Validation of the Khorana Venous Thromboembolism Risk Score in Japanese Cancer Patients
Fumie Akasaka-Kihara, MD,
Daisuke Sueta, MD, PhD,
Masanobu Ishii, MD, PhD, MPH,
Yuji Maki, MD,
Kyoko Hirakawa, MD, PhD,
Noriaki Tabata, MD, PhD,
Miwa Ito, MD, PhD,
Kenshi Yamanaga, MD, PhD,
Koichiro Fujisue, MD, PhD,
Tadashi Hoshiyama, MD, PhD,
Shinsuke Hanatani, MD, PhD,
Hisanori Kanazawa, MD, PhD,
Seiji Takashio, MD, PhD,
Yuichiro Arima, MD, PhD,
Satoshi Araki, MD, PhD,
Hiroki Usuku, MD, PhD,
Taishi Nakamura, MD, PhD,
Satoru Suzuki, MD, PhD,
Eiichiro Yamamoto, MD, PhD,
Hirofumi Soejima, MD, PhD,
Koichi Kaikita, MD, PhD,
Kenichi Matsushita, MD, PhD,
Masao Matsuoka, MD, PhD,
Koichiro Usuku, MD, PhD,
Kenichi Tsujita, MD, PhD
Affiliations
Fumie Akasaka-Kihara, MD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Daisuke Sueta, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan; Address for correspondence: Dr Daisuke Sueta, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
Masanobu Ishii, MD, PhD, MPH
Department of Cardiology, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
Yuji Maki, MD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Kyoko Hirakawa, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Noriaki Tabata, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Miwa Ito, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Kenshi Yamanaga, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Koichiro Fujisue, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Tadashi Hoshiyama, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Shinsuke Hanatani, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Hisanori Kanazawa, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Seiji Takashio, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Yuichiro Arima, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Satoshi Araki, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Hiroki Usuku, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Taishi Nakamura, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Satoru Suzuki, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Eiichiro Yamamoto, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Hirofumi Soejima, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Koichi Kaikita, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Kenichi Matsushita, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan; Division of Advanced Cardiovascular Therapeutics, Kumamoto University Hospital, Kumamoto Japan
Masao Matsuoka, MD, PhD
Department of Hematology, Rheumatology, and Infectious Diseases, Kumamoto University School of Medicine, Kumamoto Japan
Koichiro Usuku, MD, PhD
Department of Medical Information Science and Administration Planning, Kumamoto University Hospital, Kumamoto Japan
Kenichi Tsujita, MD, PhD
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
Background: Although the Khorana venous thromboembolism (VTE) risk score (KRS) is well recognized as a simple VTE risk assessment method in patients with cancer, whether it is suitable for Asian populations is unclear. Objectives: This study validated KRS for the prediction of VTE and investigated the value of the KRS in predicting mortality in Japanese patients with cancer. Methods: A body mass index value of 25 kg/m2 or more was defined as obesity according to World Health Organization consensus. A total of 27,687 patients with cancer were subdivided into low- (0), intermediate- (1-2), and high-score (3) groups by the KRS. The primary and secondary endpoints were VTE and all-cause mortality, respectively. Results: The prevalence of VTE was 1.7%, 7.3%, and 11.0% for low-, intermediate-, and high-score patients, respectively. Receiver operating characteristic (ROC) analysis showed that the KRS significantly predicted VTE (area under the curve, 0.679; 95% confidence interval [CI] 0.666-0.692; P < 0.001). The cutoff value for the KRS was 1.0. Logistic regression analysis demonstrated that the KRS was an independent predictor of VTE (odds ratio 1.766; 95% CI 1.673-1.865; P < 0.01). The cutoff value of the KRS for all-cause mortality determined by ROC analysis was 2.0. Kaplan–Meier analysis demonstrated a significantly higher incidence of mortality in the KRS ≥2 group than in the KRS 0-1 group (log-rank: P < 0.01). Conclusions: The KRS was useful in Japanese patients with cancer and might be a potentially useful marker for the prediction of mortality. Establishing optimal scores for Japanese subjects is mandatory because of its low diagnostic ability. (KUMAMON Cancer registry; UMIN000047554)
