OC 16.1 - External validation of the Khorana and Vienna-CATS nomogram scores in cancer patients of the HYPERCAN cohort

Sunday, July 10, 2022

10:45 AM – 11:00 AM

Location: ExCel Center, ICC Capital Suite Room 8&9

Presentation Format: In-Person

Presenting Author(s)

Marina Marchetti, PhD

Hematologist
Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
Bergamo, Lombardia, Italy

Co-Author(s)

CV

Cristina Verzeroli

Hospital biologist assistant
ASST Papa Giovanni XXIII Bergamo, Italy
Bergamo, Lombardia, Italy
CG

Cinzia Giaccherini

Hospital biologist assistant
ASST Papa Giovanni XXIII Bergamo, Italy
Bergamo, Lombardia, Italy
LR

Laura Russo

Hospital biologist assistant
ASST Papa Giovanni XXIII Bergamo, Italy
Bergamo, Lombardia, Italy
SG

Sara Gamba

Hospital biologist assistant
ASST Papa Giovanni XXIII Bergamo, Italy
Bergamo, Lombardia, Italy
CT

Carmen Tartari

Hospital biologist assistant
ASST Papa Giovanni XXIII Bergamo, Italy
Bergamo, Lombardia, Italy
SB

Silvia Bolognini

Hospital biologist assistant
ASST Papa Giovanni XXIII Bergamo, Italy
Bergamo, Lombardia, Italy
CT

Chiara Ticozzi

Hospital biologist assistant
ASST Papa Giovanni XXIII Bergamo, Italy
Bergamo, Lombardia, Italy
AS

Armando Santoro

Director of Oncology Unit
IRCCS Humanitas Institute, Rozzano, Italy
MIlano, Lombardia, Italy
FD

Filippo De Braud

Director of Oncology Unit
IRCCS National Cancer Institute, Milan, Italy
Milano, Lombardia, Italy
GG

Giampietro Gasparini

Director of Oncology Unit
Hospital San Filippo Neri, Rome, Italy
Roma, Lazio, Italy
FP

Fausto Petrelli

Director of Oncology Unit
Hospital Treviglio-Caravaggio, Treviglio, Italy
Treviglio, Lombardia, Italy
FG

Francesco Giuliani

Hospital medical assistant
IRCCS Cancer Institute Giovanni Paolo II, Bari, Italy
Bari, Puglia, Italy
AD

Andrea D'Alessio

Director of Medical Oncology and Internal Medicine Unit
Policlinico San Marco, Zingonia, Italy
Zingonia, Lombardia, Italy
MM

Mauro Minelli

Director of Oncology Unit
Hospital San Giovanni Addolorata, Rome, Italy
Roma, Lazio, Italy
RL

Roberto Labianca

Professor of Oncology
DIPO, ASST Papa Giovanni XXIII, Bergamo, Italy
Bergamo, Lombardia, Italy
CM

Chiara Morlotti

Assistant Professor
University of Bergamo, Bergamo, Italy
Bergamo, Lombardia, Italy
PM

Paolo Malighetti

Associate Professor
University of Bergamo, Bergamo, Italy
Bergamo, Lombardia, Italy
DS

Daniele Spinelli

Post-doctoral Researcher
University of Milan-Bicocca, Milan, Italy
Bergamo, Lombardia, Italy
Anna Falanga, MD

Professor of Hematology
Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
Bergamo, Lombardia, Italy

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.