Use of the Khorana score to predict venous thromboembolism in patients undergoing chemotherapy for uterine cancer

• Published in: Gynecologic oncology reports Vol. 46; p. 101156
• Main Authors: Piver, Rachael N., Wagner, Vincent M., Levine, Monica D., Backes, Floor J., Chambers, Laura J., Cohn, David E., Copeland, Larry J., Cosgrove, Casey M., Nagel, Christa I., O'Malley, David M., Bixel, Kristin L.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.04.2023; Elsevier
• Subjects: Chemotherapy; Endometrial cancer; Khorana score; Research Report; Thromboprophylaxis; Uterine cancer; Venous thromboembolism; Khorana score; Chemotherapy; Thromboprophylaxis; Endometrial cancer; Uterine cancer; Venous thromboembolism
• ISSN: 2352-5789; 2352-5789
• DOI: 10.1016/j.gore.2023.101156

•The Khorana score VTE risk assessment model has not been validated in patients with uterine cancer.•Patients with uterine cancer undergoing chemotherapy had a VTE rate of 6.5%.•Uterine cancer patients that had a VTE during treatment had a non-statistically significant higher average Khorana score.•A high Khorana score is a poor predictor of VTE in patients with uterine cancer undergoing chemotherapy. Gynecologic cancers are associated with a high risk of venous thromboembolism (VTE). The Khorana score is a validated tool to assess risk of VTE in cancer patients. The purpose of this study is to determine if the Khorana score can be used as a risk stratification tool for VTE in patients with uterine cancer undergoing chemotherapy. A retrospective cohort study of patients with newly diagnosed uterine cancer receiving chemotherapy over a 4-year period was conducted. The patients were stratified based on their Khorana score as well as their chemotherapy sequence, neoadjuvant or definitive versus adjuvant. A total of 276 patients were included: 40 received neoadjuvant or definitive, 236 adjuvant chemotherapy. Most patients had advanced stage disease (64.5%). 18 (6.5%) patients developed VTE within 180 days of initiating chemotherapy. High Khorana score was associated with a non-significant increase in VTE (K ≥ 2 OR 1.17, CI 0.40–3.39, K ≥ 3 OR 1.69, CI 0.61–4.69) but had poor predictive accuracy based on area under the curve (K ≥ 2 0.51, K ≥ 3 0.55). The VTE rate was higher in the neoadjuvant/definitive chemotherapy group to adjuvant (12.5% vs 5.5%, p = 0.11). While the former group had a higher average Khorana score (2.35 vs 1.93, p = 0.0048), this was not predictive of VTE. While validated in other cancer types, the Khorana score was found to be a poor predictor of VTE in patients with uterine cancer. The use of the Khorana score to guide routine thromboprophylaxis in these patients should be used with caution and further investigation is warranted.