The Khorana score for the prediction of venous thromboembolism in patients with pancreatic cancer

The Khorana score is a clinical prediction score developed to identify ambulatory cancer patients at high risk of venous thromboembolism (VTE), who may be eligible for thromboprophylaxis. This score has been validated in various populations with cancer, but its performance in patients with pancreatic cancer is less clear. This is a single center, retrospective cohort study in which consecutive, ambulatory patients with pancreatic adenocarcinoma, who started neoadjuvant or palliative chemotherapy at our center between 2003 and 2014 were included. At baseline, the Khorana score classified patients as 'intermediate risk' (2 points) or 'high risk' (≥3 points) for VTE. The primary outcome was the composite of objectively confirmed symptomatic or incidental lower extremity deep vein thrombosis (DVT) or pulmonary embolism (PE) during 2-year follow-up. The study group comprised 178 patients. The mean age was 62years and 62% had distant metastasis. Overall, 22 of 178 patients (12.4%) developed lower extremity DVT or PE. The estimated cumulative incidence at 6months was 8.2% in 'intermediate risk' patients and 9.5% in the 'high risk' patients (subhazard ratio for first 6months: 1.23; 95% CI: 0.41-3.65). At 2years, the cumulative incidence was higher in 'intermediate risk' patients (15.3%) than in 'high risk' patients (10.1%). In the present study, the Khorana score was not able to discriminate between pancreatic cancer patients at intermediate risk and high risk of VTE. Physicians should have a low threshold of considering thromboprophylaxis in patients with pancreatic cancer given the high absolute VTE risk