Screening for Occult Cancer in Unprovoked Venous Thromboembolism.

Abstract : Venous thromboembolism may be the earliest sign of cancer. Currently, there is a great diversity in practices regarding screening for occult cancer in a person who has an unprovoked venous thromboembolism. We sought to assess the efficacy of a screening strategy for occult cancer that included comprehensive computed tomography (CT) of the abdomen and pelvis in patients who had a first unprovoked venous thromboembolism. We conducted a multicenter, open-label, randomized, controlled trial in Canada. Patients were randomly assigned to undergo limited occult-cancer screening (basic blood testing, chest radiography, and screening for breast, cervical, and prostate cancer) or limited occult-cancer screening in combination with CT. The primary outcome measure was confirmed cancer that was missed by the screening strategy and detected by the end of the 1-year follow-up period. Of the 854 patients who underwent randomization, 33 (3.9%) had a new diagnosis of occult cancer between randomization and the 1-year follow-up: 14 of the 431 patients (3.2%) in the limited-screening group and 19 of the 423 patients (4.5%) in the limited-screening-plus-CT group (P=0.28). In the primary outcome analysis, 4 occult cancers (29%) were missed by the limited screening strategy, whereas 5 (26%) were missed by the strategy of limited screening plus CT (P=1.0). There was no significant difference between the two study groups in the mean time to a cancer diagnosis (4.2 months in the limited-screening group and 4.0 months in the limited-screening-plus-CT group, P=0.88) or in cancer-related mortality (1.4% and 0.9%, P=0.75). The prevalence of occult cancer was low among patients with a first unprovoked venous thromboembolism. Routine screening with CT of the abdomen and pelvis did not provide a clinically significant benefit. (Funded by the Heart and Stroke Foundation of Canada; SOME ClinicalTrials.gov number, NCT00773448.).
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New England Journal of Medicine, Massachusetts Medical Society, 2015, 373 (8), pp.697-704. 〈10.1056/NEJMoa1506623〉
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http://hal.univ-brest.fr/hal-01259402
Contributeur : Ghislaine Calvez <>
Soumis le : mercredi 20 janvier 2016 - 13:16:30
Dernière modification le : lundi 28 mai 2018 - 18:06:02

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Marc Carrier, Alejandro Lazo-Langner, Sudeep Shivakumar, Vicky Tagalakis, Ryan Zarychanski, et al.. Screening for Occult Cancer in Unprovoked Venous Thromboembolism.. New England Journal of Medicine, Massachusetts Medical Society, 2015, 373 (8), pp.697-704. 〈10.1056/NEJMoa1506623〉. 〈hal-01259402〉

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