scholarly journals Older Age Instead of Body Mass Index Predicts Cancer-Associated Thrombosis: Validation of Khorana Score in Cancer Patients Undergoing Chemotherapy with East Asian Ethnicity

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2124-2124
Author(s):  
Junshik Hong ◽  
Hyerim Ha ◽  
YeHee Ko ◽  
Kwangsoo Kim
Keyword(s):  
Body Mass Index ◽  
Cancer Patients ◽  
Scoring System ◽  
Risk Group ◽  
Asian Population ◽  
High Risk Group ◽  
Diagnosis Code ◽  
Western Population ◽  
Chemotherapy Initiation ◽  
Cancer Associated Thrombosis

Abstract Khorana score has been the most widely used for the prediction of cancer-associated thrombosis (CAT) and recent pivotal phase III trials including AVERT and CASSINI adopted Khorana score in the inclusion criteria. However, most studies in development and use of Khorana score were conducted in Western cancer patients. The prevalence of VTE is known to be substantially lower in Asians than in the Western population. In case of body mass index (BMI), experts suggest an adjusted cut-off points of the classification of weight status in Asian population since they are usually thinner than Westerners. In addition, risk of CAT according to the sites of cancer may need reassessment since the characteristics of each site of cancer varies among geographic regions or ethnicity. For those reasons, we thought that Khorana score needs to be separately validated in Asian population and conducted a retrospective real-world analysis. By using the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM), we collected de-identified data of the newly diagnosed cancer patients who underwent chemotherapy from January 2016 to June 2019 at Seoul National University Hospital (SNUH), Seoul, South Korea. Patients were eligible if they 1) had a new diagnosis code of cancer and 2) had initiated chemotherapy within 3 months after the first recoding of the cancer diagnosis. The patients undergoing chemotherapy were identified based on their prescription of chemotherapeutic agents and the procedural code for the first-time patient education for chemotherapy. Among the selected cancer patients, values of complete blood cell counts (CBC), body weight, and height on the very day of or the day closest to the chemotherapy initiation were obtained. A patient was counted as having a VTE if he or she had both newly-recorded diagnosis code of VTE and new record of anticoagulant medication code within 1 week after the emergence of VTE diagnosis code. Cumulative incidence of CAT was estimated at the time of 3, 6, and 12 months after the date of chemotherapy initiation. A total of 10,588 patients with cancer and chemotherapy were eligible and only 1.33% (141 patients) had a CAT at 6 months after the chemotherapy initiation, suggesting lower overall incidence of CAT in Asian population. Pancreas (4.9%) was the most common primary cancer site but CAT incidence rate in patients with stomach cancer was limited to 1.6%, reflecting different characteristics of the disease between the East and the West. The CAT incidences in patients with lung cancer (1.4%) and lymphoma (1.1%) were lower than expected, in line with a recent meta-analysis (Mulder at al.; Haematologica 2019), but CAT incidences in patients with liver (3.4%) and biliary (3.0%) cancer were higher than expected considering the Khorana scoring system. Among 7,431 patients who had all data for the calculation of Khorana score, 5,549 patients (74.7%) had a BMI of < 25 kg/m 2, followed by 1,633 patients (15.4%) with a BMI of 25.0-29.9 kg/m 2. Only 39 patients (0.4%) had a BMI of 35 > kg/m 2, showing the difference of BMI distribution according to the ethnicity. Moreover, BMI was not associated with CAT development at all, whereas the 3 CBC parameters and the site of cancers were associated with CAT occurrence. In addition, patients who aged ≥ 65 years had significantly higher CAT risk compared to younger group. In a multivariate regression analysis (Table 1), age ≥ 65 years, leukocyte ≥ 11 x 10 3/μL, and sites of cancers were independently associated with the development of CAT. Hemoglobin < 10 g/dL and platelet ≥ 350 x 10 3/μL showed a tendency of association but failed to reach statistical significance. When we classified the 7,431 patients according to the Khorana scoring system, 8.0% of the patients were considered as high risk group and their incidence of CAT at 6 months was 3.36% (Table 2), showing a smaller proportion of patients assigned to high risk group and their lower absolute risk of CAT compared to Western population. In conclusion, Khorana scoring system was only partially validated in Korean cancer patients who underwent first-line chemotherapy: BMI was not but older age was a good predictor for the prediction of CAT occurrence. Weighing the risk of CAT according to the sites of cancers also needs some improvement. Further studies for better CAT risk stratification reflecting ethnic or regional differences are warranted. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Clinical impact of LncRNA XIST and LncRNA NEAT1 for diagnosis of high-risk group breast cancer patients

