Performance of Khorana Score to Predict One-Year Risk of Venous Thromboembolism in over Two Million Patients with Cancer

Background: Risk stratification of venous thromboembolism (VTE) in patients with cancer is essential to evaluate the need for extended thromboprophylaxis. The Khorana score is widely used to guide VTE risk stratification in patients with cancer based on clinical parameters: cancer type, platelet count, hemoglobin level, leukocyte count, and body mass index. We sought to validate Khorana score to predict 1-year risk of VTE in a large multi-institutional, diverse, real-world cohort of patients with cancer. Methods: Using aggregated de-identified electronic medical record data from >300 major hospitals in the in the United States (IBM Watson Explorys), we performed a retrospective cohort study of all patients who had a diagnosis of cancer. We identified cancer type, platelet count, hemoglobin level, leukocyte count, and body mass index (for calculation of Khorana score) within 7 days of cancer diagnosis and followed patients for diagnosis of VTE for 1 year post cancer diagnosis. Logistic regression models were used to evaluate association between patient characteristics and VTE risk. Receiver operating characteristics with area under the curve were used to evaluate model discrimination. All analyses were performed in Statistical Package for Social Sciences. Results: A total of 2,112,260 patients with cancer were included: 52.9% females, 11.1% African Americans, 44.3% intermediate risk cancers (lymphoma, lung, breast, gynecologic, testicular and bladder), 4.5% high risk cancers (stomach and pancreas), 19.8% had Platelet counts ≥ 350,000/µL, 29% had hemoglobin <10 g/dL, 32.3% had leukocyte count >11,000/µL, and 15.1% had body mass index ≥ 35 kg/m2. Overall, 227,170 (10.8%) had a diagnosis of VTE at 1 year following cancer diagnosis. In multivariable analysis (table 1), VTE risk was associated with cancer type (intermediate vs low risk: OR 1.08 [95% CI: 1.07-1.09]; high vs low risk: OR 1.48 [95% CI: 1.45-1.51]), Platelet ≥ 350,000 (OR 1.27 [95% CI: 1.26-1.29]), hemoglobin <10 g/dL (OR 1.43 [95% CI: 1.41-1.44]), leukocyte count > 11,000 (OR 1.15 [95% CI: 1.14-1.16]), body mass index ≥ 35 kg/m2 (OR 1.29 [95% CI: 1.27-1.30]), table 1. Risk of VTE increased linearly with Khorana score between 7.7% (score = 0) to 18% (score = 6), figure 1. Khorana score had weak to modest discrimination (Area Under Receiver Operating Characteristics 0.565 [95% CI: 0.564-0.566]), figure 2. Conclusion: In this very large real-world study of diverse patients with cancer, Khorana score was a weak predictor of 1-year risk of VTE, suggesting that VTE prediction in patients with cancer is very complex. Disclosures No relevant conflicts of interest to declare.

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The Combined Effect of Body Mass Index and Tibial Slope Angles on Anterior Cruciate Ligament Injury Risk in Male Knees: A Case-Control Study

Clinical Medicine Insights Arthritis and Musculoskeletal Disorders ◽

10.1177/1179544119867922 ◽

2019 ◽

Vol 12 ◽

pp. 117954411986792

Author(s):

Volkan Kızılgöz ◽

Ali Kemal Sivrioğlu ◽

Hasan Aydın ◽

Gökhan Ragıp Ulusoy ◽

Türkhun Çetin ◽

...

Keyword(s):

