Utility of the Khorana and the new-Vienna CATS prediction scores in cancer patients of the HYPERCAN cohort
Cristina Verzeroli, Cinzia Giaccherini, Laura Russo, Silvia Bolognini, Sara Gamba, Carmen Julia Tartari, Francesca Schieppati, Chiara Ticozzi, Alfonso Vignoli, Giovanna Masci, Roberta Sarmiento, Daniele Spinelli, Paolo Malighetti, Carlo Tondini, Fausto Petrelli, Francesco Giuliani, A. D’Alessio, Giampietro Gasparini, Mauro Minelli, Filippo de Braud, Armando Santoro, Roberto Labianca, Marina Marchetti, Anna Falanga, Marchetti Marina, Silvia Bolognini, Gamba Sara, Giaccherini Cinzia, Russo Laura, Schieppati Francesca, Tartari Carmen Julia, Ticozzi Chiara, Verzeroli Cristina, Vignoli Alfonso, Santoro Armando, Masci Giovanna, de Braud Filippo, Martinetti Antonia, T. Carlo, Labianca Roberto, Gasparini Giampietro, S. Roberta, Gennaro Elisabetta, Minelli Mauro, Sandro Barni, Fausto Petrelli, Mara Ghilardi, D’Alessio Andrea, Cecchini Sara, Francesco Giuliani, Paolo Malighetti, M Chiara, Spinelli Daniele, Anna Falanga
Abstract
BACKGROUND: Risk assessment models (RAMs) are relevant approaches to identify cancer outpatients at high risk of venous thromboembolism (VTE). Among the proposed RAMs, the Khorana (KRS) and the new-Vienna CATS risk scores have been externally validated in ambulatory patients with cancer. OBJECTIVES: To test KRS and new-Vienna CATS scores in 6-month VTE prediction and mortality in a large prospective cohort of metastatic cancer outpatients during chemotherapy. PATIENTS/METHODS: Newly diagnosed patients with metastatic non-small cell lung, colorectal, gastric, or breast cancers were analyzed (n = 1286). The cumulative incidence of objectively confirmed VTE was estimated with death as a competing risk and multivariate Fine and Gray regression. RESULTS: Within 6 months, 120 VTE events (9.7%) occurred. The KRS and the new-Vienna CATS scores showed comparable c-stat. Stratification by KRS provided VTE cumulative incidences of 6.2%, 11.4%, and 11.5% in the low-, intermediate-, and high-risk categories, respectively (p = ns), and of 8.5% vs. 11.8% (p = ns) in the low- vs. high-risk group by the single 2-point cut-off value stratification. Using a pre-defined 60-point cut-off by the new-Vienna CATS score, 6.6% and 12.2% cumulative incidences were obtained in the low- and high-risk groups, respectively (p < 0.001). Furthermore, having a KRS ≥2 = or a new-Vienna CATS score >60 points was also an independent risk factor for mortality. CONCLUSION: In our cohort, the 2 RAMs showed a comparable discriminating potential; however, after the application of cut-off values, the new-Vienna CATS score provided statistically significant stratification for VTE. Both RAMs proved to be effective in identifying patients at increased risk of mortality.