2021 ◽  
pp. 100709
Author(s):  
Menha Swellam ◽  
Hekmat M EL Magdoub ◽  
May A Shawki ◽  
Marwa Adel ◽  
Mona M Hefny ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Risk Group ◽  
High Risk Group ◽  
Clinical Impact ◽  
Breast Cancer Patients ◽  
Lncrna Xist ◽  
Lncrna Neat1

Accuracy of the CARG chemotherapy toxicity risk prediction tool in older Indian patients with cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24023-e24023
Author(s):  
Shreya Gattani ◽  
Vanita Noronha ◽  
Anant Ramaswamy ◽  
Renita Castelino ◽  
Vandhita Nair ◽  
...  
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Risk Prediction ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Chemotherapy Toxicity ◽  
Patients With Cancer ◽  
Indian Patients ◽  
Grade 3

e24023 Background: Clinical judgement alone is inadequate in accurately predicting chemotherapy toxicity in older adult cancer patients. Hurria and colleagues developed and validated, the CARG score (range, 0–17) as a convenient and reliable tool for predicting chemotherapy toxicity in older cancer patients in America, however, its applicability in Indian patients is unknown. Methods: An observational retrospective and prospective study between 2018 and 2020 was conducted in the Department of Medical Oncology at Tata Memorial Hospital, Mumbai, India. The study was approved by the institutional ethics committee (IEC-III; Project No. 900596) and registered in the Clinical Trials Registry of India (CTRI/2020/04/024675). Written informed consent was obtained in the prospective part of the study. Patients aged ≥ 60 years and planned for systemic therapy were evaluated in the geriatric oncology clinic and their CARG score was calculated. Patients were stratified into low (0-4), intermediate (5-9) and high risk (10-17) based on the CARG scores. The CARG score was provided to the treating physicians, along with the results of the geriatric assessment. Chemotherapy-related toxicities were captured from the electronic medical record and graded as per the NCI CTCAE, version 4.0. Results: We assessed 130 patients, with a median age 69 years (IQR, 60 to 84); 72% patients were males. The common malignancies included gastrointestinal (52%) and lung (30%). Approximately 78% patients received polychemotherapy and 53% received full dose chemotherapy. Based on the CARG score, 28 (22%) patients belonged to low risk, 80 (61%) to intermediate risk and 22 (17%) to the high risk category. The AU-ROC of the CARG score in predicting grade 3-5 toxicities was 0.61 (95% CI, 0.51-0.71). The sensitivity and specificity of the CARG score in predicting grade 3-5 toxicities were 60.8% and 78.6%. Grade 3-5 toxicities occurred in 6/28 patients (21%) in the low risk group, compared to 62/102 patients (61%) in the intermediate /high risk group, p = 0.0002. There was also a significant difference in the time to development of grade 3-5 toxicities, which occurred at a median of 2.5 cycles (IQR, 1-3.8) in the intermediate /high risk group and at a median of 6 cycles (IQR, 3.5-8) in the low risk group, p = 0.0011. Conclusions: In older Indian patients with cancer, the CARG score reliably stratifies patients into low risk and intermediate/high risk categories, predicting both the occurrence and the time to occurrence of grade 3-5 toxicities from chemotherapy. The CARG score may aid the oncologist in estimating the risk-benefit ratio of chemotherapy. An important limitation was that we provided the CARG score to the treating oncologists prior to the start of chemotherapy, which may have resulted in alterations in the chemotherapy regimen and dose and may have impacted the CARG risk prediction model. Clinical trial information: CTRI/2020/04/024675.

scholarly journals A model for predicting carotid instability plaque in high risk group of stroke individuals

2019 ◽  
Author(s):  
Junxiong Yin ◽  
Chuanyong Yu ◽  
Hongxing Liu ◽  
Mingyang Du ◽  
Feng Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Predictive Model ◽  
Doppler Ultrasound ◽  
Scoring System ◽  
Risk Group ◽  
High Risk Group ◽  
High Risk Population ◽  
Auc Value ◽  
Validation Set

