Khorana Score Research Articles

Genomic alterations as predictive biomarkers for cancer-associated thrombosis (CAT) in biliary tract cancer (BTC).

634 Background: CAT is the second leading cause of cancer-related death, yet the genetic underpinnings of VTE risk in BTC remain underexplored. The evaluation of CAT risk is based on Khorana score (KS), which is limited to clinical parameters. Incorporation of a genomic signature in CAT risk assessment may allow for individualized risk assessment. Methods: We collected data from consecutive patients (pts) with BTC treated at Mayo Clinic Hospitals (Phoenix, Rochester, Jacksonville) between 1998-2024. Genomic profiling was conducted on FFPEs and blood samples through next-generation sequencing (NGS) (NextSeq, Tempus xT CDx, FoundationOne CDx). Association between CAT and clinic-pathologic features (age, gender, race, ethnicity, BMI, tumor site (TS), surgery, stage, radiotherapy, systemic therapy, history of thromboembolism (hVTE)) were assessed with multivariate Cox regression (p<0.05). A separate Cox regression adjusting for age, hVTE, radiotherapy, systemic therapy, metastatic disease stratified for TS was used for gene associations. Benjamini–Hochberg method was applied (q<0.1) based on previous publications. Median overall survival (mOS) was calculated from the date of diagnosis to the date of death or last follow-up. Results: 740 adult pts were included, median age 62 years (IQR: 56-71), male/female (51%/49%), median BMI 26.6 (IQR: 22.8-31.1) with intrahepatic (496, 67%) and extrahepatic BTC (173, 23%), gallbladder cancer (71, 10%). 244 (33%) had metastatic disease. 216 (29%) experienced CAT. For those with CAT, 31 (14%) scored 1, 9 (4%) scored 2 and 1 (<1%) scored 3 on KS. mOS was 33 months (mos) (95% CI 28.9-38.4) vs. 55 mos (95% CI 25.1-39.1) (p=0.2) for pts with and without CAT, respectively. hVTE was associated with CAT (HR 3.14, 95% CI 1.98-4.98, p<0.001) along with systemic therapy (HR 1.19, 95% CI 1.11-2.89, p<0.01) and metastatic disease (HR 1.65, 95% CI 1.11-2.44, p<0.01). 305 pts (41%) underwent NGS. The most common altered genes were TP53 (126, 41%), KRAS (64, 21%), CDKN2A (63, 21%). The most common altered currently targetable genes were FGFR2 (43, 14%), IDH1 (30, 10%) and HER2/ERBB2 (16, 5%). MYC (4, 1%) (HR 11.60, 95% CI 3.04-44.25, p<0.001, q=0.058) and HER2/ERBB2 (HR 2.45, 95% CI 1.26-4.77, p=0.008, q=0.087) alterations were significantly associated with an increased risk of CAT. MYC alterations were all copy number gains (100%). The most frequent HER2/ERBB2 alterations were copy number gains (10, 62%). FGFR2 fusions (31, 10%) were linked to a lower CAT risk (HR 0.46, 95%CI 0.22-0.93, p=0.032, q=0.075) with FGFR2-BICC1 being the most frequent (5,16%). Conclusions: MYC and HER2/ERBB2 alterations are novel predictive biomarkers for an increased risk of CAT in BTC, while FGFR2 fusions confer lower risk. The knowledge of mutational status lends insight into guidance for anticoagulant prophylaxis management for this subgroup and integration with KS.

Beyond Khorana score 2: Molecular correlates of venous thromboembolism in pancreatic cancer.

