Key result
The Khorana score high-risk classification was associated with a higher incidence of venous thromboembolism compared to low- and intermediate-risk groups (10.3% vs 7.8%, OR 1.3) in cancer patients.
Why the study?
Venous thromboembolism is a leading cause of cancer-related death, and this study aimed to investigate the usefulness of the Khorana score prediction model using literature data.
Does high-risk classification by the Khorana score predict increased incidence of venous thromboembolism in cancer patients compared to low/intermediate-risk classification?
Meta-Analysis (n=8,047)
Does high-risk classification by the Khorana score predict increased incidence of venous thromboembolism in cancer patients compared to low/intermediate-risk classification?
Effect estimate: OR 1.3 (95% CI 1.0-1.6)
Absolute Event Rate: 10.3% vs 7.8%
While the Khorana score may help predict VTE in cancer patients, the majority of VTE events occur in low- and intermediate-risk groups, necessitating comprehensive clinical evaluation beyond the score alone.
Most VTE events occur in low- and intermediate-risk groups; leaves open whether Khorana score alone guides prophylaxis decisions.
Venous thromboembolism (VTE) is the second most common cause of cancer-related deaths globally. The Khorana score, a VTE prediction model, is calculated using the site of cancer, white blood cell count, hemoglobin level, platelet count, and body mass index. This study aimed to investigate the usefulness of the Khorana score, using data available in the literature. On July 28, 2020, we collected papers using the following keywords: “cancer”, “venous thromboembolism”, “deep vein thrombosis”, “pulmonary embolism”, and “Khorana score” on PubMed. Papers published after 2016 were eligible. The selection criteria were as follows: “English or Japanese”, “original paper”, “abstract and full text”, and “comply with the clinical question”. There were 131 papers that matched the keywords, and 15 of them complied with the selection criteria. In 15 papers, Khorana score was calculated in 8047 patients. In the low- and intermediate-risk groups, 532 of 6812 patients developed VTE [7.8%, 95%confidence intervals (CI) 7.2-8.5], whereas in the high-risk group, 127 of 1235 patients developed VTE (10.3%, 95% CI 8.7-12.1) [odds ratio (OR) 1.3, 95% CI 1.0-1.6] (I2=0%, τ2=0, p=0.50). Venous thromboembolism prediction using the Khorana score might be useful. However, most of the number of VTE patients are in the low- and intermediate-risk groups. Therefore, a comprehensive evaluation according to clinical conditions is required, regardless of the risk classification using the Khorana score.
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Nishimura et al. (2021) conducted a meta-analysis in Venous thromboembolism in cancer (n=8,047). Khorana score high-risk classification vs. Khorana score low- and intermediate-risk classification was evaluated on Incidence of venous thromboembolism (OR 1.3, 95% CI 1.0-1.6). The Khorana score high-risk classification was associated with a higher incidence of venous thromboembolism compared to low- and intermediate-risk groups (10.3% vs 7.8%, OR 1.3) in cancer patients.
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