Abstract Objective: To establish a predictive model of carotid vulnerable plaque through systematic screening of high-risk population for stroke.Patients and methods: All community residents who participated in the screening of stroke high-risk population by the China National Stroke Screening and Prevention Project (CNSSPP). A total of 19 risk factors were analyzed. Individuals were randomly divided into Derivation Set group and Validation Set group. According to carotid ultrasonography, the derivation set group patients were divided into instability plaque group and non-instability plaque group. Univariate and multivariable logistic regression were taken for risk factors. A predictive model scoring system were established by the coefficient. The AUC value of both derivation and validation set group were used to verify the effectiveness of the model.Results: A total of 2841 high-risk stroke patients were enrolled in this study, 266 (9.4%) patients were found instability plaque. According to the results of Doppler ultrasound, Derivation Set group were divided into instability plaque group (174 cases) and non-instability plaque group (1720 cases). The independent risk factors for carotid instability plaque were: male (OR 1.966, 95%CI 1.406-2.749)，older age (50-59, OR 6.012, 95%CI 1.410-25.629; 60-69, OR 13.915, 95%CI 3.381-57.267;≥70, OR 31.267, 95%CI 7.472-130.83) , married(OR 1.780, 95%CI 1.186-2.672)，LDL-c(OR 2.015, 95%CI 1.443-2.814), and HDL-C(OR 2.130, 95%CI 1.360-3.338). A predictive scoring system was created, range 0-10. The cut-off value of prediction model score is 6.5. The AUC value of derivation and validation set group were 0.738 and 0.737.Conclusion：For a high risk group of stroke individual, We provide a model that could distinguishing those who have a high probability of having carotid instability plaque. When resident’s predictive model score exceeds 6.5, the incidence of carotid instability plaque is high, carotid artery Doppler ultrasound would be checked immediately. This model can be helpful in the primary prevention of stroke.

Adjuvant Chemotherapy Guidance for pT1-3N0-1 Breast Cancer Patients with HR+, HER2- subtype: a study based on SEER database

2021 ◽  
Author(s):  
juanjuan Qiu ◽  
Li Xu ◽  
Yu Wang ◽  
Jia Zhang ◽  
Jiqiao Yang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
High Risk ◽  
Cancer Patients ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Rank Test ◽  
Breast Cancer Patients ◽  
Group Score

Abstract Background Although the results of gene testing can guide early breast cancer patients with HR+, HER2- to decide whether they need chemotherapy, there are still many patients worldwide whose problems cannot be solved well by genetic testing. Methods 144 735 patients with HR+, HER2-, pT1-3N0-1 breast cancer from the Surveillance, Epidemiology, and End Results database were included from 2010 to 2015. They were divided into chemotherapy (n = 38 392) and no chemotherapy (n = 106 343) group, and after propensity score matching, 23 297 pairs of patients were left. Overall survival (OS) and breast cancer-specific survival (BCSS) were tested by Kaplan–Meier plot and log-rank test and Cox proportional hazards regression model was used to identify independent prognostic factors. A nomogram was constructed and validated by C-index and calibrate curves. Patients were divided into high- or low-risk group according to their nomogram score using X-tile. Results Patients receiving chemotherapy had better OS before and after matching (p < 0.05) but BCSS was not significantly different between patients with and without chemotherapy after matching: hazard ratio (HR) 1.005 (95%CI 0.897, 1.126). Independent prognostic factors were included to construct the nomogram to predict BCSS of patients without chemotherapy. Patients in the high-risk group (score > 238) can get better OS HR 0.583 (0.507, 0.671) and BCSS HR 0.791 (0.663, 0.944) from chemotherapy but the low-risk group (score ≤ 238) cannot. Conclusion The well-validated nomogram and a risk stratification model was built. Patients in the high-risk group should receive chemotherapy while patients in low-risk group may be exempt from chemotherapy.

scholarly journals Determination of Risk Factors for Venous Thromboembolism by an Adapted Caprini Scoring System in Surgical Patients

2019 ◽  
Vol 9 (3) ◽  
pp. 36 ◽  
Author(s):  
Bui My Hanh ◽  
Le Quang Cuong ◽  
Nguyen Truong Son ◽  
Duong Tuan Duc ◽  
Tran Tien Hung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Scoring System ◽  
Risk Group ◽  
Risk Groups ◽  
High Risk Group ◽  
Assessment Model ◽  
Surgical Patients ◽  
Risk Scoring