751 Background: Pancreatic ductal adenocarcinoma (PDAC) is associated with a hypercoagulable state leading to thrombosis. Risk models such as the Khorana score automatically classify PDAC as intermediate-high risk, and recent guidelines recommend consideration of thromboprophylaxis. However, little is known about the molecular correlates of PDAC for venous thromboembolism (VTE). Methods: We examined clinical and genomic data from the prospective multi-institution COMPASS trial (NCT02750657), which enrolled patients with treatment-naïve metastatic PDAC who underwent a fresh tumor biopsy for real-time whole genome and transcriptome sequencing. Laser capture microdissection was performed. Patients underwent restaging scans at 8-week intervals. Detailed chart review was conducted to focus on VTE risk factors, timing of VTE diagnosis, and anticoagulation. We also compared clinical and molecular factors based on timing of VTE diagnosis. Overall survival was defined as time from VTE to death. Results: Of 268 patients enrolled in the COMPASS trial, 166 patients had detailed clinical data available regarding VTE status. 82 patients (49%) developed a VTE, where 16 (20%) had breakthrough clots. Baseline epidemiological variables were similar for those with and without VTE, including no differences between age, sex, BMI, and baseline CA 19-9. No patients were on routine prophylactic anticoagulation. SMAD4 mutations were more frequently seen in the VTE subgroup (57% vs. 40%, p= 0.04), but no differences were seen in other driver genes (KRAS, TP53, CDKN2A), Moffitt subtype, or homologous recombination deficiency status. Patients who developed an early VTE (within 3 months) had a higher baseline CA 19-9 (median 4015 vs. 891, p= 0.02), and none were port-associated. A higher incidence of KRAS wildtype cases (10%) were observed in the early vs. later VTE groups (p= 0.03), but no differences in KRAS allelic status. There were no differences in burden of SNVs, indels, or SVs. Early VTE occurred in 46% of all basal cases, which are typically more aggressive, and only in 37% of classical subtypes. Overall survival was shorter with early VTE (HR 1.74, p= 0.02). Conclusions: A higher incidence of SMAD4 alterations were observed among patients with metastatic PDAC who developed VTE. VTE diagnosed earlier were associated with shorter survival, suggesting that early thromboprophylaxis should be considered at the time of diagnosis. Clinical trial information: NCT02750657 .

Risk factors for venous thromboembolism in patients undergoing neoadjuvant chemotherapy as treatment for ovarian cancer.

During the treatment of ovarian cancer, the risk of venous thromboembolism (VTE) post operatively is well established, however, patients may be at even greater risk during neoadjuvant chemotherapy (NACT). This study aimed to determine the incidence and timing of VTE amongst patients undergoing NACT, whether there was an association with survival, and examine risk factors associated with the development of VTE. This was a retrospective cohort study of patients diagnosed with ovarian, fallopian tube and primary peritoneal cancer receiving neoadjuvant chemotherapy betweenApril 2011 and April 2022 at a gynaecological cancer centre in England. Clinical factors examined included: age at diagnosis, Body Mass Index (BMI), presence of inflammatory co-morbidity, tumour morphology, stage of disease, pelvic mass,ascites,retroperitoneal lymphadenopathy, Khorana score, serum albumin levels, chemotherapy regime, bevacizumab administration and Ca 125 levels. Of 304 patients analysed, 73 (24%) patients developed venous thromboembolism. Of the patients who developed VTE, fifty-five patients developed pulmonary embolism (75%) and the stage of treatment at which most VTEs were diagnosed was neoadjuvant chemotherapy (32%). There was no correlation observed, between the incidence of VTE and any risk factors, including Khorana score, with the exception of low albumin (<35g/L)(odds ratio (OR):2.1(95%CI 1.1-3.9; p=0.06) and patients who did not receive paclitaxel chemotherapy (OR:2.04(95%CI 1.02-4.05; p=0.08). There was no difference in survival rates between the VTE group and the non-VTE group. This study demonstrates high rates of VTE, especially pulmonary embolism, in ovarian cancer patients undergoing NACT. The present study, amongst others in the literature also suggest that the risk of VTE in ovarian cancer patients undergoing NACT is underestimated by current risk stratification models. Therefore, prospective trials dedicated to ovarian cancer patients specifically, and a development of a risk model that takes into account factors established by higher levels of evidence, are strongly recommended.

Real-world validation of the Khorana risk score in gastric cancer patients receiving immune checkpoint inhibitors.