Body Mass Index ◽

Anterior Cruciate Ligament ◽

Body Mass ◽

Injury Risk ◽

Cruciate Ligament ◽

Acl Injury ◽

Tibial Slope ◽

Receiver Operating Characteristics ◽

Operating Characteristics ◽

Anterior Cruciate

Introduction: Tibial slope angles (TSAs) have been identified as potential risk factors of anterior cruciate ligament (ACL) injury in the literature. A higher body mass index (BMI) might increase the risk of ACL tear because of greater axial compressive force. The aim of this study was to determine the relationship of these factors and the combined effect of BMI and TSA in determination of risk potential for ACL injury. Methods: The preoperative magnetic resonance (MR) images of 81 ACL-injured male knees and of 68 male individuals with no ACL injuries were evaluated by 2 radiologists to measure the TSA. The Mann-Whitney U-test was performed to indicate the significant difference in height, weight, and BMI values. The independent samples t-test was used to determine the differences between ACL-injured and non-injured groups regarding TSA values. Odds ratios were calculated by logistic regression tests, and receiver operating characteristics (ROC) curves revealed the area under the receiver operating characteristics curve (AUC) values to compare the relationships of these parameters with ACL injury. Results: Body mass index, lateral tibial slope (LTS), and medial tibial slope (MTS) were predictive of ACL risk injury. Body mass index alone had the greatest effect among these parameters, and there were no statistically significant differences in coronal tibial slope values between the ACL-ruptured and control groups. The greatest AUC was observed for the combination of BMI, MTS, and LTS. Conclusions: Body mass index, LTS, and MTS angles were associated with ACL injury risk and BMI + MTS + LTS together revealed the greatest effect on ACL injury.

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

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e19612 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e19612-e19612

Author(s):

Sandro Barni ◽

Roberto Labianca ◽

Melina Verso ◽

Giampietro Gasparini ◽

Erminio Bonizzoni ◽

...

Keyword(s):

Body Mass Index ◽

Platelet Count ◽

High Risk ◽

Retrospective Analysis ◽

Body Mass ◽

Risk Score ◽

Roc Curve ◽

Leukocyte Count ◽

Ks Variables ◽

Risk Patients

e19612 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. [Table: see text]

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Association of body mass index with hemoglobin level, erythrocyte indices and red cell distribution width.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.03.5334 ◽

2021 ◽

Vol 28 (03) ◽

pp. 311-317

Author(s):

Saleemullah Abro ◽

Qurratulain Saleem ◽

Syeda Asiya Parveen ◽

Ali Ahmed ◽

Syed Hafeezul Hussan ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Hemoglobin Level ◽

Red Cell Distribution Width ◽

Deficiency Anemia ◽

Red Cell ◽

Cell Distribution ◽

Distribution Width ◽

Erythrocyte Indices ◽

Study Participants

Objectives: Objective of this study is to evaluate the association of body mass index with hemoglobin Level, erythrocyte Indices and red cell distribution width in medical students of Baqai Medical University Karachi. Study Design: Descriptive cross - sectional study. Setting: Physiology Department of Baqai Medical University Karachi. Period: 15 February 2017 to 15 August 2017. Material & Methods: A total of 500 students were enrolled in this study. The anthropometric measurement [height (m2) and weight (kg)] was recorded for calculation of the Body Mass Index and Complete blood count i-e Hemoglobin%, erythrocyte indices {Mean corpuscular volume(MCV), Mean corpuscular hemoglobin(MCH), Mean corpuscular hemoglobin concentration (MCHC), Red cell distribution width (RDW) were done and Mentzer’s Index was calculated. Statistical Package for the Social Sciences (SPSS) version 22.0 was used to analyze the collected data. Results: It was observed in 500 medical students that 36% of the students were having low hemoglobin % level, while low values of erythrocyte indices (MCH: 38.0%, MCV 36.6% and MCHC 39.0% respectively) and 93.8% of participants had a higher values of RDW in study participants. Iron deficiency anemia (87.2%) and thalassemia (carrier or minor: 12.8%) were determined by using Menterzer Index. Mean body mass index of study participants were 23.04±3.68 and it was observed in study participants that only RDW was significantly associated with obese students (X²=9.878, p=0.02). Conclusion: With regard to our study results, higher percentage (87.2%) of Iron deficiency anemia were observed and having association between red cell distribution width to obesity.

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Clinical Verification of Body Mass Index and Tumor Immune Response in Patients With Breast Cancer Receiving Preoperative Chemotherapy

10.21203/rs.3.rs-131688/v3 ◽

2021 ◽

Author(s):

Koji Takada ◽

Shinichiro Kashiwagi ◽

Yuka Asano ◽

Wataru Goto ◽

Rika Kouhashi ◽

...

