Table 2_Predictive model for CRT risk in cancer patients with central venous access devices: a systematic review and meta-analysis.docx

IntroductionWith the high incidence of central venous access device catheter-related thrombosis (CRT) in patients with cancer, its early onset, and the characteristics of clinically insignificant symptoms, risk assessment is essential for the targeted application of thromboprophylaxis. The aim of this paper was to review the risk prediction models developed for central venous access device CRT in patients with cancer and to evaluate their performance.
MethodsPubMed, Embase, Web of Science, Cochrane Library, CNKI, SinoMed, Wanfang Data, and VIP databases were searched, and the search timeframes ranged from the establishment of the database to May 22, 2024. Two researchers independently performed literature screenings, data extractions, and quality assessments. The risk of bias and applicability of the included studies were assessed using the Predictive Model Risk of Bias Assessment Tool. A meta-analysis of the areas under the curve (AUC) values for model validation was performed using Stata 17.0 software.
ResultsNineteen papers with 29 predictive models were included in this systematic review, reporting AUC values of 0.470–1.000. The incidence of central venous access device CRT in cancer patients ranges from 2.02 to 39.4%. The most commonly used predictors are D-dimer levels, BMI, and diabetes. All studies were judged to have a high risk of bias, mainly due to poor reporting of the areas analyzed. The combined AUC value of the six validated models was 0.81 (95% confidence interval: 0.76–0.86), indicating good model discrimination.
DiscussionMost available CRT prediction models exhibited moderate-to-good predictive performance. However, all the studies were rated as having a high risk of bias according to the PROBAST scale. Future studies should adhere to methodological and reporting guidelines for large-sample, multi-center external validation of models, focusing on studies that report rigorous design and optimization or on the development of new models.
Systematic review registrationPROSPERO, identifier: CRD42024516563.

引言
鉴于癌症患者中心静脉导管相关性血栓（central venous access device catheter-related thrombosis, CRT）发病率较高、起病隐匿且临床症状多无明显特异性，风险评估对于血栓预防措施的精准应用至关重要。本研究旨在综述针对癌症患者中心静脉导管相关性血栓开发的风险预测模型，并对其预测效能进行评价。

方法
本研究检索了PubMed、Embase、Web of Science、Cochrane Library、中国知网（CNKI）、中国生物医学文献数据库（SinoMed）、万方数据知识服务平台（Wanfang Data）以及维普资讯（VIP），检索时限为各数据库建库至2024年5月22日。由2名研究者独立完成文献筛选、数据提取及质量评价。采用预测模型偏倚风险评估工具（Predictive Model Risk of Bias Assessment Tool, PROBAST）对纳入研究的偏倚风险及适用性进行评价。采用Stata 17.0软件对模型验证的受试者工作特征曲线下面积（area under the curve, AUC）值进行Meta分析。

结果
本系统评价共纳入19项研究，涉及29个预测模型，其报告的AUC值范围为0.470~1.000。癌症患者中心静脉导管相关性血栓的发病率为2.02%~39.4%。最常纳入的预测变量包括D-二聚体水平、体质量指数（Body Mass Index, BMI）及糖尿病史。所有纳入研究均被评定为存在较高偏倚风险，主要原因是分析区域的报告质量欠佳。对6个经过验证的模型进行合并分析后，其合并AUC值为0.81（95%置信区间：0.76~0.86），提示模型具有良好的区分效能。

讨论
现有多数中心静脉导管相关性血栓预测模型均表现出中等至良好的预测效能。但根据PROBAST量表评价结果，所有纳入研究均被评定为存在较高偏倚风险。未来研究应遵循方法学及报告规范，开展大样本、多中心的模型外部验证研究，重点关注设计严谨、优化完善的现有模型开发研究，或开发全新的预测模型。

系统评价注册
PROSPERO，注册号：CRD42024516563。