CAN WE Predict Risk Factors of Venous Thromboembolism Among Cancer Inpatients?

Abstract Introduction Increased risk of venous thromboembolism (VTE) has been noted among cancer patients as compared to non-cancer. VTE identified as leading cause of death among those with cancer. Cancer associated thrombosis caused increased hospitalizations, increased inpatient/outpatient medical and prescription claims, and increased total health care costs per patient. Our objective was to study demographic, clinical and laboratory risk factors for venous thromboembolism (VTE) among hospitalized cancer patients and built a predictive model for VTE risk. Methods Ours was a retrospective cohort study focused on patients with VTE and cancer from January 2013 - September 2015. Univariate and multivariate logistic regression analysis using stepwise approach was performed. A final predictive model was derived using receiver-operating characteristics (ROC) curves and concordance indices (c-statistics). Results N=3948 cancer inpatients were identified which was split into a derivation cohort and a validation cohort, each with 1957. Mean age 65.9±13.8 years; 52.6% were male; 85.6% Caucasian, 7% African Americans; 15.5% were obese; common comorbidities were hypertension (46%), pulmonary disease (34.5%), diabetes (22.9%), renal disease (20.9%) and congestive heart failure (10.4%). Overall, there was 152 (3.9%) events of VTE with 77 (3.9%) in derivation and 75 (3.8%) in validation cohort. On univariate analysis, comorbidities such as infection and renal diseases, laboratory findings such as low hemoglobin and low albumin was associated with high VTE risk. The derivation set had a c-statistic or AUC of 0.668 while the validation set had an AUC of 0.65. Conclusions Infection, renal disease (comorbidity) and low albumin levels were associated with a higher risk of VTE. Digestive and respiratory cancers were associated with higher VTE risk. We identified three clinical and laboratory variable that was associated with increased risk of VTE in addition to the cancer group. Future research could use this analysis as a basis for forming a risk score that could be used by clinicians to identify those cancer patients at risk for VTE. Disclosures No relevant conflicts of interest to declare.

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Risk factors for hospitalization in elderly cancer patients receiving chemotherapy

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.9035 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 9035-9035

Author(s):

J. M. Kleiner ◽

E. Culakova ◽

D. C. Dale ◽

J. Crawford ◽

M. S. Poniewierski ◽

...

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Cancer Patients ◽

Solid Tumors ◽

Univariate Analysis ◽

The Elderly ◽

Hematologic Toxicity ◽

Elderly Age ◽

Elderly Cancer Patients ◽

Increased Risk

9035 Background: Chemotherapy-associated hospitalization is a major source of morbidity and cost in cancer care, particularly for elderly (age ≥ 65) cancer patients. Hospitalization in the elderly often leads to an irreversible decline in functional status unrelated to the acute event that prompted hospital admission. Currently, little is known about the risk factors that may lead to increased risk of hospitalization in elderly patients receiving chemotherapy (CTX). Methods: 871 patients with solid tumors or lymphoma initiating a new CTX regimen were prospectively enrolled at 60 randomly selected US community oncology sites between 8/2004 and 10/2005. Of these, 361 elderly patients aged 65–91 were identified and followed. Primary endpoint of this investigation was hematologic toxicity and hospitalization was secondary. Pre- CTX patient data were analyzed for increased risk of hospitalization in univariate analysis using the chi-square test. Results: A total of 155 (18%) patients were hospitalized resulting in 215 hospitalizations. Median time to first hospitalization was the second cycle of CTX. 81/361 (22%) of elderly patients were hospitalized compared to only 74/510 (15%) of younger patients (p=0.003). The rate of hospitalization increased in a linear fashion between ages 65–80. Reasons for hospitalization in the elderly included infection, fever, or febrile neutropenia (36%), cardiopulmonary disease (CPD) (12%), vomiting or dehydration (13%), other gastrointestinal (11%), transfusion (8%), thrombosis (4%), CTX administration (4%), and other (13%). Major independent pre-CTX factors that predicted hospitalization in the elderly included male gender (p=0.0004), hemoglobin <11 g/dL (p=0.02), abnormal platelet count (<150k or >350k) (p=0.05), CPD (p=0.03), creatinine >1.5 mg/dL (p=0.05), and ≥ 2 concomitant medications (p=0.0008). Elderly patients with lung cancer (p=0.001) and lymphoma (p=0.05) had significantly higher rates of hospitalization when compared to other solid tumors. Conclusions: These data suggest that the risk of hospitalization increases in elderly cancer patients with age and that pre-CTX factors may be useful in identifying a subpopulation at increased risk for hospitalization. No significant financial relationships to disclose.