363 Background: Thrombosis is a common cancer-related complication, particularly in gastric cancer. Studies show that immune checkpoint inhibitors (ICIs) increase the risk of venous thromboembolism (VTE) and arterial thrombosis. The Khorana risk score is widely used to assess thrombosis risk before starting chemotherapy. This study aimed to validate the Khorana score in gastric cancer patients receiving ICIs using a large global database. Methods: We used the TriNetX Global Collaborative Network, which contains de-identified data from over 120 million patients. We included patients diagnosed with gastric cancer who received ICIs between January 2014 and July 2023. The Khorana risk score was calculated based on lab values and BMI within two weeks before ICI initiation. Patients were divided into two cohorts: elevated risk (score 3-6) and intermediate risk (score 2). Cox-proportional hazard analyses were conducted over a one-year follow-up. The primary outcome was VTE (deep vein thrombosis [DVT] and pulmonary embolism [PE]). Secondary outcomes were arterial thrombosis, including myocardial infarction (AMI) and ischemic stroke, and all-cause mortality. Results: The study included 551 patients, with 362 in the intermediate risk and 189 in the elevated risk cohorts. The mean age was 64 in both cohorts, with the elevated group consisting of more males (76% vs. 63%) and a higher proportion of Black patients (11% vs. 6%). Pembrolizumab (49%) and nivolumab (47%) were the most used ICIs. Patients with elevated risk had a significantly higher risk of VTE (HR 1.74, 95% CI 1.18-2.58), DVT (HR 1.82, 95% CI 1.07-3.10), and PE (HR 1.74, 95% CI 1.07-2.84). However, no significant associations were found with arterial thrombosis (HR 1.28, 95% CI 0.74-2.20), including cerebral infarction (HR 1.05, 95% CI 0.51-2.16), or AMI (HR 1.46, 95% CI 0.70-3.05). The elevated risk cohort also had significantly higher mortality (HR 1.44, 95% CI 1.11-1.87). Conclusions: An elevated Khorana risk score is associated with a higher risk of VTE, but not arterial thrombosis, in gastric cancer patients treated with ICIs. Further studies are needed to determine how the Khorana score can be applied to predict ICI-related thrombosis and guide prophylactic anticoagulation. Outcomes Khorana risk score 3-6 Khorana risk score 2 Hazard ratio(95% CI) P-value(Log-rank) At risk patients Cases At risk patients Cases Venous thromboembolism 189 45 362 58 1.74 (1.18-2.58) 0.005 Deep vein thrombosis 189 25 362 30 1.82 (1.07-3.10) 0.025 Pulmonary embolism 189 29 362 36 1.74 (1.07-2.84) 0.025 Arterial thrombosis 189 21 362 34 1.28 (0.74-2.20) 0.375 Cerebral infarction 189 11 362 22 1.05 (0.51-2.16) 0.901 Acute myocardial infarction 189 12 362 17 1.46 (0.70-3.05) 0.317 All-cause mortality 189 93 362 145 1.44 (1.11-1.87) 0.006

The role of germline and somatic mutations in predicting cancer-associated thrombosis: a narrative review.

Patients with cancer have an increased risk of venous thromboembolism (VTE). Guidelines suggest to use risk assessment tools to guide decisions about thromboprophylaxis, but current tools have modest discriminatory ability. Genetic information from the germline or tumor has the potential to improve VTE prediction. Here, we provide a clinical overview of the current role of genetics in cancer-associated VTE. Germline mutations, such as factor V Leiden and prothrombin G20210A, are associated with a 2- to 2.5-fold increased VTE risk in patients with cancer. Tumor-specific somatic mutations also contribute to VTE risk, such as ALK rearrangements increasing the risk in nonsmall cell lung cancer and IDH1 mutations decreasing the risk in gliomas. Other somatic mutations associated with VTE independent of tumor type include KRAS, STK11, MET, KEAP1, CTNNB1, and CDKN2B. Incorporating data on germline or somatic mutations in risk scores improves discriminatory ability compared with the Khorana score. Specific germline and somatic mutations are associated with an increased VTE risk in patients with cancer and potentially improve performance of clinical risk scores. The increasing and widespread use of genetic testing in cancer care provides an opportunity for further development of prediction models incorporating genetic predictors.