Keyword(s):

Breast Cancer ◽

Body Mass Index ◽

Body Mass ◽

Preoperative Chemotherapy ◽

Early Stage ◽

Normal Weight ◽

World Health ◽

Cancer Type ◽

Immune Microenvironment ◽

Tumor Immune Microenvironment

Abstract PurposeThe body mass index (BMI) is commonly used as a simple indicator of obesity; patients with early-stage breast cancer who are obese (OB) per BMI measurements have been shown to have high postoperative recurrence and low survival rates. On the other hand, it has been shown that lymphocytes present in the vicinity of malignant growths that are involved in the tumors’ immune responses influence the efficacy chemotherapy. Therefore, we hypothesized that OB patients with breast cancer have a lower density of tumor-infiltrating lymphocytes (TILs), which may influence the therapeutic effect of preoperative chemotherapy (POC). In this study, we measured pretreatment BMI and TILs in patients with breast cancer who underwent POC, examined the correlations between these two factors, and retrospectively analyzed their therapeutic outcomes and prognoses.MethodsThe participants in this study were 421 patients with breast cancer who underwent surgical treatment after POC between February 2007 and January 2019. The patient’s height and weight were measured before POC to calculate the BMI (weight [kg] divided by the square of the height [m2]). According to the World Health Organization categorization, patients who weighed under 18.5 kg/m2 were classified as underweight (UW), those ≥18.5 kg/m2 and >25 kg/m2 were considered normal weight (NW), those ≥25 kg/m2 and <30 kg/m2 were overweight (OW), and those ≥30 kg/m2 were OB. The TILs were those lymphocytes that infiltrated the tumor stroma according to the definition of the International TILs Working Group 2014.ResultsThe median BMI was 21.9 kg/m2 (range, 14.3–38.5 kg/m2); most patients (244; 64.5%) were NW. Among all 378 patients with breast cancer, the TIL density was significantly lower in OB than in NW and OW patients (vs. NW: p=0.001; vs. OW: p=0.003). Furthermore, when examining patients with each breast cancer type individually, the OS of those with TNBC who had low BMIs was significantly poorer than that of their high-BMI counterparts (log rank p=0.031).ConclusionsOur data did not support the hypothesis that obesity affects the tumor immune microenvironment; however, we showed that being UW does affect the tumor immune microenvironment.

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Effects of smoking and body mass index on the exposure of fentanyl in patients with cancer

PLoS ONE ◽

10.1371/journal.pone.0198289 ◽

2018 ◽

Vol 13 (6) ◽

pp. e0198289

Author(s):

Evelien J. M. Kuip ◽

Wendy H. Oldenmenger ◽

Martine F. Thijs—Visser ◽

Peter de Bruijn ◽

Astrid W. Oosten ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Patients With Cancer

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Cancer Cachexia in the Age of Obesity: Skeletal Muscle Depletion Is a Powerful Prognostic Factor, Independent of Body Mass Index

Journal of Clinical Oncology ◽

10.1200/jco.2012.45.2722 ◽

2013 ◽

Vol 31 (12) ◽

pp. 1539-1547 ◽

Cited By ~ 949

Author(s):

Lisa Martin ◽

Laura Birdsell ◽

Neil MacDonald ◽

Tony Reiman ◽

M. Thomas Clandinin ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Mass Index ◽

Weight Loss ◽

Body Mass ◽

Normal Weight ◽

Cancer Center ◽

Skeletal Muscle Index ◽

Patients With Cancer ◽

C Statistic ◽

Muscle Attenuation

Purpose Emerging evidence suggests muscle depletion predicts survival of patients with cancer. Patients and Methods At a cancer center in Alberta, Canada, consecutive patients with cancer (lung or GI; N = 1,473) were assessed at presentation for weight loss history, lumbar skeletal muscle index, and mean muscle attenuation (Hounsfield units) by computed tomography (CT). Univariate and multivariate analyses were conducted. Concordance (c) statistics were used to test predictive accuracy of survival models. Results Body mass index (BMI) distribution was 17% obese, 35% overweight, 36% normal weight, and 12% underweight. Patients in all BMI categories varied widely in weight loss, muscle index, and muscle attenuation. Thresholds defining associations between these three variables and survival were determined using optimal stratification. High weight loss, low muscle index, and low muscle attenuation were independently prognostic of survival. A survival model containing conventional covariates (cancer diagnosis, stage, age, performance status) gave a c statistic of 0.73 (95% CI, 0.67 to 0.79), whereas a model ignoring conventional variables and including only BMI, weight loss, muscle index, and muscle attenuation gave a c statistic of 0.92 (95% CI, 0.88 to 0.95; P < .001). Patients who possessed all three of these poor prognostic variables survived 8.4 months (95% CI, 6.5 to 10.3), regardless of whether they presented as obese, overweight, normal weight, or underweight, in contrast to patients who had none of these features, who survived 28.4 months (95% CI, 24.2 to 32.6; P < .001). Conclusion CT images reveal otherwise occult muscle depletion. Patients with cancer who are cachexic by the conventional criterion (involuntary weight loss) and by two additional criteria (muscle depletion and low muscle attenuation) share a poor prognosis, regardless of overall body weight.

