Predictors of active cancer thromboembolic outcomes: validation of the Khorana score among patients with lung cancer

• Published in: Journal of thrombosis and haemostasis Vol. 14; no. 9; pp. 1773 - 1778
• Main Authors: Mansfield, A. S., Tafur, A. J., Wang, C. E., Kourelis, T. V., Wysokinska, E. M., Yang, P.
• Format: Journal Article
• Language: English
• Published: England Elsevier Limited 01-09-2016
• Subjects: Aged; Anticoagulants - therapeutic use; Carcinoma, Non-Small-Cell Lung - complications; Carcinoma, Non-Small-Cell Lung - diagnosis; Carcinoma, Non-Small-Cell Lung - therapy; Confidence intervals; Female; Health risk assessment; Humans; Incidence; Lung cancer; Lung Neoplasms - complications; Lung Neoplasms - diagnosis; Lung Neoplasms - therapy; Male; Middle Aged; Mortality; Multivariate Analysis; prediction score; prevention; Prospective Studies; Retrospective Studies; Risk Assessment; Severity of Illness Index; Thromboembolism; Treatment Outcome; venous thromboembolism; Venous Thromboembolism - complications; Venous Thromboembolism - diagnosis; Venous Thromboembolism - therapy; lung cancer; mortality; prediction score; venous thromboembolism; prevention
• ISSN: 1538-7933; 1538-7836; 1538-7836
• DOI: 10.1111/jth.13378

Essentials
Venous thromboembolism (VTE) prevention strategies require effective risk assessment models.
We sought to validate the Khorana Risk Score (KRS) in patients with lung cancer.
A high KRS was not predictive of VTE but was independently associated with all‐cause mortality.
Our findings stress the need for a lung cancer‐specific VTE risk assessment model.
Summary
Objectives
Lung cancer is strongly associated with venous thromboembolism (VTE), but primary prevention against VTE is not a validated management strategy. Risk assessment models will be necessary for efficient implementation of preventative strategies.
Materials and methods
Utilizing a prospectively collected lung cancer database, we aimed to validate the Khorana Risk Score (KRS) in the prediction of VTE among patients with lung cancer. VTE events were retrospectively identified by reviewers unaware of the clinical prediction score calculation. The association between KRS and the risk of VTE was examined using cumulative incidence function with competing risk models. Mortality prediction was evaluated as a secondary outcome.
Results
We included 719 patients in our review. The patients were predominantly older men with non‐small cell lung cancer and 40% had metastatic disease at inception. The median follow‐up was 15.2 months. There were 83 VTEs (11.5%) and 568 (78.8%) patients died. A high KRS (cumulative incidence, 12.4%; 95% confidence interval [CI], 6.4–20.5%) was not associated with VTE compared with an intermediate score (cumulative incidence, 12.1%; 95% confidence interval, 9.5–15.0%) in both univariate and multivariable analyses. However, a high KRS was a predictor of mortality (hazard ratio, 1.7; 95% CI, 1.4–2.2).
Conclusions
Among patients with lung cancer, the KRS did not stratify the patients at the highest risk of VTE. Improved risk stratification methods are needed for this group of patients prior to implementing a primary prevention strategy.