External validation of a novel cancer-associated venous thromboembolism risk assessment score in a safety-net hospital

Cancer-associated thrombosis (CAT) is a leading cause of death in patients diagnosed with cancer. However, pharmacologic thromboprophylaxis use in cancer patients must be carefully evaluated due to a 2-fold increased risk of experiencing a major bleeding event within this population. The electronic health record CAT (EHR-CAT) risk assessment model (RAM) was recently developed, and reports improved performance over the widely used Khorana score. Extensive RAM external validation is crucial to determine accuracy across diverse patient populations prior to clinical utilization. To externally validate EHR-CAT using data from 2103 patients with cancer at the Boston Medical Center (BMC), New England's largest safety-net hospital, and to compare this RAM with the Khorana score. We conducted a retrospective study of BMC cancer patients diagnosed between January 2014 and December 2022 using data from the BMC tumor registry and EHR system. We validated the RAM using measures of discrimination and calibration. The EHR-CAT score exhibited a strong ability to discriminate the risk of CAT (C statistic, 0.67), which was substantially higher than the classic Khorana score (C statistic, 0.58). This increased discrimination power reflects the 20% of patients that were reclassified into high or low risk by the expanded score. Model calibration was also strong in this dataset. In our external validation, the recently published EHR-CAT score showed clear and improved separation of patients at high and low risk for CAT. The utilization of this expanded CAT score could facilitate improved targeting of at-risk cancer patients for prophylactic therapy.

Assessment of risk prediction scores for venous thromboembolism in ambulatory cancer patients with solid tumors receiving chemotherapy: A comparative analysis

AbstractObjectiveCancer patients have a 4−7‐fold increased risk of thrombotic complications due to cancer as well as chemotherapy‐induced hypercoagulable state. This study compared the different risk assessment models (Khorana, PROTECHT, CONKO, and COMPASS‐CAT scores) that help predict venous thromboembolism (VTE) in ambulatory cancer patients. Early identification of high‐risk patients would benefit from thromboprophylaxis, thereby improving the mortality and morbidity due to thrombotic events.MethodsThis is a single‐center, prospective, cross‐sectional study on ambulatory patients with solid malignancy. The study was conducted over six months, from March 2022 to August 2022. Data on VTE predictors were gathered from 230 ambulatory cancer patients undergoing chemotherapy.ResultsAmong the 230 patients receiving chemotherapy, 20 were diagnosed with VTE, with the majority of this population being either diagnosed with gynecological cancer or lung cancer, constituting 25% of VTE‐diagnosed patients. The Khorana score, with a VTE accuracy of 83.04%, was found to be the highest, followed by the CONKO (80.00%), PROTECHT (69.57%), COMPASS‐CAT Ⅱ (54.35%), and COMPASS‐CAT Ⅰ (38.26%) scores. The cumulative incidence of VTE among high‐risk patients showed that the PROTECHT score had the highest cumulative incidence (CI = 14.28), and the CONKO score had the lowest (CI = 9.40).ConclusionThe Khorana score was the most accurate, followed by the CONKO, PROTECHT, and COMPASS‐CAT Ⅱ scores, while the COMPASS‐CAT Ⅰ score was the least accurate. Hence, the Khorana scoring is essential for diagnosing VTE in patients with ambulatory cancer treated with chemotherapy.

Incidence, Risk Factors, and Modified Risk Assessment Model of Venous Thromboembolism in Non-Hodgkin Lymphoma Patients.