Venous thromboembolism (VTE) is a frequent preventable complication among surgical patients. Precise risk assessment is a necessary step for providing appropriate thromboprophylaxis and reducing mortality as well as morbidity caused by VTE. We carried out this work to define the rate of VTE postoperatively, following a Caprini score, and to determine VTE risk factors through a modified Caprini risk scoring system. This multicenter, observational, cohort study involved 2,790,027 patients who underwent surgery in four Vietnamese hospitals from 01/2017 to 12/2018. All patients who were evaluated before surgery by using a Caprini risk assessment model (RAM) and monitored within 90 days after surgery. The endpoint of the study was ultrasound-confirmed VTE. Our data showed that the 90-day postoperative VTE was found in 3068 patients. Most of VTE (46.97%) cases were found in the highest risk group (Caprini score > 5). A total of 37.19% were observed in the high risk group, while the rest (15.84%) were from low to moderate risk groups. The likelihood of occurring VTE was heightened 2.83 times for patients with a Caprini score of 3–4, 4.83 times for a Caprini score of 5–6, 8.84 times for a score of 7–8, and 11.42 times for a score of >8, comparing to ones with a score of 0 to 2 (all p values < 0.05). Thus, the frequency of postoperative VTE rises substantially, according to the advanced Caprini score. Further categorizing patients among the highest risk group need delivering more appropriate thromboprophylaxis.

Chemotherapy-associated thrombosis in cancer outpatients: Risk factors and decision making of a prophylactic approach.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20647-e20647
Author(s):  
Martina Torchio ◽  
Benvenuto Franceschetti ◽  
Carla Cavali ◽  
Sonia Zanirato ◽  
Angelo Olgiati ◽  
...  
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
High Risk ◽  
Scoring System ◽  
Risk Group ◽  
Venous Catheter ◽  
Risk Groups ◽  
High Risk Group ◽  
Factors Analysis ◽  
Negative Predictor

e20647 Background: Venous thromboembolism (VTE), is a negative predictor of survival in pts with advanced cancer. International guidelines don’t recommend routine prophlaxis but suggest to consider pts, undergoing chemotherapy (CT), with high risk of VTE. Many clinical risk factors for cancer-associated VTE have been evaluated in a 5 parameter-based (body mass index, platelet and leucocyte counts, hemoglobin value and tumor site) scoring system, the Khorana score, utilized to indicate a prophylactic approach. We prospectively applied this score in cancer outpts beginning CT and an implementation based on 6 addictional factors analysis (sex, age, central venous catheter, CT-agents, antiangiogenetic drugs, erithropoiesis stimulating agent) to evaluate their impact in pts assignment into risk groups. Methods: We studied adult pts, followed at our Department from August 2011 to December 2012, with advanced cancers (breast, NSCLC, colorectal, pancreatic/gastric, urogenital, LNH, Hodgkin's disease, HD, and MM), receiving a first or second line standard CT. We stratified pts into three risk groups (score 0= low; score 1-2=intermediate; score 3-4-5=high) considering both the Khorana scoring system and its implementation. Results: We analyzed 169 pts (103F/66M, median age 62.3, range 35-80 yrs), pt population included: 38 breast, 32 colorectal, 31 LNH, HD and MM, 27 urogenital, 22 NSCLC and 19 pancreatic/gastric. With the Khorana score 49 pts were assigned to the low risk, 87 pts to the intermediate risk (57 with score=1, 28 with score=2), 16 pts (9.4%) to the high risk group (9 with score=3, 4 with score=4, 3 with score=5). When we considered 11 parameters 37 pts (21.8%) were assigned to the high risk group. Conclusions: A more comprehensive quantification of VTE risk, also considering new independent factors, is mandatory for a correct decision making of an antithrombotic-prophylactic approach.

A nation-wide analysis of venous thromboembolism in 497,180 cancer patients with the development and validation of a risk-stratification scoring system

2012 ◽  
Vol 108 (08) ◽  
pp. 225-235 ◽  
Author(s):  
Chun-Yu Liu ◽  
Muh-Hwa Yang ◽  
Shu-Chiung Chiang ◽  
Hui-Chi Hsu ◽  
Ying-Chung Hong ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Risk Stratification ◽  
Cancer Patients ◽  
Scoring System ◽  
Asian Population ◽  
Low Risk ◽  
Prior History ◽  
Research Database ◽  
Hospitalised Patients

