Evaluation of the Khorana, PROTECHT, and 5-SNP scores for prediction of venous thromboembolism in patients with cancer.

Autor: Guman NAM; 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., van Geffen RJ; Department of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands., Mulder FI; 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., van Haaps TF; Department of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands., Hovsepjan V; Department of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands., Labots M; Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., Cirkel GA; Department of Internal Medicine, Meander Medical Center, Amersfoort, the Netherlands., Y F L de Vos F; Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands., Ten Tije AJ; Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands., Beerepoot LV; Department of Internal Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands., Tjan-Heijnen VCG; Department of Medical Oncology, Maastricht University Medical Center, Maastricht, the Netherlands., van Laarhoven HWM; Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.; Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands., Hamberg P; Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam-Schiedam, the Netherlands., Vulink AJE; Department of Medical Oncology, Reinier de Graaf Hospital, Delft, the Netherlands., Los M; Department of Internal Medicine, St Antonius Hospital, Nieuwegein, the Netherlands., Zwinderman AH; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Center, Amsterdam, the Netherlands., Ferwerda B; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Center, Amsterdam, the Netherlands., Lolkema MPJK; Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands., Steeghs N; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands., Büller HR; Department of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands., Kamphuisen PW; 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., van Es N; Department of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
Jazyk: angličtina
Zdroj: Journal of thrombosis and haemostasis : JTH [J Thromb Haemost] 2021 Dec; Vol. 19 (12), pp. 2974-2983. Date of Electronic Publication: 2021 Sep 06.
DOI: 10.1111/jth.15503
Abstrakt: Background: The Khorana score is a validated tool to identify cancer patients at higher risk of venous thromboembolism (VTE).
Objective: 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.
Results: 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.
Conclusions: 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.
(© 2021 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis.)
Databáze: MEDLINE
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