Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index

Background: Our objective was to develop a prognostic stratification tool that enables patients with cancer and pulmonary embolism (PE), whether incidental or symptomatic, to be classified according to the risk of serious complications within 15 days. Methods: The sample comprised cases from a natio...

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Authors: Carmona Bayonas, Alberto, Jiménez Fonseca, Paula, Font, C., Fenoy, F., Otero, Remedios, Beato, Carmen, Plasencia, J. M., Biosca, M., Sánchez, M., Benegas, Mariana, Calvo Temprano, D., Varona, D., Faez, L., Haba, I. de la, Antonio, Maite, Madridano, O., Solis, M. P., Ramchandani, Avinash, Castanon, E., Marchena, Pablo Javier, Martin, M., Ayala de la Peña, Francisco, Vicente, Vicente
Format: article
Status:Published version
Publication Date:2017
Country:España
Institution:Universidad de Barcelona
Repository:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/124406
Online Access:https://hdl.handle.net/2445/124406
Access Level:Open access
Keyword:Embòlia pulmonar
Càncer
Pulmonary embolism
Cancer
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spelling Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY IndexCarmona Bayonas, AlbertoJiménez Fonseca, PaulaFont, C.Fenoy, F.Otero, RemediosBeato, CarmenPlasencia, J. M.Biosca, M.Sánchez, M.Benegas, MarianaCalvo Temprano, D.Varona, D.Faez, L.Haba, I. de laAntonio, MaiteMadridano, O.Solis, M. P.Ramchandani, AvinashCastanon, E.Marchena, Pablo JavierMartin, M.Ayala de la Peña, FranciscoVicente, VicenteEmbòlia pulmonarCàncerPulmonary embolismCancerBackground: Our objective was to develop a prognostic stratification tool that enables patients with cancer and pulmonary embolism (PE), whether incidental or symptomatic, to be classified according to the risk of serious complications within 15 days. Methods: The sample comprised cases from a national registry of pulmonary thromboembolism in patients with cancer (1075 patients from 14 Spanish centres). Diagnosis was incidental in 53.5% of the events in this registry. The Exhaustive CHAID analysis was applied with 10-fold crossvalidation to predict development of serious complications following PE diagnosis. Results: About 208 patients (19.3%, 95% confidence interval (CI), 17.1-21.8%) developed a serious complication after PE diagnosis. The 15-day mortality rate was 10.1%, (95% CI, 8.4-12.1%). The decision tree detected six explanatory covariates: Hestia-like clinical decision rule (any risk criterion present vs none), Eastern Cooperative Group performance scale (ECOG-PS; <2 vs >= 2), O-2 saturation (<90 vs >= 90%), presence of PE-specific symptoms, tumour response (progression, unknown, or not evaluated vs others), and primary tumour resection. Three risk classes were created (low, intermediate, and high risk). The risk of serious complications within 15 days increases according to the group: 1.6, 9.4, 30.6%; P<0.0001. Fifteen-day mortality rates also rise progressively in low-, intermediate-, and high-risk patients: 0.3, 6.1, and 17.1%; P<0.0001. The cross-validated risk estimate is 0.191 (s.e. = 0.012). The optimism-corrected area under the receiver operating characteristic curve is 0.779 (95% CI, 0.717-0.840). Conclusions: We have developed and internally validated a prognostic index to predict serious complications with the potential to impact decision-making in patients with cancer and PE.Nature Publishing2017info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/124406Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1038/bjc.2017.48British Journal of Cancer, 2017, vol. 116, num. 8, p. 994-1001https://doi.org/10.1038/bjc.2017.48cc by-nc-sa (c) Carmona Bayonas et al., 2017http://creativecommons.org/licenses/by-nc-sa/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1244062026-05-27T06:46:51Z
dc.title.none.fl_str_mv Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index
title Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index
spellingShingle Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index
Carmona Bayonas, Alberto
Embòlia pulmonar
Càncer
Pulmonary embolism
Cancer
title_short Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index
