Alfonso J. Tafur, MD, NorthShore University HealthSystem, 9650 Gross Point Road, Suite 4900, Skokie, IL 60076, USA, Tel.: +1 847 663 8050, Fax: +1 224 251 4407, E-mail:
Thromb Haemost. 2017 Jun 2;117(6):1192-1198. doi: 10.1160/TH16-11-0840. Epub 2017 Mar 9.
Even though the Khorana risk score (KRS) has been validated to predict against the development of VTE among patients with cancer, it has a low positive predictive value. It is also unknown whether the score predicts outcomes in patients with cancer with established VTE. We selected a cohort of patients with active cancer from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry to assess the prognostic value of the KRS at inception in predicting the likelihood of VTE recurrences, major bleeding and mortality during the course of anticoagulant therapy. We analysed 7948 consecutive patients with cancer-associated VTE. Of these, 2253 (28 %) scored 0 points, 4550 (57 %) 1-2 points and 1145 (14 %) scored ≥3 points. During the course of anticoagulation, amongst patient with low, moderate and high risk KRS, the rate of VTE recurrences was of 6.21 (95 %CI: 4.99-7.63), 11.2 (95 %CI: 9.91-12.7) and 19.4 (95 %CI: 15.4-24.1) events per 100 patient-years; the rate of major bleeding of 5.24 (95 %CI: 4.13-6.56), 10.3 (95 %CI: 9.02-11.7) and 19.4 (95 %CI: 15.4-24.1) bleeds per 100 patient-years and the mortality rate of 25.3 (95 %CI: 22.8-28.0), 58.5 (95 %CI: 55.5-61.7) and 120 (95 %CI: 110-131) deaths per 100 patient-years, respectively. The C-statistic was 0.53 (0.50-0.56) for recurrent VTE, 0.56 (95 %CI: 0.54-0.59) for major bleeding and 0.54 (95 %CI: 0.52-0.56) for death. In conclusion, most VTEs occur in patients with low or moderate risk scores. The KRS did not accurately predict VTE recurrence, major bleeding, or mortality among patients with cancer-associated thrombosis.
尽管 Khorana 风险评分（KRS）已被验证可预测癌症患者发生静脉血栓栓塞（VTE）的风险，但它的阳性预测值较低。目前尚不清楚该评分是否能预测已确诊 VTE 的癌症患者的结局。我们从 RIETE（血栓栓塞登记研究）登记处选择了一组活动性癌症患者，以评估 KRS 在起始时的预测价值，预测抗凝治疗过程中 VTE 复发、大出血和死亡率的可能性。我们分析了 7948 例伴有癌症相关 VTE 的连续患者。其中，2253 例（28%）得分为 0 分，4550 例（57%）得分为 1-2 分，1145 例（14%）得分为≥3 分。在抗凝过程中，低、中、高危 KRS 的患者中 VTE 复发率分别为 6.21（95%CI：4.99-7.63）、11.2（95%CI：9.91-12.7）和 19.4（95%CI：15.4-24.1）/100 患者年；大出血发生率分别为 5.24（95%CI：4.13-6.56）、10.3（95%CI：9.02-11.7）和 19.4（95%CI：15.4-24.1）/100 患者年；死亡率分别为 25.3（95%CI：22.8-28.0）、58.5（95%CI：55.5-61.7）和 120（95%CI：110-131）/100 患者年。复发性 VTE 的 C 统计量为 0.53（0.50-0.56），大出血为 0.56（95%CI：0.54-0.59），死亡为 0.54（95%CI：0.52-0.56）。总之，大多数 VTE 发生在低危或中危评分的患者中。KRS 不能准确预测癌症相关血栓形成患者的 VTE 复发、大出血或死亡率。
