A new tool for neuro-oncologists: GliomaRiskThrombosis Calculator

Venous thromboembolic complications in cancer patients are a collective term combining lower limb venous thrombosis and pulmonary embolism. Cancer-associated thrombosis increases mortality and is often the reason for refusal of surgery, which adversely affects the patient's prognosis. The incidence of thrombosis depends on the location of the primary tumour.

To date, central nervous system malignancies have been shown to be among the most thrombogenic tumours. Glioblastoma, a brain tumour with extremely low survival rates, is the most common primary CNS malignancy. Venous thromboembolic events are the third leading cause of death in these patients, after tumour progression and infectious complications. This complex group of patients has been the subject of research aimed at clarifying the pathogenetic mechanisms of thrombosis and creating a risk calculation tool for this complication. The work is being carried out by specialists in the Cardio-Oncology Research Group of the Personalised Oncology Research Centre at the WCRC for Personalised Medicine.

It is important to note that treatment and prophylaxis of venous thrombosis in brain tumour patients is associated with a high risk of haemorrhage (development of intracranial haemorrhage, especially after surgical treatment). Moreover, the fact of surgical intervention for this type is a contraindication to anticoagulants used in the treatment and prevention of pulmonary embolism and lower extremity venous thrombosis. Therefore, this group of patients has an extremely high risk of venous thrombosis and a high probability of intracranial haemorrhage if anticoagulant therapy is initiated.

Based on data from 285 patients treated in the neurosurgical departments of Almazov Centre over the last three years, a model was developed and validated to predict the risk of venous thromboembolic complications in patients with glial tumours of the central nervous system after surgery for the duration of inpatient treatment. (AUC 0.908). The model was implemented as a user-friendly web application. After the input of five simple indicators, the clinician is informed of the risk category of a particular patient. The information obtained must be interpreted in conjunction with other clinical data and taken into account by the clinician when making a decision about thromboprophylaxis.

The researchers plan to complete external validation of the GliomaRiskThrombosis Calculator and continue to develop a personalised approach to risk stratification for venous thromboembolic events in brain tumour patients. This will involve adding to the existing calculator a module to calculate the risk of venous thrombosis for the outpatient setting based on additional clinical data available at the time of discharge (molecular and genetic type of tumour, dynamics of laboratory markers and patient’s clinical status).

The calculator demonstrates the multidisciplinary approach to solving complex clinical problems that has been achieved through the teamwork of WCRC researchers.

02.02.2024