Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
Department of Internal Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
J Endourol. 2021 Jun;35(6):821-827. doi: 10.1089/end.2020.0800. Epub 2020 Dec 30.
The Khorana score (KS) is used to predict the risk of venous thromboembolism (VTE) for cancer patients. We sought to assess the association between KS and VTE for patients who underwent robot-assisted radical cystectomy (RARC). We reviewed our prospectively maintained quality assurance RARC database between 2005 and 2020. KS was calculated for all patients (one point for each body mass index [BMI] ≥35 kg/m, platelet count ≥350 × 10/L, leukocyte count >11 × 10/L, and hemoglobin level <10 g/dL, or use of erythropoiesis-stimulating agents). All patients received one point by default for the cancer type (bladder). Patients were divided into intermediate-risk (KS 1-2) or high-risk (KS ≥3) groups. Receiver operating characteristic curve was used to assess the ability of KS to predict VTE. Kaplan-Meier curves were stratified based on their KS risk and used to depict overall survival (OS). Multivariate analysis (MVA) was used to identify variables associated with VTE. Out of 589 patients, 33 (6%) developed VTE (18 had deep vein thrombosis and 15 had pulmonary embolism). Five hundred forty-six (93%) patients had intermediate-risk KS and 30 (5%) of them developed VTE. Forty-three (7%) patients were classified as high-risk KS and 3 (7%) developed VTE. This difference was not significant ( = 0.73). The KS area under the curve for VTE prediction was 0.51. On MVA, BMI ≥35 kg/m (odds ratio [OR] 2.69, confidence interval [CI] 1.19-6.11, = 0.02), longer inpatient stay (OR 1.04, CI 1.003-1.07, = 0.03), and ≥pT disease (OR 2.29, CI 1.11-4.71, = 0.03) were associated with VTE, whereas KS was not associated with VTE ( = 0.68). Five-year OS of patients with intermediate KS was 53% compared with 30% for high-risk KS (log rank < 0.01). KS underestimated VTE risk after RARC and showed poor accuracy. This highlights the need to develop procedure-specific tools to estimate the risk of VTE after RARC.
Khorana 评分（KS）用于预测癌症患者发生静脉血栓栓塞（VTE）的风险。我们旨在评估 KS 与接受机器人辅助根治性膀胱切除术（RARC）的患者发生 VTE 的相关性。我们回顾了 2005 年至 2020 年期间前瞻性维护的质量保证 RARC 数据库。为所有患者计算 KS（每满足一项体质量指数[BMI]≥35kg/m2、血小板计数≥350×10/L、白细胞计数>11×10/L 和血红蛋白水平<10g/dL，或使用促红细胞生成素）计 1 分，默认每位癌症患者（膀胱癌）计 1 分。所有患者分为中危（KS 1-2）或高危（KS≥3）组。使用受试者工作特征曲线评估 KS 预测 VTE 的能力。根据 KS 风险分层绘制 Kaplan-Meier 曲线，以描绘总生存（OS）。多变量分析（MVA）用于确定与 VTE 相关的变量。在 589 例患者中，33 例（6%）发生 VTE（18 例深静脉血栓形成，15 例肺栓塞）。546 例（93%）患者的 KS 为中危，其中 30 例（5%）发生 VTE。43 例（7%）患者的 KS 为高危，其中 3 例（7%）发生 VTE。差异无统计学意义（ = 0.73）。KS 预测 VTE 的曲线下面积为 0.51。在 MVA 中，BMI≥35kg/m2（比值比[OR]2.69，置信区间[CI]1.19-6.11， = 0.02）、较长的住院时间（OR 1.04，CI 1.003-1.07， = 0.03）和≥pT 疾病（OR 2.29，CI 1.11-4.71， = 0.03）与 VTE 相关，而 KS 与 VTE 无关（ = 0.68）。中危 KS 患者的 5 年 OS 为 53%，高危 KS 患者为 30%（对数秩检验<0.01）。KS 低估了 RARC 后 VTE 的风险，且准确性较差。这突显了需要开发特定于手术的工具来估计 RARC 后 VTE 的风险。