Venous thromboembolic events (VTEs) are the second-leading cause of death in cancer patients, with an incidence of 5%-17% in lymphoma patients, particularly higher in those with non-Hodgkin lymphoma (NHL). Existing risk assessment models (RAMs) like the Khorana and ThroLy scores have limitations and are inadequately validated for NHL patients. Coagulation markers such as D-dimer, thrombin-antithrombin complex (TAT), and thrombomodulin (TM) show a potential predictive value for cancer-associated VTE but lack extensive research in NHL. This study aimed to analyze characteristics and predictive risk factors for VTE in newly diagnosed NHL patients and to evaluate and improve the clinical applicability of the Khorana and ThroLy scores. Data were collected from newly diagnosed NHL patients to analyze characteristics and potential predictive risk factors for VTE. The clinical applicability of the Khorana and ThroLy scores was evaluated, and the ThroLy score was improved by adjusting the hemoglobin cutoff and combining it with D-dimer testing. Sequential testing with TM and TAT levels was also performed. VTE developed in 7.09% of NHL patients. Independent risk factors for VTE included clinical Stage III/IV, mediastinal involvement, history of VTE, D-dimer≥ 1345 μg/dL, and platelet (PLT)≥ 298 × 109, and Hb≥ 110 g/L was an independent protective factor for VTE. The ThroLy score was improved by adjusting the hemoglobin cutoff and combining it with D-dimer testing. Sequential testing of TM and TAT achieved a sensitivity of 66.7%, specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 96.7%. VTE is a significant complication in NHL patients. The study highlighted independent risk factors and proposed a modified risk assessment model that effectively predicted VTE risk, potentially optimizing prevention and reducing healthcare costs.

Preventative and curative treatment of venous thromboembolic disease in cancer patients

Cancer-associated venous thromboembolism (CAT) is common in patients with cancer and associated with significant morbidity and mortality. The incidence of CAT continues to rise, complicating patient care and burdening healthcare systems. Patients with cancer experiencing VTE face poorer prognoses, making prevention and effective management imperative. This narrative review synthesizes evidence on thromboprophylaxis in ambulatory patients with cancer receiving systemic therapy and acute treatment strategies for CAT. Risk assessment models (e.g., Khorana score) aid in identifying high-risk patients who may benefit from thromboprophylaxis. Pharmacological thromboprophylaxis with low molecular weight heparins (LMWHs) direct oral anticoagulants (DOACs) has been shown to reduce the risk of CAT without significantly increasing the risk of bleeding complications. However, implementation of risk-based strategies remains limited in clinical practice. For acute CAT management, LMWHs have been the standard of care, but DOACs are increasingly favored due to their convenience and efficacy. However, challenges persist, including bleeding risks and drug interactions. Emerging therapies targeting Factor XI inhibitors present promising alternatives, potentially addressing current limitations in anticoagulation management for CAT.

Development and validation of a predictive risk tool for VTE in women with breast cancer under chemotherapy: a cohort study in China.

The incidence of venous thromboembolism (VTE) is significantly elevated in breast cancer patients, with a three-to-fourfold increase, and further escalates to sixfold in those undergoing chemotherapy. This study aims to identify the risk factors for VTE and develop a Nomogram risk prediction model distinct from the traditional Khorana score. Univariate Cox regression analysis assessed the impact of each variable on the occurrence of VTE, while stepwise multivariate Cox regression analysis identified independent predictors. Based on these results, we constructed a Nomogram model. The model's performance was validated using the C-index, receiver-operating characteristic curve (ROC), calibration curves, and decision curve analysis (DCA). Comparisons were made with the Khorana score to evaluate the practical application value. Out of the 903 patients, 108 (11.96%) developed VTE. Cox regression analysis identified that Stage, undergoing surgery, age, white blood cells (WBC), D-dimer, and carcinoembryonic antigen (CEA) were significant risk factors for VTE (P < 0.05). The Nomogram model's C-index was 0.77 (95% CI 0.72-0.83) in the training set and 0.76 (95% CI 0.69-0.84) in the validation set. The model demonstrated excellent predictive accuracy and generalizability on the receiver-operating characteristic (ROC) curves and calibration curves. Compared to the traditional Khorana score, the Nomogram model showed superior predictive accuracy and greater clinical benefit. This study established a VTE risk prediction model for breast cancer patients undergoing chemotherapy. The model is characterized by its intuitive and straightforward application, making it highly suitable for rapid VTE risk assessment in clinical practice.

