Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany.
Institute of Laboratory Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany.
Thromb Res. 2017 Sep;157:9-15. doi: 10.1016/j.thromres.2017.06.021. Epub 2017 Jun 20.
Venous thromboembolism (VTE) is frequent in advanced pancreatic cancer (APC). Recent studies demonstrated that the Khorana score - an established risk stratification tool for VTE in cancer - performs poorly in identifying pancreatic cancer patients at high risk for VTE.
We performed a retrospective cohort study in order to define incidence, treatment and outcome of VTE as well as the performance of VTE risk stratification tools (Khorana score, CONKO score and aPTT ratio) in a "real life" clinical cohort of APC patients undergoing palliative chemotherapy.
One hundred and seventy-two eligible APC patients from our comprehensive cancer center were identified. VTE after start of palliative chemotherapy was diagnosed in 71 patients (41.3%). Most VTE events were asymptomatic (n=50, 29.1%) with only 21 symptomatic events (12.2%). On multivariate analysis - including age, performance status and carbohydrate antigen 19-9 (CA 19-9) - symptomatic VTE was an independent risk factor for death (hazard ratio [HR]: 2.22, 95% CI: 1.05-2.60, p<0.05). Khorana score, CONKO score and aPTT ratio alone were not able to predict the risk for symptomatic VTE. High risk patients could only be identified by using a combination of either Khorana or CONKO score with aPTT ratio (30% vs. 10% symptomatic VTE events in high vs. low risk patients, p<0.05). The combination of Khorana or CONKO score with aPTT thus may represent a novel risk stratification tool for symptomatic VTE in APC and should further be validated within prospective clinical trials.
静脉血栓栓塞症（VTE）在晚期胰腺癌（APC）中很常见。最近的研究表明，Khorana 评分——一种用于癌症 VTE 风险分层的既定工具——在识别有 VTE 高风险的胰腺癌患者方面表现不佳。
我们进行了一项回顾性队列研究，以确定 VTE 的发生率、治疗和结局，以及 VTE 风险分层工具（Khorana 评分、CONKO 评分和 aPTT 比值）在接受姑息化疗的 APC 患者“真实生活”临床队列中的表现。
我们从综合性癌症中心确定了 172 名符合条件的 APC 患者。在开始姑息化疗后，71 名患者（41.3%）被诊断出 VTE。大多数 VTE 事件是无症状的（n=50，29.1%），只有 21 个有症状的事件（12.2%）。在多变量分析中——包括年龄、表现状态和肿瘤标志物 CA 19-9（CA 19-9）——有症状的 VTE 是死亡的独立危险因素（危险比 [HR]：2.22，95%CI：1.05-2.60，p<0.05）。单独的 Khorana 评分、CONKO 评分和 aPTT 比值均不能预测有症状 VTE 的风险。只有通过将 Khorana 评分或 CONKO 评分与 aPTT 比值相结合，才能识别高危患者（高危患者中 30%有症状 VTE 事件，而低危患者中 10%有症状 VTE 事件，p<0.05）。因此，Khorana 评分或 CONKO 评分与 aPTT 的组合可能代表 APC 中用于有症状 VTE 的一种新的风险分层工具，应在前瞻性临床试验中进一步验证。
