Page 12 - JCTR-11-4

Journal of Clinical and
Translational Research Hidden cancer after VTE

Figure 1. Flow diagram of included studies
Abbreviations: ICTP: International clinical trials registry platform.

exhaustive screening strategy did not provide a clinically out of 423 patients (3.3%) received a cancer diagnosis at
significant benefit. In the SOMIT trial, cancer was detected initial screening, compared to 10 of the 431 patients (2.3%)
in 13 out of 99 participants (13.1%) who underwent extensive in the limited-screening group (p=0.28). The extensive
testing. During the follow-up period, a single malignancy screening strategy missed five occult cancers (1.2%), while
(1.0%) emerged in the comprehensive screening group, the limited screening missed four (0.9%) (p=1.0). Cancer-
whereas 10 malignancies (9.8%) became symptomatic in the related mortality rates were 0.9% and 1.4%, respectively
limited screening group (relative risk: 9.7; 95% CI: 1.3 – 36.8; (p=0.75).
p<0.01). Within this trial, 2 out of 99 participants (2.0%) in
the comprehensive testing group and 4 out of 102 (3.9%) in In a small-scale RCT, two diagnostic strategies were
the group tested at the physician’s discretion died of cancer compared: A CT-based strategy involving thoracic,
(absolute difference: 1.9%; 95% CI: −5.5 ‒ 10.9). abdominal, and pelvic scans combined with a fecal occult
blood test, and a strategy based on physicians’ clinical
The Screening for Occult Malignancy in Patients 18
with Idiopathic VTE (SOME) trial was a multicenter, judgment. The study involved 195 participants with a
open-label, RCT that compared a screening strategy for mean age of 69.3 ± 14 years, of whom 94 (48.2%) were
occult cancer using CT scan of the abdomen and pelvis females. Occult cancer was detected in 10.2% (10/98) of
to a limited screening in patients with a first episode of patients assigned to the CT-based strategy, compared to
VTE. The mean age was 53.5 ± 14.0 years, and 32.5% 8.2% (8/97) in the control group (absolute difference: 2.0%;
17
were female. Limited screening included blood testing, 95% CI: −7.2 ‒ 11.1; p=0.81). Over a follow-up period of up
chest radiography, and targeted cancer screening based on to 24 months, two patients in each group were diagnosed
age and gender: Breast examinations and mammography with cancer. The overall mortality rates were 7.1% (7/98)
for women over 50 years old, papanicolaou testing and a in the CT-based group and 11.3% (11/97) in the control
pelvic exam for sexually active women aged 18 – 70 years, group (absolute difference: −4.2%; 95% CI: −12.3 – 3.9;
and prostate examination and PSA testing for men over p=0.67), with two and four cancer-related deaths in each
40 years old. In the limited-screening-plus-CT group, 14 group, respectively.

Volume 11 Issue 4 (2025) 6 doi: 10.36922/jctr.24.00069