The Khorana score for the prediction of venous thromboembolism in patients with pancreatic cancer

Es, Nick van; Franke, Viola; Middeldorp, Saskia; Wilmink, Johanna W.; Büller, Harry R.

doi:10.1016/j.thromres.2016.12.013

Cited by 74 publications

(77 citation statements)

References 9 publications

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“…[8][9][10][11][12] Recently research shows that the KRS failed to discriminate between high-and low-risk patients with cancer for VTE development, including patients with lymphoma. [13][14][15][16]36,37 This is further supported by our study in which the KRS did not adequately predict VTE events in patients at a higher risk of VTE in a cohort of patients with lymphoid malignancies. 37 Therefore, Antic et al developed the prognostic Thrombosis Lymphoma (ThroLy) score which is more specific for lymphoma patients than any other available scores targeting thrombosis in cancer patients.…”

Section: Discussionmentioning

confidence: 52%

“…Due to poor discriminatory performance, most of the recently established VTE-assessment models have proven to be of limited clinical utility because of the low predictive value of VTE events in subsequent studies, particularly in studies based on a single cancer cohort. [13][14][15][16] It is believed that the risk to patients with lymphoma, undergoing ambulatory chemotherapy, of developing VTE is similar to that of patients with solid tumours with the incidence reaching 14.6%. 17,18 Lymphoma is considered to constitute a high risk of VTE development in the best-validated model to stratify outpatients with cancer, which was developed by Khorana and is known as the Khorana risk score (KRS).…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the ThroLy score for the prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies in clinical practice

Rupa‐Matysek

Brzeźniakiewicz‐Janus

Gil

et al. 2018

Cancer Medicine

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The utility in clinical practice of a recently developed and validated predictive model for venous thromboembolism (VTE) events in lymphoma patients, known as the thrombosis lymphoma (ThroLy) score, is unknown. We evaluated the association of ThroLy with VTE in patients treated for diffuse large B‐cell lymphoma (DLBCL) or Hodgkin lymphoma (HL) undergoing ambulatory first‐line chemotherapy. Retrospective analyses were performed on 428 patients (median age 50), 241 were newly diagnosed DLBCL, and 187 had HL. During initial chemotherapy, 64 (15%) patients developed VTE. According to the ThroLy, 322 (75.2%) patients were considered low risk, 88 (20.6%) patients had intermediate risk and 18 (4.2%) patients high risk for VTE development. Patients with DLBCL were more often in the high‐risk ThroLy group and had more VTE events than HL. VTE occurred in; 38.9% (n = 7) high‐risk patients, 29.5% (n = 26) intermediate risk, and 9.6% (n = 31) low risk according to the ThroLy score. However, in multivariate analysis, high ThroLy (OR 5.13; 95% CI: 1.83‐14.36, P = .002), intermediate ThroLy (OR 3.96; 95% CI: 2.19‐7.17, P < .001), and aggressive lymphoma‐DLBCL (OR 1.91; 95% CI: 1.05‐3.47, P = .034) were all significantly associated with development of VTE, 48% of the VTE events occurred in the low‐risk ThroLy score group (the ROC AUC (95% CI) 0.40‐0.70 and C statistic‐0.55). In our study, the ThroLy score was not a suitably accurate model for predicting VTE events in patients at higher risk of VTE. Further research should be conducted to identify new biomarkers that will predict these events and to establish a new VTE risk assessment model.

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Evaluation of the ThroLy score for the prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies in clinical practice

Rupa‐Matysek

Brzeźniakiewicz‐Janus

Gil

et al. 2018

Cancer Medicine

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“…The Khorana score is commonly used in predicting the risk of VTE in chemotherapy treatment [10]. As for all clinical assessment scores there are limitations [12,[16][17][18][19][20] and current tools for predicting and monitoring the risk of VTE are inadequate, especially in pancreatic cancer [21]. The discovery of novel and precise biomarkers to identify cancer patients with a high risk of VTE could either, replace or strengthen a clinical risk score.…”

Section: Introductionmentioning

confidence: 99%

MicroRNAs and Neutrophil Activation Markers Predict Venous Thrombosis in Pancreatic Ductal Adenocarcinoma and Distal Extrahepatic Cholangiocarcinoma