title_full Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index
title_fullStr Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index
title_full_unstemmed Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index
title_sort Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index
dc.creator.none.fl_str_mv Carmona Bayonas, Alberto
Jiménez Fonseca, Paula
Font, C.
Fenoy, F.
Otero, Remedios
Beato, Carmen
Plasencia, J. M.
Biosca, M.
Sánchez, M.
Benegas, Mariana
Calvo Temprano, D.
Varona, D.
Faez, L.
Haba, I. de la
Antonio, Maite
Madridano, O.
Solis, M. P.
Ramchandani, Avinash
Castanon, E.
Marchena, Pablo Javier
Martin, M.
Ayala de la Peña, Francisco
Vicente, Vicente
author Carmona Bayonas, Alberto
author_facet Carmona Bayonas, Alberto
Jiménez Fonseca, Paula
Font, C.
Fenoy, F.
Otero, Remedios
Beato, Carmen
Plasencia, J. M.
Biosca, M.
Sánchez, M.
Benegas, Mariana
Calvo Temprano, D.
Varona, D.
Faez, L.
Haba, I. de la
Antonio, Maite
Madridano, O.
Solis, M. P.
Ramchandani, Avinash
Castanon, E.
Marchena, Pablo Javier
Martin, M.
Ayala de la Peña, Francisco
Vicente, Vicente
author_role author
author2 Jiménez Fonseca, Paula
Font, C.
Fenoy, F.
Otero, Remedios
Beato, Carmen
Plasencia, J. M.
Biosca, M.
Sánchez, M.
Benegas, Mariana
Calvo Temprano, D.
Varona, D.
Faez, L.
Haba, I. de la
Antonio, Maite
Madridano, O.
Solis, M. P.
Ramchandani, Avinash
Castanon, E.
Marchena, Pablo Javier
Martin, M.
Ayala de la Peña, Francisco
Vicente, Vicente
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Embòlia pulmonar
Càncer
Pulmonary embolism
Cancer
topic Embòlia pulmonar
Càncer
Pulmonary embolism
Cancer
description Background: Our objective was to develop a prognostic stratification tool that enables patients with cancer and pulmonary embolism (PE), whether incidental or symptomatic, to be classified according to the risk of serious complications within 15 days. Methods: The sample comprised cases from a national registry of pulmonary thromboembolism in patients with cancer (1075 patients from 14 Spanish centres). Diagnosis was incidental in 53.5% of the events in this registry. The Exhaustive CHAID analysis was applied with 10-fold crossvalidation to predict development of serious complications following PE diagnosis. Results: About 208 patients (19.3%, 95% confidence interval (CI), 17.1-21.8%) developed a serious complication after PE diagnosis. The 15-day mortality rate was 10.1%, (95% CI, 8.4-12.1%). The decision tree detected six explanatory covariates: Hestia-like clinical decision rule (any risk criterion present vs none), Eastern Cooperative Group performance scale (ECOG-PS; <2 vs >= 2), O-2 saturation (<90 vs >= 90%), presence of PE-specific symptoms, tumour response (progression, unknown, or not evaluated vs others), and primary tumour resection. Three risk classes were created (low, intermediate, and high risk). The risk of serious complications within 15 days increases according to the group: 1.6, 9.4, 30.6%; P<0.0001. Fifteen-day mortality rates also rise progressively in low-, intermediate-, and high-risk patients: 0.3, 6.1, and 17.1%; P<0.0001. The cross-validated risk estimate is 0.191 (s.e. = 0.012). The optimism-corrected area under the receiver operating characteristic curve is 0.779 (95% CI, 0.717-0.840). Conclusions: We have developed and internally validated a prognostic index to predict serious complications with the potential to impact decision-making in patients with cancer and PE.
publishDate 2017
dc.date.none.fl_str_mv 2017
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/124406
url https://hdl.handle.net/2445/124406
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1038/bjc.2017.48
British Journal of Cancer, 2017, vol. 116, num. 8, p. 994-1001
https://doi.org/10.1038/bjc.2017.48
dc.rights.none.fl_str_mv cc by-nc-sa (c) Carmona Bayonas et al., 2017
http://creativecommons.org/licenses/by-nc-sa/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by-nc-sa (c) Carmona Bayonas et al., 2017
http://creativecommons.org/licenses/by-nc-sa/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Nature Publishing
publisher.none.fl_str_mv Nature Publishing
dc.source.none.fl_str_mv Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300719

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