Risk scores for occult cancer in patients with unprovoked venous thromboembolism: Results from an individual patient data meta‐analysis

BACKGROUND: The Registro Informatizado de Pacientes con Enfermedad TromboEmbólica (RIETE) score and the Screening for Occult Malignancy in Patients with Idiopathic Venous Thromboembolism (SOME) risk scores aim to identify patients with acute unprovoked venous thromboembolism (VTE) at high risk of occult cancer, but their predictive performance is unclear. METHODS: The scores were evaluated in an individual patient data meta‐analysis. Studies were eligible if enrolling consecutive adults with unprovoked VTE who underwent protocol‐mandated screening for cancer. The primary outcome was a cancer diagnosis between 30 days and 2 years of follow‐up. The discriminatory performance was evaluated by computing the area under the receiver (ROC) curve in random‐effects meta‐analyses. RESULTS: The RIETE score could be calculated in 1753 patients, of whom 63 (3.6%) were diagnosed with cancer. The pooled area under the ROC curve was 0.59 (95% confidence interval [CI], 0.52‐0.66; I (2) = 0%). Of the 427 patients (24%) classified as high risk, 25 (5.9%) were diagnosed with cancer compared with 38 of 1326 (2.9%) low‐risk patients (hazard ratio [HR], 2.0; 95% CI, 1.3‐3.4). The SOME score was calculated in 925 patients, of whom 37 (4.0%) were diagnosed with cancer. The pooled area under the ROC curve was 0.56 (95% CI, 0.46‐0.65; I (2) = 46%). Of the 161 patients (17%) classified as high risk (≥2 points), eight (5.0%) were diagnosed with cancer compared with 29 of 764 (3.8%) low‐risk patients (HR, 1.2; 95% CI, 0.55‐2.7). CONCLUSIONS: The predictive discriminatory performance of both scores is poor. When used dichotomously, the RIETE score is able to discriminate between low‐ and high‐risk patients. Because this is largely driven by advanced age, these results do not support the use of these scores in daily clinical practice.