Oto

Navarro

Larsen

et al. 2020

IJMS

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Cancer-associated venous thrombosis (VTE) increases mortality and morbidity. However, limited tools are available to identify high risk patients. Upon activation, neutrophils release their content through different mechanisms, thereby prompting thrombosis. We explored plasma microRNAs (miRNAs) and neutrophil activation markers to predict VTE in pancreatic ductal adenocarcinoma (PDAC) and distal extrahepatic cholangiocarcinoma (DECC). Twenty-six PDAC and 6 DECC patients recruited at cancer diagnosis, were examined for deep vein thrombosis and pulmonary embolisms, and were then followed-up with clinical examinations, blood collections, and biCUS. Ten patients developed VTE and were compared with 22 age- and sex-matched controls. miRNA expression levels were measured at diagnosis and right before VTE, and neutrophil activation markers (cell-free DNA, nucleosomes, calprotectin, and myeloperoxidase) were measured in every sample obtained during follow-up. We obtained a profile of 7 miRNAs able to estimate the risk of future VTE at diagnosis (AUC = 0.95; 95% Confidence Interval (CI) (0.987, 1)) with targets involved in the pancreatic cancer and complement and coagulation cascades pathways. Seven miRNAs were up- or down-regulated before VTE compared with diagnosis. We obtained a predictive model of VTE with calprotectin as predictor (AUC = 0.77; 95% CI (0.57, 0.95)). This is the first study that addresses the ability of plasma miRNAs and neutrophil activation markers to predict VTE in PDAC and DECC.

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“…The KS discriminates three groups of patients according to risk of VTE: a low-risk group (score of 0), an intermediate-risk group (score of 1-2) and a high-risk group (score ≥3). Several small retrospective studies in PC patients undergoing chemotherapy found no difference in the rates of VTE between intermediate and high-risk patients, as estimated by the Khorana score (Table 3) [33,[36][37][38]86]. In the BACAP-VTE study, the KS did not discriminate between patients with intermediate vs. high VTE risk scores [41].…”

Section: Risk Assessment Models (Ram) For Prediction Of Vte In Patienmentioning

confidence: 96%

Primary Thromboprophylaxis in Pancreatic Cancer Patients: Why Clinical Practice Guidelines Should Be Implemented

Farge

Bournet

Conroy

et al. 2020

Cancers

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Exocrine pancreatic ductal adenocarcinoma, simply referred to as pancreatic cancer (PC) has the worst prognosis of any malignancy. Despite recent advances in the use of adjuvant chemotherapy in PC, the prognosis remains poor, with fewer than 8% of patients being alive at 5 years after diagnosis. The prevalence of PC has steadily increased over the past decades, and it is projected to become the second-leading cause of cancer-related death by 2030. In this context, optimizing and integrating supportive care is important to improve quality of life and survival. Venous thromboembolism (VTE) is a common but preventable complication in PC patients. VTE occurs in one out of five PC patients and is associated with significantly reduced progression-free survival and overall survival. The appropriate use of primary thromboprophylaxis can drastically and safely reduce the rates of VTE in PC patients as shown from subgroup analysis of non-PC targeted placebo-controlled randomized trials of cancer patients and from two dedicated controlled randomized trials in locally advanced PC patients receiving chemotherapy. Therefore, primary thromboprophylaxis with a Grade 1B evidence level is recommended in locally advanced PC patients receiving chemotherapy by the International Initiative on Cancer and Thrombosis clinical practice guidelines since 2013. However, its use and potential significant clinical benefit continues to be underrecognized worldwide. This narrative review aims to summarize the main recent advances in the field including on the use of individualized risk assessment models to stratify the risk of VTE in each patient with individual available treatment options.

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The Khorana score for the prediction of venous thromboembolism in patients with pancreatic cancer

Cited by 74 publications

References 9 publications

Evaluation of the ThroLy score for the prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies in clinical practice

Evaluation of the ThroLy score for the prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies in clinical practice

MicroRNAs and Neutrophil Activation Markers Predict Venous Thrombosis in Pancreatic Ductal Adenocarcinoma and Distal Extrahepatic Cholangiocarcinoma

Primary Thromboprophylaxis in Pancreatic Cancer Patients: Why Clinical Practice Guidelines Should Be Implemented

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