Khorana risk score: Is the body mass index a predictable factor for thromboembolism in European countries- A retrospective analysis.

Patient and Survivor Care
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This abstract will not be presented at the 2012 ASCO Annual Meeting but has been published in conjunction with the meeting.
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J Clin Oncol 30, 2012 (suppl; abstr e19612)


Sandro Barni, Roberto Labianca, Melina Verso, Giampietro Gasparini, Erminio Bonizzoni, Mario Mandala, Matteo Brighenti, Fausto Petrelli, Carlo Bianchini, Tania Perrone, Giancarlo Agnelli; Treviglio and Caravaggio Hospital, Division of Medical Oncology, Treviglio, Italy; Oncology Department, Ospedali Riuniti di Bergamo, Bergamo, Italy; University of Perugia, Perugia, Italy; San Filippo Neri Hospital, Rome, Italy; Institute of Medical Statistics and Biometry, University of Milan, Milan, Italy; Hospital of Bergamo, Bergamo, Italy; Cremona Hospital, Cremona, Italy; Division of Oncology, Treviglio Hospital, Treviglio, Italy; Italfarmaco, Cinisello Balsamo, Italy; Scientific Department, Italfarmaco, Cinisello Balsamo, Italy

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Background: Five variables (site of cancer, platelet count, haemoglobin level, leukocyte count, and body mass index-BMI) define the Khorana risk score (KS), predicting the high (≥ 3), the moderate (1-2) and the low (0) risk of thromboembolic events (TEs) in cancer outpatients. Nadroparin has been demonstrated to reduce the incidence of TEs by about 50% in cancer outpatients receiving chemotherapy (PROTECHT study) and patients receiving chemotherapy including gemcitabine, platinum analogues or their combination are at higher risk of TEs. Methods: 378 patients enrolled in the PROTECHT study didn’t receive thromboprophylaxis (placebo group) and were evaluable for the KS. The aim of this retrospective analysis was to assess the distribution of the five KS variables and if the replacing of BMI variable, in the KS, with a chemotherapy variable (administration of platinum compound or gemcitabine added 1point and their association 2points) in a PROTECHT score (PrS) could better predict high risk patients. A receiver operating characteristic (ROC) curve has been used to assess the accuracy of both scores. Results: Among patients the five KS variables were distributed as follow: 15% of stomach/pancreas cancer (2points), 33% with lung/gynecologic cancer (1point), 24% with platelet count of ≥350x10^9/L, 7.9% hemoglobin <10g/dL , 14.3% leukocyte count >11x10^9/L (1point each variable) and only 1.3% with BMI ≥ 35 (1point). 15 TEs occurred in the 378 pts, below the TEs distribution according to KS and PrS (see table). The area under the ROC curve was larger with PrS in comparison with KS (0.70 and 0.65 respectively). Conclusions: BMI ≥ 35 seems not to be a predictable factor for TEs in European cancer patients and the use of a chemotherapy variable could be more useful to identify patient at high risk of TE. A formal study is needed to evaluate which score could have a higher predictability to identify high risk patients for TEs.
Score TEs in high-risk pts TEs in moderate-risk pts TEs in low-risk pts
KS (%) 33.3 46.7 20
PrS (%) 66.7 13.3 20