Prevalence of Venous Thromboembolism in Cholangiocarcinoma Patients Receiving Chemotherapy and Validation of Khorana Score

Prevalence of Venous Thromboembolism in Cholangiocarcinoma Patients Receiving Chemotherapy and Validation of Khorana Score

Venous thromboembolism is associated with increased all-cause mortality in ALK-positive non-small cell lung cancer

BackgroundVenous thromboembolic events (VTE) are often diagnosed in ALK-positive lung cancer although it has not been demonstrated how their co-occurrence affects patients' survival.MethodsThe study included patients with ALK-positive lung cancer recognized in metastatic stage in the period 2017–2022. All received treatment with ALK inhibitors at The Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw. The main aim of the study was to assess overall survival (OS) in relation to VTE occurrence. The additional purpose was to define predictors of VTE and OS.ResultsThe study included 54 patients in median age 60 years, men were a minority (25 / 46.3%). VTE was diagnosed in 12 (22.2%) patients: 9 (16.7%) cases with pulmonary embolism (PE), 2 cases with thrombosis in vena cava superior, one case with deep vein thrombosis and thrombosis in vena cava inferior. Among patients with PE: 2 patients died directly due to the first PE episode and one due to a recurrent PE. Patients with VTE had significantly shorter overall survival (median 11.7 vs. 37.4 months, log-rank test p = 0.003). The risk of all-cause mortality was increased significantly in both: VTE (HR = 3.47; 95%CI: 1.61—7.49; p = 0.0016) or alone PE (HR = 2.41; 95%CI: 1.06—5.50; p = 0.037). The risk of VTE diagnosis was significantly increased during active treatment with crizotinib (HR = 8.72; p = 0.0004) or alectinib (HR = 21.47; p = 0.000002). Metastases to liver and baseline leukocyte count > 11 × 10⁹/L were significant predictors of VTE and OS. Khorana score ≥ 3 points predicted OS (HR = 2,66; 95%CI: 1,05—6,75; p = 0,04), but remained insignificant for VTE.ConclusionThe diagnosis of any type of VTE or alone PE was associated with significantly worse overall survival in patients with ALK-positive non-small cell lung cancer.

Evaluation of the Khorana score and association with venous thromboembolism incidence among patients with uterine cancer: Implications for patient care

Evaluation of the Khorana score and association with venous thromboembolism incidence among patients with uterine cancer: Implications for patient care

As easy as EMR? Utilization of the electronic medical record to encourage thromboprophylaxis for gynecologic oncology patients with a high Khorana score

As easy as EMR? Utilization of the electronic medical record to encourage thromboprophylaxis for gynecologic oncology patients with a high Khorana score

Validation of risk assessment scores in predicting venous thromboembolism in patients with lung cancer receiving immune checkpoint inhibitors

IntroductionSeveral risk scores have been proposed to predict venous thromboembolism (VTE) in hospitalized patients. However, their predictive performances in lung cancer patients receiving immune checkpoint inhibitors (ICIs) is unclear. We aimed to validate and compare their performances of the Caprini, Padua and Khorana risk scores in lung cancer patients receiving ICIs.MethodsThis was a retrospective cohort study of patients with lung cancer treated with ICIs at West China Hospital between January 2018 and March 2022. The primary outcome was VTE during 12 months of follow-up from the first day of treatment with ICIs. The predictive performances of risk scores was determined using receiver operating characteristic (ROC) curve analysis.ResultsAmong the 1115 eligible patients with lung cancer who received ICIs, 105 patients (9.4%) experienced VTE during the 12-month follow-up period. There was a statistically significant difference in the cumulative incidence of VTE between the different risk levels as determined by Caprini and Padua scores (all P < 0.001). However, no significant difference was observed for the Khorana score (P = 0.488). The Caprini and Padua scores demonstrated good discriminative performances (AUC 0.743, 95% CI 0.688-0.799 for Caprini score; AUC 0.745, 95% CI 0.687‐0.803 for Padua score), which were significantly better than that of the Khorana score (AUC 0.553, 95% CI, 0.493‐0.613) (P < 0.05).ConclusionIn our study, the Caprini and Padua risk scores had better discriminative ability than the Khorana score to identify lung cancer patients treated with ICIs who were at high risk of VTE.