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Predictors of venous thromboembolism in cancer patients using machine learning.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e24042 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e24042-e24042

Author(s):

Ayse Ece Cali Daylan ◽

Danai Khemasuwan ◽

Hyun S. Kim ◽

Parvathy Geetha ◽

Sylvia Vania Alarcon Velasco ◽

...

Keyword(s):

Machine Learning ◽

Risk Factors ◽

Lung Cancer ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Hematological Malignancies ◽

Cancer Subtypes ◽

Kaplan Meier ◽

Increased Risk

e24042 Background: The increased risk of venous thromboembolism (VTE) in cancer patients is clearly documented. However, given the heterogeneity and increased risk of bleeding in cancer population, patient selection for thromboprophylaxis is still challenging. Methods: In order to predict risk factors of VTE in cancer patients, we performed a retrospective study of 706 patients who were diagnosed with either solid or hematological malignancies between 2015 and 2019. Demographics, body mass index, complete blood count with differential, kidney function tests, electrolytes, liver function tests, lipid profile and cancer staging were recorded. Random forest analysis with bagging was used to rank these variables and the Kaplan-Meier survival analysis was implemented to stratify cancer subtypes based on the risk of VTE occurrence. Results: The mean follow-up time was 19 months. 8.2% of the patients developed VTE. Based on the random forest analysis, the most important five factors in prediction of VTE in cancer patients were determined as cancer subtype, white blood cell count, platelets, neutrophil and hemoglobin. At one-year mark, the risk of VTE in lung cancer and hematological malignancies was found to be significantly higher than breast, colorectal and endometrial cancer (p<0.05). Conclusions: Machine learning approach is infrequently used in risk factor prediction of VTE in cancer patients. The risk factors identified by the machine learning algorithm in our study are consistent with prior studies and show a clear difference in risk of VTE in various cancer subtypes. Moreover, hematological malignancies and lung cancer patients may develop VTE earlier than other cancer subtypes based on the Kaplan-Meier analysis. Further prospective studies with longer follow up are needed to better risk-stratify cancer patients and explore the temporal associations of VTE risk factors. [Table: see text]

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Venous Thromboembolism Requiring Extended Anticoagulation Among HIV-Infected Patients in a Rural, Resource-Constrained Setting in Western Kenya

Annals of Pharmacotherapy ◽

10.1177/1060028016686106 ◽

2017 ◽

Vol 51 (5) ◽

pp. 380-387 ◽

Cited By ~ 3

Author(s):

John Kanyi ◽

Rakhi Karwa ◽

Sonak Dinesh Pastakia ◽

Imran Manji ◽

Simon Manyara ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Opportunistic Infections ◽

