Akasaka-Kihara Fumie, Sueta Daisuke, Ishii Masanobu, Maki Yuji, Hirakawa Kyoko, Tabata Noriaki, Ito Miwa, Yamanaga Kenshi, Fujisue Koichiro, Hoshiyama Tadashi, Hanatani Shinsuke, Kanazawa Hisanori, Takashio Seiji, Arima Yuichiro, Araki Satoshi, Usuku Hiroki, Nakamura Taishi, Suzuki Satoru, Yamamoto Eiichiro, Soejima Hirofumi, Kaikita Koichi, Matsushita Kenichi, Matsuoka Masao, Usuku Koichiro, Tsujita Kenichi
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan.
Department of Cardiology, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan.
JACC Asia. 2021 Sep 21;1(2):259-270. doi: 10.1016/j.jacasi.2021.07.006. eCollection 2021 Sep.
Although the Khorana venous thromboembolism (VTE) risk score (KRS) is well recognized as a simple VTE risk assessment method in patients with cancer, whether it is suitable for Asian populations is unclear.
This study validated KRS for the prediction of VTE and investigated the value of the KRS in predicting mortality in Japanese patients with cancer.
A body mass index value of 25 kg/m or more was defined as obesity according to World Health Organization consensus. A total of 27,687 patients with cancer were subdivided into low- (0), intermediate- (1-2), and high-score (3) groups by the KRS. The primary and secondary endpoints were VTE and all-cause mortality, respectively.
The prevalence of VTE was 1.7%, 7.3%, and 11.0% for low-, intermediate-, and high-score patients, respectively. Receiver operating characteristic (ROC) analysis showed that the KRS significantly predicted VTE (area under the curve, 0.679; 95% confidence interval [CI] 0.666-0.692; < 0.001). The cutoff value for the KRS was 1.0. Logistic regression analysis demonstrated that the KRS was an independent predictor of VTE (odds ratio 1.766; 95% CI 1.673-1.865; < 0.01). The cutoff value of the KRS for all-cause mortality determined by ROC analysis was 2.0. Kaplan-Meier analysis demonstrated a significantly higher incidence of mortality in the KRS ≥2 group than in the KRS 0-1 group (log-rank: < 0.01).
The KRS was useful in Japanese patients with cancer and might be a potentially useful marker for the prediction of mortality. Establishing optimal scores for Japanese subjects is mandatory because of its low diagnostic ability. (KUMAMON Cancer registry; UMIN000047554).
尽管科拉纳静脉血栓栓塞（VTE）风险评分（KRS）被公认为是一种用于癌症患者的简单VTE风险评估方法，但它是否适用于亚洲人群尚不清楚。
本研究验证KRS对VTE的预测作用，并探讨KRS在预测日本癌症患者死亡率方面的价值。
根据世界卫生组织的共识，体重指数值25kg/m²及以上定义为肥胖。总共27687例癌症患者按KRS分为低（0）、中（1-2）、高（3）分三组。主要和次要终点分别为VTE和全因死亡率。
低、中、高分患者的VTE患病率分别为1.7%、7.3%和11.0%。受试者工作特征（ROC）分析显示，KRS能显著预测VTE（曲线下面积为0.679；95%置信区间[CI]为0.666-0.692；P<0.001）。KRS的截断值为1.0。逻辑回归分析表明，KRS是VTE的独立预测因子（比值比为1.766；95%CI为1.673-1.865；P<0.01）。通过ROC分析确定的KRS全因死亡率截断值为2.0。Kaplan-Meier分析显示，KRS≥2组的死亡率显著高于KRS 0-1组（对数秩检验：P<0.01）。
KRS对日本癌症患者有用，可能是预测死亡率的潜在有用标志物。由于其诊断能力较低，为日本受试者建立最佳评分是必要的。（熊本癌症登记处；UMIN000047554）
