Using the Khorana risk score to predict venous thromboembolism and overall survival in a cohort of Hispanic patients with solid malignancies

Abstract

Background:The Khorana risk score (KRS) for prognosis of venous thromboembolism (VTE) has been rarely explored in Hispanic populations.Objective: To determine the value of the KRS for prediction of VTE and overall survival (OS) among Hispanic individuals with cancer. Methods:We retrospectively evaluated all outpatients with newly diagnosed solid tumours receiving systemic chemotherapy in Hospital San Juan Dios, San José, Costa Rica, from January to December 2021. The 6-month cumulative VTE incidence according to the KRS categories was estimated using the Fine & Gray competing risk model. A Kaplan-Meier analysis was used to compare OS among KRS categories. The Cox regression analysis was performed to calculate the hazard ratio (HR) and its corresponding 95% confidence interval (CI). The receiver operating characteristic (ROC) analysis was performed to identify the optimal cutoff value to predict VTE during follow-up.Results: A total of 708 patients were included in the analysis. After a median followup of 8.13 months, the cumulative incidence of VTE at 6 months was 1.56% (95% CI: 0.83%-6.82%), 4.83% (95% CI: 2.81%-7.66%) and 8.84% (95% CI: 4.30%-15.42%) for low-, intermediate-and high-risk Khorana score categories, respectively (Gray's p value: 0.0178). The optimal cutoff for the KRS to predict VTE was 2 (area under the ROC curve: 0.65; 95% CI: 0.55-0.756). The KRS was independently associated with overall mortality (HR: 1.83; 95% CI: 1.46-2.29; p < 0.001, for the comparison of 'high-risk' and 'low-risk' KRS). Conclusions:The KRS is a valid tool to predict VTE and mortality in a cohort of Hispanic outpatients with newly diagnosed solid tumours.

Estimating Venous Thromboembolism Risk in Metastatic Colorectal Cancer Inpatients: Validation of Existing Risk Scores and Development of New Risk Scores

“…Similarly, low specificity of Khorana model has also been reported in several studies. 21,22 Notably, despite satisfactory sensitivity at the calculated cutoff value, the Vienna CATS model classified over 50% of mCRC patients (> 700 patients) as high-risk, and its low positive predictive value (∼ 50%) indicated that a significant number of patients might be subjected to unnecessary risks associated with VTE prophylaxis. A similar trend was observed in the Protecht score with its calculated cutoff point.…”

Novel Insights in Venous Thromboembolism Risk Assessment Methods in Ambulatory Cancer Patients: From the Guidelines to Clinical Practice

“…Mulder et al's meta-analysis reported the Khorana score as a tool for selecting high-risk VTE in oncologic patients [33], and Akasaka-Kihara et al validated it in the Japanese cancer population [34]. Ramos-Esquivel et al recently found the Khorana score to perform an accurate categorization of VTE risk in ambulatory Hispanic patients who were newly diagnosed with solid tumors and were receiving systemic chemotherapy [35]. El-Sayed et al reported a calculated VTE occurrence probability of 87.5% when using the Khorana score at cut-off levels ≥ 3 in patients with hematological malignancy [36].…”