Thromboembolism during immune checkpoint inhibitor therapy: frequency and risk factors

BackgroundThromboembolism (TE) is a well-known complication during chemotherapy in cancer patients. However, the risk of TE associated with immune checkpoint inhibitors (ICIs) is unknown. This study was performed to investigate the incidence of TE and associated risk factors in patients treated with ICIs.MethodsWe conducted a retrospective chart survey of patients receiving at least one ICI at Shinshu University Hospital between September 2014 and October 2021. Age, sex, cancer type, body mass index, medical history, laboratory data at commencement of treatment, and medication data were obtained from electronic medical records. TE events (venous thromboembolism [VTE], arterial thromboembolism [ATE]) were identified after ICI initiation.ResultsThe study population consisted of 548 patients with a median age of 70.0 (19–89) years, 71.4% men, and a median follow-up of 15.1 months (range; 0.16–72.0 months). Nivolumab was the most commonly used ICI (45.8%), followed by pembrolizumab (23.9%), pembrolizumab plus anticancer drugs (7.8%), and nivolumab plus ipilimumab (5.1%). Thirty-eight cases of TE (6.9%) occurred (22 VTE, 16 ATE). Risk factors significantly associated with TE in multivariate logistic analysis were dyslipidemia (OR 2.44; 95% CI 1.17–5.09; p = 0.017), Khorana score ≥ 2 (HR 2.40; 95% CI 1.14–5.04; p = 0.021). Overall survival was not significantly different from patients without TE (p = 0.963).ConclusionThese results suggested that the frequency of TE is higher than expected and should be considered and monitored in patients treated with ICIs.

Prevention and treatment of cancer-associated thrombosis during chemotherapy

In patients with malignant neoplasms, the incidence of symptomatic venous thromboembolism (VTE) is 4–7 times higher than in the general population. The presence of distant metastases of solid tumors increases the risk of VTE. Most often, VTE develops in pancreatic and stomach cancers. Chemotherapy increases the risk of VTE development. Low-molecular-weight heparin and direct oral anticoagulants are used for the treatment of VTE in patients receiving chemotherapy.Prior to the start of chemotherapy, it is necessary to assess the risk of VTE development using the Khorana risk score. Outpatient patients with high-risk cancer (Khorana score &gt;3 before the start of a new systemic chemotherapy regimen) may be prescribed thromboprophylaxis.

Validation of clinical risk assessment scores for venous thromboembolism in patients with cancer: a population-based cohort study

BackgroundGuidelines recommend using risk assessment tools to identify ambulatory patients with cancer at high risk of venous thromboembolism (VTE). ObjectivesWe aimed to validate a new cancer-associated thrombosis (CAT) risk score in a population-based healthcare setting. MethodsWe used healthcare registry data and electronic medical records from the Central Denmark Region to calculate the new CAT risk score and the guideline-recommended Khorana score in patients with a first-time cancer diagnosis who initiated systemic cancer therapy. Patients were followed for 6 months after initiation of therapy. The outcome was any VTE identified through hospital discharge diagnoses. Discrimination was assessed using C statistics. ResultsWe included 12 471 patients from 2012 to 2020. Of these, 416 (3.3%) developed VTE. The C statistic was 0.71 (95% CI, 0.68-0.74) for the new CAT score and 0.66 (95% CI, 0.63-0.70) for the Khorana score. The 6-month cumulative VTE incidence was 5.0% in 6175 patients classified as high risk by the new CAT score compared with 1.7% in 6296 patients classified as low risk. The 6-month cumulative VTE incidence was 5.2% in 4263 patients classified as high risk by the Khorana score compared with 2.4% in 8208 patients classified as low risk. ConclusionThe new CAT score had a discriminatory ability similar to that reported in the derivation study. The C statistic was numerically higher than that of the Khorana score. Our findings support the implementation of the new CAT score to identify ambulatory patients with cancer who are at high risk of VTE.

1857P Machine learning models (MLM) predict venous thromboembolism events (VTE) in Asian oncological inpatients better than the Khorana Score (KS)

1857P Machine learning models (MLM) predict venous thromboembolism events (VTE) in Asian oncological inpatients better than the Khorana Score (KS)

1858P Efficacy and safety of thromboprophylaxis in oncology patients with Khorana score

1858P Efficacy and safety of thromboprophylaxis in oncology patients with Khorana score<2: Combined results from GMaT and ACT4CAT studies