SummaryThe Asian population is thought to have a low risk of venous thromboembolism (VTE), but the epidemiology of VTE in cancer patients remains unclear. The National Health Insurance Research Database of Taiwan was used to find hospitalised patients newly-diagnosed with cancer to determine the incidence of VTE in cancer patients and to identify the risk factors for VTE. Between 1997 and 2005, 497,180 cancer patients were identified. During a median follow-up of 21.3 months (range 0–119.9 months), 5,296 patients developed VTE. The estimated incidence was 185 events per 100,000 person-years. Patients with a prior history of VTE and female patients between the ages of 40 and 80 carried high risk of VTE. The rate of VTE was relatively high in patients with myeloma, prostate cancer, lung cancer, gynaecologic cancers, sarcoma, and metastasis of unknown origin. We developed a risk-stratification scoring system to divide the cancer patients into four discrete risk groups (very low risk, low risk, intermediate, and high risk). The incidence of VTE in each group was 0.5%, 0.9%, 1.5%, and 8.7%, respectively (p < 0.001). This scoring system was validated in a separate patient cohort. In conclusion, VTE is a distinct burden for cancer patients in Taiwan. The risk scoring system could prove helpful in decision-making concerning thromboprophylaxis in cancer patients.Note: The results of this paper were presented as an Asian-Pacific Scholarship Award at the 23rd Congress of the International Society on Thrombosis and Haemostasis, Kyoto, Japan, 23–28 July 2011.

scholarly journals Predicting Neutropenia Risk in Breast Cancer Patients from Pre- Chemotherapy Characteristics

2014 ◽  
Vol 8 (1) ◽  
pp. 16-21
Author(s):  
Sodiq Lawal ◽  
Michael J. Korenberg ◽  
Natalia Pittman ◽  
Mihaela Mates
Keyword(s):  
Breast Cancer ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Correlation Coefficient ◽  
Tumor Size ◽  
Odds Ratio ◽  
Risk Group ◽  
High Risk Group ◽  
Breast Cancer Patients ◽  
Computing Device

A previous study (Pittman, Hopman, Mates) of breast cancer patients undergoing curative chemotherapy (CT) found that the third most common reason for emergency department (ER) visits and hospital admission (HA) was febrile neutropenia. Factors associated with ER visits and HA included (1) stage of the cancer, (2) size of tumor, (3) adjuvant versus neo-adjuvant CT (“adjuvance”), and (4) number of CT cycles. We hypothesized that a statistically-significant predictor of neutropenia could be built based on some of these factors, so that risk of neutropenia predicted for a patient feeling unwell during CT could be used in weighing need to visit the ER. The number of CT cycles was not used as a factor so that the predictor could calculate the neutropenia risk for a patient before the first CT cycle. Different models were built corresponding to different pre-chemotherapy factors or combinations of factors. The single factor yielding the best classification accuracy was tumor size (Mathews’ correlation coefficient φ = +0.18, Fisher’s exact two-tailed probability P < 0.0374). The odds ratio of developing febrile neutropenia for the predicted high-risk group compared to the predicted low-risk group was 5.1875. Combining tumor size with adjuvance yielded a slightly more accurate predictor (Mathews’ correlation coefficient φ = +0.19, Fisher’s exact two-tailed probability P < 0.0331, odds ratio = 5.5093). Based on the observed odds ratios, we conclude that a simple predictor of neutropenia may have value in deciding whether to recommend an ER visit. The predictor is sufficiently fast that it can run conveniently as an Applet on a mobile computing device.

scholarly journals Treatment and secondary prevention of venous thromboembolism in cancer patients

Kardiologiia ◽  
2020 ◽  
Vol 60 (3) ◽  
pp. 71-79
Author(s):  
G. A. Shakaryants ◽  
D. A. Budanova ◽  
K. V. Lobastov ◽  
N. V. Khabarova ◽  
Yu. Yu. Kirichenko ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Secondary Prevention ◽  
Cancer Patients ◽  
Risk Group ◽  
High Risk Group ◽  
Efficacy And Safety ◽  
Thromboembolic Complications ◽  
Oncological Patients ◽  
Venous Thromboembolic

Oncological patients are a high-risk group for venous thromboembolic complications. These complications significantly impair the outcome of antitumor treatment and take a leading place in the structure of mortality. Treatment of venous thromboembolic complications in oncological patients is a serious challenge. When selecting an anticoagulant, the physician should consider its efficacy and safety and possible drug interactions. Based on results of multiple studies presented in this article, physicians will be able to choose an optimum therapeutic tactics and secondary prevention of thromboembolic complications for this group of patients.

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