Department of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
Department of Internal Medicine, Tergooi Hospital, Hilversum, the Netherlands.
J Thromb Haemost. 2021 Dec;19(12):2974-2983. doi: 10.1111/jth.15503. Epub 2021 Sep 6.
The Khorana score is a validated tool to identify cancer patients at higher risk of venous thromboembolism (VTE).
We compared its predictive performance to that of the clinical PROTECHT and the polygenic 5-SNP scores in patients who participated in the Dutch CPCT-02 study.
PATIENTS/METHODS: Data on VTE and its risk factors were retrospectively collected for 2729 patients with advanced stage solid tumors planned for systemic cancer treatment. Patients were followed for 6 months. Overall discriminatory performance of the scores was evaluated by time-dependent c-indices. The scores were additionally evaluated dichotomously in competing risk models.
A total of 160 (5.9%) patients developed VTE during follow-up. Time-dependent c-indices at 6 months for the Khorana, PROTECHT, and 5-SNP scores were 0.57 (95% confidence interval [CI]: 0.55-0.60), 0.60 (95% CI: 0.57-0.62), and 0.54 (95% CI: 0.51-0.57), respectively. The dichotomous scores classified 9.6%, 16.8%, and 9.5% as high-risk, respectively. VTE risk was about 2-fold higher among high-risk patients than low-risk patients for the Khorana (subdistribution hazard ratio [SHR] 1.9, 95% CI: 1.3-3.0), PROTECHT (SHR 2.1, 95% CI: 1.5-3.0), and 5-SNP scores (SHR 1.7, 95% CI: 1.03-2.8). The sensitivity at 6 months was 16.6% (95% CI: 10.5-22.7), 28.9% (95% CI: 21.5-36.3), and 14.9% (95% CI: 8.5-21.2), respectively.
Performance of the PROTECHT or 5-SNP score was not superior to that of the Khorana score. The majority of cancer patients who developed VTE during 6-month follow-up were not identified by these scores. Future directions for studies on cancer-associated VTE prediction may include combined clinical-genetic scores.
Khorana 评分是一种经过验证的工具，可用于识别静脉血栓栓塞（VTE）风险较高的癌症患者。
我们比较了该评分在参与荷兰 CPCT-02 研究的患者中的预测性能与临床 PROTECHT 和多基因 5-SNP 评分。
患者/方法：回顾性收集了 2729 例计划接受全身癌症治疗的晚期实体瘤患者的 VTE 及其危险因素数据。对患者进行了 6 个月的随访。通过时间依赖性 c 指数评估评分的整体区分性能。在竞争风险模型中，评分还进行了二分类评估。
在随访期间，共有 160 例（5.9%）患者发生 VTE。6 个月时 Khorana、PROTECHT 和 5-SNP 评分的时间依赖性 c 指数分别为 0.57（95%置信区间[CI]：0.55-0.60）、0.60（95% CI：0.57-0.62）和 0.54（95% CI：0.51-0.57）。二分类评分分别将 9.6%、16.8%和 9.5%归类为高危。Khorana（亚分布危险比[SHR] 1.9，95% CI：1.3-3.0）、PROTECHT（SHR 2.1，95% CI：1.5-3.0）和 5-SNP 评分（SHR 1.7，95% CI：1.03-2.8）中高危患者的 VTE 风险约为低危患者的两倍。6 个月时的敏感性分别为 16.6%（95% CI：10.5-22.7）、28.9%（95% CI：21.5-36.3）和 14.9%（95% CI：8.5-21.2）。
PROTECHT 或 5-SNP 评分的性能并不优于 Khorana 评分。在 6 个月的随访期间发生 VTE 的大多数癌症患者并未被这些评分识别。癌症相关 VTE 预测研究的未来方向可能包括联合临床-遗传评分。