Univariate Analysis ◽

Retrospective Chart Review ◽

International Normalized Ratio ◽

Western Kenya ◽

Adjusted Analysis ◽

Healthcare Data ◽

Increased Risk

Background: HIV-infected patients are at an increased risk of developing venous thromboembolism (VTE), and minimal data are available to describe the need for extended treatment. Objective: To evaluate the frequency of and determine predictive risk factors for extended anticoagulation of VTE in HIV-infected patients in rural, western Kenya. Methods: A retrospective chart review was conducted at the Anticoagulation Monitoring Service affiliated with Moi Teaching and Referral Hospital and the Academic Model Providing Access to Healthcare. Data were collected on patients who were HIV-infected and receiving anticoagulation for lower-limb deep vein thrombosis. The need for extended anticoagulation, defined as receiving ≥7 months of warfarin therapy, was established based on patient symptoms or Doppler ultrasound–confirmed diagnosis. Evaluation of the secondary outcomes utilized a univariate analysis to identify risk factors associated with extended anticoagulation. Results: A total of 71 patients were included in the analysis; 27 patients (38%) required extended anticoagulation. The univariate analysis showed a statistically significant association between the need for extended anticoagulation and achieving a therapeutic international normalized ratio within 21 days in both the unadjusted and adjusted analysis. Patients with a history of opportunistic infections required an extended duration of anticoagulation in the adjusted analysis: odds ratio = 3.42; 95% CI = 1.04-11.32; P = 0.04. Conclusions: This study shows that there may be a need for increased duration of anticoagulation in HIV-infected patients, with a need to address the issue of long-term management. Guideline recommendations are needed to address the complexity of treatment issues in this population.

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Venous thromboembolism and lung cancer: a review

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2015.301 ◽

2019 ◽

Vol 10 ◽

Author(s):

Carolina Vitale ◽

Mario D’Amato ◽

Paolo Calabrò ◽

Anna Agnese Stanziola ◽

Mauro Mornile ◽

...

Keyword(s):

Risk Factors ◽

Lung Cancer ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Advanced Disease ◽

Antiangiogenic Therapy ◽

Epidemiological Studies ◽

Incidence Rates ◽

Lung Cancer Patients ◽

Increased Risk

Venous thromboembolism (VTE) is a common complication of malignancies and epidemiological studies suggest that lung cancer belonged to the group of malignancies with the highest incidence rates of VTE. Risk factors for VTE in lung cancer patients are adenocarcinoma, NSCLC in comparison with SCLC, advanced disease, pneumonectomy, chemotherapy including antiangiogenic therapy. Other risk factors are pretreatment platelet counts and increased release of TF-positive microparticles. Elevated D-dimer levels do not necessarily indicate an increased risk of VTE but have been shown to be predictive for a worse clinical outcome in lung cancer patients. Mechanisms responsible for the increase in venous thrombosis in patients with lung cancer are not understood. Currently no biomarker is recognized as a predictor for VTE in lung cancer patients. Although several clinical trials have reported the efficacy of antithrombotic prophylaxis in patients with lung cancer who are receiving chemotherapy, further trials are needed to assess the clinical benefit since these patients are at an increased risk of developing a thromboembolism.

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Factors at Admission That Are Predictive of Increased In-Hospital Bleeding in Acutely Ill Medical Patients: Findings from the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE).

Blood ◽

10.1182/blood.v106.11.264.264 ◽

2005 ◽

Vol 106 (11) ◽

pp. 264-264

Author(s):

Hervé Decousus ◽

Rainer B. Zotz ◽

Victor F. Tapson ◽

Beng H. Chong ◽

James B. Froehlich ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Univariate Analysis ◽