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Abstract P6-09-09: Body mass index and prognosis after breast cancer diagnosis in Japanese women

10.1158/1538-7445.sabcs14-p6-09-09 ◽

2015 ◽

Author(s):

Toshinari Yamashita ◽

Tomoyuki Aruga ◽

Hiromi Miyamoto ◽

Kazumi Horiguchi ◽

Yayoi Honda ◽

...

Keyword(s):

Breast Cancer ◽

Body Mass Index ◽

Body Mass ◽

Cancer Diagnosis ◽

Breast Cancer Diagnosis ◽

Japanese Women

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The association of fitness and body mass index (BMI) on all-cause mortality in cancer survivors: The Henry Ford Exercise Testing Project (The FIT Project).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.7060 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 7060-7060

Author(s):

Catherine Handy Marshall ◽

Paul A McAuley ◽

Hua-Ling Tsai ◽

Zeina Dardari ◽

Mouaz H Al-Mallah ◽

...

Keyword(s):

Prostate Cancer ◽

Body Mass Index ◽

Cancer Patients ◽

Body Mass ◽

Cancer Diagnosis ◽

Exercise Test ◽

Normal Weight ◽

Risk Of Mortality ◽

All Cause Mortality ◽

Henry Ford

7060 Background: The obesity paradox –i.e. inverse associations between body mass index (BMI) and mortality – has been reported in patients with cancer, heart failure, and diabetes. However, the influence of cardiorespiratory fitness (CRF) on this relationship is not well established. This study assesses the association of BMI and CRF with all-cause mortality among cancer patients. Methods: The Henry Ford (HF) FIT Project is a retrospective cohort study of 69,885 consecutive patients who underwent physician-referred exercise stress testing from 1991 through 2009. Cancer diagnosis was identified through linkage to the HF tumor registry. We included patients 40-70 years old, with BMI recorded, at time of exercise test, with a history of cancer > 6 months prior. BMI was categorized as normal (18.5-24.9kg/m2), overweight (25-29.9kg/m2), or obese ( > = 30kg/m2). All-cause mortality was obtained from the National Death Index. Because of a significant interaction between BMI and cancer type, patients with breast or prostate cancer were excluded. Multivariable adjusted Cox proportional hazard models were used to evaluate the association of CRF andBMI with all-cause mortality; adjusted for age at exercise test, sex, diabetes, smoking, cancer stage, and time from cancer diagnosis to exercise test. Results: Included were 676 patients with a mean age of 58 years (SD 7.5), 51% female, 70% White, 25% Black, with a median of 4.8 years from diagnosis to exercise test and median follow up time of 10.3 years. Among patients achieving < 10 METs, those who are overweight and obese had a lower risk of mortality HR 0.47 (95% CI 0.25,0.86) and HR 0.44 (95% CI 0.26, 0.74, respectively), compared to those with normal BMI. Among patients with METs > = 10, those who were overweight had the lowest risk of all-cause mortality (HR 0.23, 95% CI 0.09-0.62) compared to normal weight, while no statistically significant different risk of mortality was observed when comparing those who are obese to normal weight (HR 0.37, 95% CI 0.13-1.06). In an analysis combining BMI and fitness groups (four categories), those with BMI > = 25 and METs > = 10 had the lowest risk of all-cause mortality (Table). Conclusions: In non-breast/non-prostate cancer patients, increased BMI is associated with improved overall survival in those with METs < 10, while a U-shaped relationship between BMI and all-cause mortality exists among those with METs > = 10. [Table: see text]

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