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External validation of the Khorana and Vienna-CATS nomogram scores in cancer patients of the HYPERCAN cohort

1ASST Papa Giovanni XXIII Bergamo, Italy, Dalmine, Lombardia, Italy, 2ASST Papa Giovanni XXIII Bergamo, Italy, Bergamo, Lombardia, Italy, 3IRCCS Humanitas Institute, Rozzano, Italy, MIlano, Lombardia, Italy, 4IRCCS National Cancer Institute, Milan, Italy, Milano, Lombardia, Italy, 5Hospital San Filippo Neri, Rome, Italy, Roma, Lazio, Italy, 6Hospital Treviglio-Caravaggio, Treviglio, Italy, Treviglio, Lombardia, Italy, 7IRCCS Cancer Institute Giovanni Paolo II, Bari, Italy, Bari, Puglia, Italy, 8Policlinico San Marco, Zingonia, Italy, Zingonia, Lombardia, Italy, 9Hospital San Giovanni Addolorata, Rome, Italy, Roma, Lazio, Italy, 10DIPO, ASST Papa Giovanni XXIII, Bergamo, Italy, Bergamo, Lombardia, Italy, 11University of Bergamo, Bergamo, Italy, Bergamo, Lombardia, Italy, 12University of Milan-Bicocca, Milan, Italy, Bergamo, Lombardia, Italy, 13ASST Papa Giovanni XXIII Bergamo and University of Milan-Bicocca, Italy, Bergamo, Lombardia, Italy

Abstract Number: OC 16.1

Meeting: ISTH 2022 Congress

Theme: Venous Thromboembolism » Cancer Associated Thrombosis

Background: Identifying cancer outpatients at high risk of venous thromboembolism (VTE) is an unmet clinical need. The use of validated risk assessment models (RAMs) can be a relevant approach to hit this goal.

Among several proposed RAMs, the Khorana risk score (KRS) and the Vienna-CATS nomogram score have been developed and externally validated in newly diagnosed ambulatory cancer patients.

Aims: In a large prospective cohort of 1,286 outpatients with metastatic non-small cell lung, colorectal, gastric, or breast cancers undergoing chemotherapy [the HYPERCAN study], we aimed to evaluate the performance of KRS and Vienna-CATS nomogram score for VTE prediction.

Methods: KRS and Vienna-CATS nomogram score were applied to the HYPERCAN cohort using pre-chemotherapy patient variables (leucocyte and platelet counts, hemoglobin level, and BMI for KRS and D-dimer level (HemosIL D-dimer HS, Werfen) for Vienna-CATS nomogram). All objectively confirmed VTE events within 6 months were considered for analysis.

Results: One hundred-twenty VTE (10.3%) were recorded, including isolated deep vein thrombosis (DVT, 45.8%), pulmonary embolism (PE, 42.5%), and PE+DVT (11.7%). By ROC analysis, KRS provided a non-relevant AUC of 0.39 for 6-months VTE. Cumulative VTE incidence was 6.0 % (95% CI 3.8-9.7) for KRS < 2 and 12.3% (95% CI 9.9-15.3) for KRS≥2, p=ns. AUC for 6-months VTE was 0.63 with Vienna-CATS nomogram score. Cumulative VTE incidence was 7.2% (95% CI 5.6-9.2) in patients with a predicted VTE risk ≤5% (low risk) and 17% (95% CI 13.5-21.3) in those with a predicted VTE risk >5% (high risk), SHR=2.4, p < 0.001.

Conclusion(s): In our cohort, the KRS showed a low performance, while the Vienna-CATS nomogram score significantly categorized patients at low and high VTE risk. The addition of D-dimer, a circulating coagulation biomarker, seems to be a promising approach towards reliable and clinically applicable RAMs for VTE prediction in these widespread cancers.

To cite this abstract in AMA style:

Marchetti M, Verzeroli C, Giaccherini C, Russo L, Gamba S, Tartari C, Bolognini S, Ticozzi C, Santoro A, De Braud F, Gasparini G, Petrelli F, Giuliani F, D'Alessio A, Minelli M, Labianca R, Morlotti C, Malighetti P, Spinelli D, Falanga A. External validation of the Khorana and Vienna-CATS nomogram scores in cancer patients of the HYPERCAN cohort [abstract]. https://abstracts.isth.org/abstract/external-validation-of-the-khorana-and-vienna-cats-nomogram-scores-in-cancer-patients-of-the-hypercan-cohort/. Accessed September 22, 2023.

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