Medical Illness ◽

Medical Patients ◽

Vte Prophylaxis ◽

Risk Of Bleeding ◽

Increased Risk ◽

Significant Difference ◽

Clinically Significant

Abstract Background Although clinical studies have not shown a significant difference between the risk of bleeding in acutely ill medical patients receiving pharmacologic venous thromboembolism (VTE) prophylaxis and those receiving placebo, fear of bleeding may lead physicians to withhold pharmacologic prophylaxis for patients who should receive it. We therefore aimed to determine the incidence of, and risk factors for in-hospital bleeding in hospitalized acutely ill medical patients in IMPROVE, an international, observational registry. Methods Patients aged ≥18 years, hospitalized ≥3 days with an acute medical illness have been enrolled consecutively since July 2002. Exclusion criteria: therapeutic antithrombotics/thrombolytics at admission, major surgery or trauma during 3 months prior to admission, and VTE treatment within 24 hours of admission. Patients bleeding immediately before, or at admission were excluded from this analysis. Factors present at admission and associated with increased risk of in-hospital bleeding (defined as major or clinically significant nonmajor [Büller et al. N Engl J Med2003;349:1695–702]) were identified by univariate analysis (p<0.15) and included in a multiple logistic regression model (significant at p<0.05). The model was adjusted for patients’ length of stay in hospital. Results Data were from 5960 patients enrolled up to 31 March 2005 in 49 hospitals (12 countries). In-hospital bleeding occurred in 170 (2.9%) patients: 68 (1.1%) major and 102 (1.7%) clinically significant nonmajor bleeding. Independent risk factors for in-hospital bleeding are shown in the Table. In-hospital prophylaxis with low-molecular-weight and unfractionated heparin were not independently associated with an increased risk of bleeding when added to the analysis (p=0.51 and 0.38, respectively). In patients with 0, 1, 2 or ≥3 of these risk factors, the incidences of major in-hospital bleeding were 0.1%, 0.4%, 1.2% and 5.2%, respectively. Conclusions In this unselected patient population, the rate of major in-hospital bleeding was low (1.1%) and similar to that in the MEDENOX study (1.0%), a major clinical study of VTE prophylaxis. Factors that we identified will be valuable for predicting the risk of in-hospital bleeding in acutely ill medical patients. Table. Factors predictive of an increased risk of in-hospital bleeding in acutely ill medical patients Factor Odds ratio 95% confidence interval Active gastroduodenal ulcer 5.38 2.90–10.00 Bleeding disorder 4.54 2.02–10.19 Hepatic failure 3.34 1.80–6.19 Serum creatinine >1.5 mg/dL 2.29 1.63-3.21 Current cancer 2.08 1.43-3.03 Central venous catheter 2.00 1.31-3.05 ICU/CCU stay 1.92 1.23-3.02 Immobile ≥ 4 days 1.75 1.24-2.46 Ischemic heart disease 1.57 1.02-2.40

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Incidence and Risk Factors for Central Venous Catheter-Related Venous Thromboembolism in Breast Cancer Patients Under Neoadjuvant Chemotherapy: the Caveccas (Catheter Veineux Central et Cancer du Sein) Study

Blood ◽

10.1182/blood.v128.22.2607.2607 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2607-2607

Author(s):

Philippe Debourdeau ◽

Marc Espié ◽

Sylvie Chevret ◽

Joseph Gligorov ◽

Antoine Elias ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Thrombin Generation ◽

