基于DNA液体活检的预测与癌症相关的静脉血栓栓塞
Justin Jee1, A Rose Brannon1, Rohan Singh1
1Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Nature medicine
|August 15, 2024
概括
使用循环瘤DNA (ctDNA) 的液体活检在识别高风险静脉血栓栓塞 (VTE) 的癌症患者方面表现有前途. 这种方法可以改善预防性抗凝策略,降低高风险个体的VTE发病率.
科学领域:
- 在瘤学瘤学.
- 血液学 血液学 血液学
- 基因组学就是基因组学.
背景情况:
- 与癌症相关的静脉血栓塞栓症 (VTE) 是一个重大的临床挑战,增加癌症患者的发病率和死亡率.
- 目前用于识别高风险患者进行预防性抗凝剂的方法往往不足,并且对临床医生来说是繁重的.
研究的目的:
- 研究循环瘤DNA (ctDNA) 测序试验 ("液体活检") 对癌症患者静脉瘤预后的有用性.
- 评估在液体活检数据上训练的机器学习模型是否可以改善与现有分数相比的VTE风险分层.
主要方法:
- 分析了三个等离子体测序队列,包括各种癌症类型的发现 (4,141名患者),验证 (1,426名患者) 和通用性 (463名患者) 队列.
- 开发和评估一个机器学习模型,利用液体活检数据进行VTE风险预测.
- 检查现实世界的数据,以根据ctDNA检测状态来评估抗凝剂的影响.
主要成果:
- 在所有队列中,ctDNA检测独立与VTE风险有关.
- 基于液体活检数据的机器学习模型在VTE风险预测方面表现优异,与Khorana评分相比 (c指数0.74-0.67对0.57-0.54).
- 在现实世界的数据中,抗凝剂在ctDNA阳性患者中降低了VTE率,但在ctDNA阴性患者中没有降低.
结论:
- 液体活检显示,在癌症患者中增强VTE风险分层的潜力超出了传统的临床参数.
- 需要进一步的干预性随机化研究来证实液体活检在指导癌症相关静脉血栓炎的抗凝决定中的临床实用性.
相关概念视频
01:30Venous Thrombosis I: Introduction
Venous thrombosis, the most common disorder of the veins, involves the formation of a thrombus or blood clot associated with vein inflammation. It can be classified as either superficial vein thrombosis or deep vein thrombosis.Superficial Vein Thrombosis: This involves the formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein. Though less severe than deep vein thrombosis (DVT), SVT can lead to complications if untreated.Deep Vein Thrombosis (DVT): This...
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
01:29Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...