Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA.
Departments of Medicine and Pathology & Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA.
J Thromb Haemost. 2019 Dec;17(12):2152-2159. doi: 10.1111/jth.14614. Epub 2019 Sep 22.
The Khorana Score is a validated risk score for predicting 6-month incidence of cancer-associated venous thromboembolism (CAT) among patients starting chemotherapy. Venous thromboembolism (VTE) risk factors important in the general population, including age, sex, prior VTE, and hospitalization, are not included in this score, their association with VTE in cancer patients is unknown.
To examine risk factors for CAT and the impact of incorporating longitudinal hospitalization into risk assessment.
Risk factors were recorded among patients starting chemotherapy at a single institution from 2012-14. Hospitalization and time-periods after hospitalization were assessed as time-varying covariates. Logistic regression was used to determine factors related to 6-month CAT risk (the Khorana Score endpoint). Proportional hazard models were used for risk factor identification throughout the 3-year observation period.
Among 1,583 patients starting chemotherapy (mean age 60, 48% male), 187 developed CAT (11.8%) with 129 (69%) cases occurring within 6 months of starting chemotherapy. In the 6-month analysis, no additional risk factors were associated with CAT. In the 3-year analysis, male sex (HR 1.57, 95%CI 1.21, 2.07), prior VTE (HR 2.12, 95%CI 1.41, 3.18), and hospitalization (HR 2.69, 95%CI 1.92, 3.75) were associated with increased hazard of CAT, adjusting for risk factors in the Khorana score.
When time-to-event data were incorporated into CAT risk assessment, male sex, prior VTE, and hospitalization were important risk factors. These data highlight the need to consider dynamic methods for assessing VTE risk in cancer patients, with particular attention to the period around hospitalizations.
Khorana 评分是一种经过验证的风险评分，用于预测开始化疗的患者 6 个月内癌症相关静脉血栓栓塞（CAT）的发生率。该评分未包含在普通人群中重要的静脉血栓栓塞（VTE）危险因素，包括年龄、性别、既往 VTE 和住院治疗，其与癌症患者 VTE 的相关性尚不清楚。
研究 CAT 的危险因素，并探讨将纵向住院情况纳入风险评估的影响。
记录了 2012-14 年期间在一家机构开始化疗的患者的危险因素。将住院治疗和住院后时间段评估为时间变化的协变量。采用逻辑回归确定与 6 个月 CAT 风险（Khorana 评分终点）相关的因素。采用比例风险模型在 3 年观察期内确定危险因素。
在 1583 例开始化疗的患者中（平均年龄 60 岁，48%为男性），有 187 例发生 CAT（11.8%），其中 129 例（69%）发生在开始化疗后的 6 个月内。在 6 个月的分析中，没有其他危险因素与 CAT 相关。在 3 年的分析中，男性（HR 1.57，95%CI 1.21-2.07）、既往 VTE（HR 2.12，95%CI 1.41-3.18）和住院治疗（HR 2.69，95%CI 1.92-3.75）与 CAT 风险增加相关，校正了 Khorana 评分中的危险因素。
当将时间事件数据纳入 CAT 风险评估中时，男性、既往 VTE 和住院治疗是重要的危险因素。这些数据强调需要考虑动态方法来评估癌症患者的 VTE 风险，特别是要关注住院期间。