Lobular Carcinoma ◽

Univariate Analysis ◽

Central Venous ◽

Cathéter Veineux Central

Abstract Background: Symptomatic Catheter Related Thrombosis (CRT) occurs in 3-5% of cancer patients with Central Venous Catheters (CVC) and, overall, the incidence of CRT could reach 30% when including asymptomatic cases (1). In women with Breast Cancer (BC), the most frequent cancer in females world-wide, the high risk of Venous Thromboembolism (VTE) during chemotherapy may be related in part to CRT (2). We therefore designed the CAVECCAS (Cathéter VEineux Central et CAncer du Sein) study to analyze CRT incidence and CRT risk factors in BC patients with CVC receiving (neo)adjuvant chemotherapy (NAC). Methods: CAVECCAS is a prospective, multicenter cohort study of patients with non metastatic invasive BC undergoing insertion of a single lumen CVC for at least 3 months of NAC. All included patients with signed informed consent between September 2008 and December 2011 underwent repeated double-blind Doppler US evaluation before (D0) and at 7, 30 and 90 days (D) after CVC insertion. In case of VTE symptoms, diagnosis was confirmed by venography, ultrasonography and/or computed tomography. Venous blood samples were systematically drawn before and 2 days after CVC insertion to determine D-Dimers levels (VIDAS® D-Dimer Exclusion™), Platelet-derived MPs (Pd-MPs) and Pd-MPs expressing phosphatidyl serin (Pd-MP/PS+) levels (3), thrombin generation (Calibrated Automated Thrombogram assay®, Stago) and endogenous thrombin potential (ETP). After completing recruitment and follow-up (D90), a nested case-control study analyzed additional individual thrombophilic risk factors (Antithrombin, Protein C and Protein S levels, presence of Factor V and Factor II Leiden mutations, presence of antiphospholipid, anticardiolipin and antiβ2GP1 antibodies) using two controls without CRT from the CAVECCAS cohort matched for TNM status with each symptomatic or asymptomatic CRT patient. Statistical analysis used Fisher or Wilcoxon tests for univariate analysis; step down selection procedure with p-values < 0.10 for multivariate models; conditional logistic model to study the occurrence of CRT based on thrombophilia testing (open-source software R Version 2.15.2 (2012-10-26). Results(expressed as median and inter-quartile range [IQR] for quantitative data and numbers and percentages for categorical data). 524 patients with non metastatic BC (85% ductal carcinoma, 12.2% Lobular carcinoma, 2.8% other) with respective T0/T1/T2/T3/T4 staging (0.5%/47.6%/43.3%/8.0%/0.7%), SBR 1/2/3 grading (11.2%/53%/35.8%), 49.2 % having node involvement and 79.5% steroid hormone receptors, were analyzed. During follow-up, the overall CRT incidence rate was 2.18 cases/100 patient-months, with 14 symptomatic and 46 asymptomatic patients, 27, 10 and 9 of the asymptomatic CRT being respectively diagnosed on D8, 30 and day 90 US. In univariate analysis, increased age (>50 years) (OR, 1.80; 95% CI, 1.01-3.22; p=0.048), BMI> 30 kg/m² (OR, 2.64; 95% CI, 1.46-4.76; p=0.001) and comorbidities (OR, 2.05; 95% CI, 1.18-3.56; p=0.011) were associated with CRT. CRT was less frequent in ductal (OR, 0.55; 95% CI, 0.28-1.07; p=0.078) versus lobular carcinoma (OR, 2.53; 95% CI, 1.32-4.85; p= 0.005). In multivariate analysis, BMI>30 kg/m² (OR, 2.66: 99%CI, 1.46-4.84, p=0.001) and lobular carcinoma histology (OR, 2.56; 95%CI, .32-4.96, p=0.005) remained CRT risk factors. Pd-MPs (981.5 [518-2147] vs 758.5 [416.5-373] /mL; p<0.0001) and Pd-MP/PS+(778 [409-1851] vs 730 [380.5-412]/mL; p=0.021) levels decreased after CVC insertion versus baseline, while D-Dimers levels increased (454[294.2-757] vs 586 [366-842] ng/mL; p<0.0001), as did all thrombin generation parameters increased except ETP (1322 [1052-582] vs 1304 [1063-652] nM/min; p=0.023). None of these biomarkers appeared significant predictors for CRT. Conclusion: In this large sample size study with serial measurements of clinical parameters and biomarkers for thrombosis, only obesity and lobular carcinoma histology appeared strong risk factors for CRT in non metastatic BC treated with NAC. Further studies will elucidate how individual stratification of BC patients may identify those who may benefit from CRT prophylaxis. 1) Debourdeau P and Farge D et al. J Thromb Haemost 2013; 11:71-80 2) Walker AJ et al. Blood 2016;127(7):849-57 3) Robert S et al J Thromb Haemost 2009;7:190-7 Disclosures No relevant conflicts of interest to declare.

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Stroke in chronic renal failure

Orvosi Hetilap ◽

10.1556/oh.2008.28292 ◽

2008 ◽

Vol 149 (15) ◽

pp. 691-696

Author(s):

Dániel Bereczki

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

Chronic Renal Disease ◽

Kidney Diseases ◽

Cerebrovascular Diseases ◽

Lipid Lowering ◽

Increased Risk ◽

Intracerebral Hemorrhages

Chronic kidney diseases and cardiovascular diseases have several common risk factors like hypertension and diabetes. In chronic renal disease stroke risk is several times higher than in the average population. The combination of classical risk factors and those characteristic of chronic kidney disease might explain this increased risk. Among acute cerebrovascular diseases intracerebral hemorrhages are more frequent than in those with normal kidney function. The outcome of stroke is worse in chronic kidney disease. The treatment of stroke (thrombolysis, antiplatelet and anticoagulant treatment, statins, etc.) is an area of clinical research in this patient group. There are no reliable data on the application of thrombolysis in acute stroke in patients with chronic renal disease. Aspirin might be administered. Carefulness, individual considerations and lower doses might be appropriate when using other treatments. The condition of the kidney as well as other associated diseases should be considered during administration of antihypertensive and lipid lowering medications.

