Page 15 - JCTR-11-4

Journal of Clinical and
Translational Research Hidden cancer after VTE

Finally, in the MVTEP study, 394 patients with breast (5.3%), and prostate (5.3%). At initial screening,
unprovoked VTE were randomized into two groups: one cancer was detected in 5.9% (48 out of 817) of patients
combining a limited screening strategy with PET/CT in the exhaustive screening group, compared to 2.7% (22
imaging (197 participants) and the other following a limited out of 827) in those who received standard testing (OR:
screening strategy alone (197 participants). The trial 2.28; 95% CI: 1.37 ‒ 3.82; p<0.001) (Figure 2). During the
19
included 47.5% females, with participants’ ages ranging follow-up period, cancer was identified in 1.1% (9 out of
from 49 to 76 years, with a mean age of 63 years. The limited 817) of the exhaustive screening group, compared to 3.0%
screening involved medical history assessment, physical (25 out of 827) in the standard testing group (OR: 0.35;
examination, routine laboratory tests, and a chest X-ray, 95% CI: 0.16 ‒ 0.77; p < 0.001) (Figure 2). In the extensive
with additional age- and sex-specific cancer screenings screening group, 27 cancers were detected at an early stage,
(PSA testing for men over 50 years old, mammography while nine were identified at advanced stages. In contrast,
for women over 50 years old, and Papanicolaou smear six cancers were detected at early stages in the limited
for all women). After the initial screening assessment, screening group, and 17 were diagnosed at advanced
cancer was diagnosed in 11 (5.6%) patients in the PET/ stages (OR: 8.5; 95% CI: 2.57 ‒ 28.17; p<0.001) (Table 2).
TC group and four (2.0%) patients in the limited screening The all-cause mortality rate during the follow-up period
group (absolute risk difference: 3.6%; 95% CI: −0.4 ‒ 7.9; was 2.8% (20 out of 718) in the exhaustive screening group,
p=0.07). Furthermore, one (0.5%) occult malignancy compared to 3.4% (25 out of 725) in the standard testing
was detected in 186 patients who had a negative initial group (OR: 0.80; 95% CI: 0.44 ‒ 1.45; p=0.567) (Figure 3).
screening in the PET/CT group, compared with nine The cancer-related mortality rate was 1.2% (10 out of 817)
out of 193 patients (4.7%) in the limited screening group in the exhaustive screening group, compared to 2.3% (19
(absolute risk difference: 4.1%; 95% CI: 0.8 ‒ 8.4; p=0.01). out of 827) in the standard testing group (OR: 1.07; 95%
During follow-up, 16 patients died, eight in each group. CI: 0.57 ‒ 2.00; p=0.143) (Figure 3).
Two (1.0%) patients in the PET/CT group and five (2.5%) All four studies were randomized. Methods for
in the limited screening group had cancer-related deaths. randomization and double-blinding were described and
In the PET/CT group, non-cancer-related deaths included deemed appropriate. Although none of the studies offered
myocardial infarction (one patient), pneumonia (three information on withdrawals and dropouts during the
patients), congestive heart failure with hemorrhagic shock follow-up period, they were considered to have a low risk
(one patient), and unknown causes (one patient). The of bias (Table 3).
limited screening group reported deaths due to myocardial
infarction (one patient), ischemic stroke (one patient), and 3.3. Prospective studies related to cancer
sudden death (one patient). investigations in patients with unprovoked VTE
Pooling data from all trials revealed an overall cancer Across the six observational prospective studies
incidence of 6.3% (104 out of 1644 patients). The most investigating screening for occult cancer in patients with
common cancer sites were colorectal (13.8%), lung (8.5%), unprovoked VTE, a total of 977 patients were included. 20-25

A

B

Figure 2. Forest plot comparing extensive versus limited screening for cancer detection at initial screening (A) and during follow-up (B)

Volume 11 Issue 4 (2025) 9 doi: 10.36922/jctr.24.00069