöse Thromboembolieprophylaxe bei ambulanten Patienten mit fortgeschrittenem Pankreaskarzinom unter Chemotherapie? Deutsche Medizinische Wochenschrift, 138, 2084-2088. [Google Scholar] [CrossRef] [PubMed]
[37] Rupa-Matysek, J., Lembicz, M., Rogowska, E.K., Gil, L., Komarnicki, M. and Batura-Gabryel, H. (2018) Evaluation of Risk Factors and Assessment Models for Predicting Venous Thromboembolism in Lung Cancer Patients. Medical Oncology, 35, Article No. 63. [Google Scholar] [CrossRef] [PubMed]
[38] Gerotziafas, G.T., Taher, A., Abdel-Razeq, H., AboElnazar, E., Spyropoulos, A.C., El Shemmari, S., et al. (2017) A Predictive Score for Thrombosis Associated with Breast, Colorectal, Lung, or Ovarian Cancer: The Prospective Compass-Cancer-Associated Thrombosis Study. The Oncologist, 22, 1222-1231. [Google Scholar] [CrossRef] [PubMed]
[39] Mosaad, M., Elnaem, M.H., Cheema, E., Ibrahim, I., Ab Rahman, J., Kori, A.N., et al. (2021) Cancer-Associated Thrombosis: A Clinical Scoping Review of the Risk Assessment Models across Solid Tumours and Haematological Malignancies. International Journal of General Medicine, 14, 3881-3897. [Google Scholar] [CrossRef] [PubMed]
[40] Wang, Y.F., Ma, F., Liu, B.L., et al. (2020) Risk Prediction of Venous Thromboembolism in Non-Small Cell Lung Cancer Patients Based on COMPASS-CAT Risk Assessment Model. Chinese Journal of Oncology, 42, 340-345.
[41] Syrigos, K., Grapsa, D., Sangare, R., Evmorfiadis, I., Larsen, A.K., Van Dreden, P., et al. (2018) Prospective Assessment of Clinical Risk Factors and Biomarkers of Hypercoagulability for the Identification of Patients with Lung Adenocarcinoma at Risk for Cancer-Associated Thrombosis: The Observational ROADMAP-CAT Study. The Oncologist, 23, 1372-1381. [Google Scholar] [CrossRef] [PubMed]
[42] Kravchenko, J., Berry, M., Arbeev, K., Lyerly, H.K., Yashin, A. and Akushevich, I. (2015) Cardiovascular Comorbidities and Survival of Lung Cancer Patients: Medicare Data Based Analysis. Lung Cancer, 88, 85-93. [Google Scholar] [CrossRef] [PubMed]
[43] Rinde, L.B., Lind, C., Småbrekke, B., Njølstad, I., Mathiesen, E.B., Wilsgaard, T., et al. (2016) Impact of Incident Myocardial Infarction on the Risk of Venous Thromboembolism: The Tromsø Study. Journal of Thrombosis and Haemostasis, 14, 1183-1191. [Google Scholar] [CrossRef] [PubMed]
[44] Spyropoulos, A.C., Eldredge, J.B., Anand, L.N., Zhang, M., Qiu, M., Nourabadi, S., et al. (2020) External Validation of a Venous Thromboembolic Risk Score for Cancer Outpatients with Solid Tumors: The COMPASS-CAT Venous Thromboembolism Risk Assessment Model. The Oncologist, 25, e1083-e1090. [Google Scholar] [CrossRef] [PubMed]
[45] Howard, L. (2019) Acute Pulmonary Embolism. Clinical Medicine, 19, 243-247. [Google Scholar] [CrossRef] [PubMed]
[46] Caprini, J.A. (2005) Thrombosis Risk Assessment as a Guide to Quality Patient Care. Disease-a-Month, 51, 70-78. [Google Scholar] [CrossRef] [PubMed]
[47] Chen, X., Pan, L., Deng, H., Zhang, J., Tong, X., Huang, H., et al. (2018) Risk Assessment in Chinese Hospitalized Patients Comparing the Padua and Caprini Scoring Algorithms. Clinical and Applied Thrombosis/Hemostasis, 24, 127S-135S. [Google Scholar] [CrossRef] [PubMed]

为你推荐