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An Exploration of Heart Failure Risk in Breast Cancer Patients Receiving Anthracyclines with or without Trastuzumab in Thailand: A Retrospective Study

Clinics and Practice ◽

10.3390/clinpract11030064 ◽

2021 ◽

Vol 11 (3) ◽

pp. 484-493

Author(s):

Jukapun Yoodee ◽

Aumkhae Sookprasert ◽

Phitjira Sanguanboonyaphong ◽

Suthan Chanthawong ◽

Manit Seateaw ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Cancer Patients ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Breast Cancer Patients ◽

Ventricular Ejection Fraction ◽

Factors Associated ◽

Palliative Intent ◽

Increased Risk

Anthracycline-based regimens with or without anti-human epidermal growth factor receptor (HER) 2 agents such as trastuzumab are effective in breast cancer treatment. Nevertheless, heart failure (HF) has become a significant side effect of these regimens. This study aimed to investigate the incidence and factors associated with HF in breast cancer patients treated with anthracyclines with or without trastuzumab. A retrospective cohort study was performed in patients with breast cancer who were treated with anthracyclines with or without trastuzumab between 1 January 2014 and 31 December 2018. The primary outcome was the incidence of HF. The secondary outcome was the risk factors associated with HF by using the univariable and multivariable cox-proportional hazard model. A total of 475 breast cancer patients were enrolled with a median follow-up time of 2.88 years (interquartile range (IQR), 1.59–3.93). The incidence of HF was 3.2%, corresponding to an incidence rate of 11.1 per 1000 person-years. The increased risk of HF was seen in patients receiving a combination of anthracycline and trastuzumab therapy, patients treated with radiotherapy or palliative-intent chemotherapy, and baseline left ventricular ejection fraction <65%, respectively. There were no statistically significant differences in other risk factors for HF, such as age, cardiovascular comorbidities, and cumulative doxorubicin dose. In conclusion, the incidence of HF was consistently high in patients receiving combination anthracyclines trastuzumab regimens. A reduced baseline left ventricular ejection fraction, radiotherapy, and palliative-intent chemotherapy were associated with an increased risk of HF. Intensive cardiac monitoring in breast cancer patients with an increased risk of HF should be advised to prevent undesired cardiac outcomes.

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Combining Carcinoembryonic Antigen and Platelet to Lymphocyte Ratio to Predict Brain Metastasis of Resected Lung Adenocarcinoma Patients

BioMed Research International ◽

10.1155/2017/8076384 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Wei Wang ◽

Chao Bian ◽

Di Xia ◽

Jin-Xi He ◽

Ping Hai ◽

...

Keyword(s):

Risk Factors ◽

Brain Metastasis ◽

Lung Adenocarcinoma ◽

Carcinoembryonic Antigen ◽

Roc Curve ◽

Univariate Analysis ◽

Significant Risk ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Increased Risk

We aimed to evaluate the role of pretreatment carcinoembryonic antigen (CEA) and platelet to lymphocyte ratio (PLR) in predicting brain metastasis after radical surgery for lung adenocarcinoma patients. The records of 103 patients with completely resected lung adenocarcinoma between 2013 and 2014 were reviewed. Clinicopathologic characteristics of these patients were assessed in the Cox proportional hazards regression model. Brain metastasis occurred in 12 patients (11.6%). On univariate analysis, N2 stage (P = 0.013), stage III (P = 0.016), increased CEA level (P = 0.006), and higher PLR value (P = 0.020) before treatment were associated with an increased risk of developing brain metastasis. In multivariate model analysis, CEA above 5.2 ng/mL (P = 0.014) and PLR ≥ 120 (P = 0.036) remained as the risk factors for brain metastasis. The combination of CEA and PLR was superior to CEA or PLR alone in predicting brain metastasis according to the receiver operating characteristic (ROC) curve analysis (area under ROC curve, AUC 0.872 versus 0.784 versus 0.704). Pretreatment CEA and PLR are independent and significant risk factors for occurrence of brain metastasis in resected lung adenocarcinoma patients. Combining these two factors may improve the predictability of brain metastasis.

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