# Assessing venous thromboembolism risk in lung cancer: a comprehensive evaluation of the khorana score, clinical characteristics, and incidence of thrombosis

## TL;DR

This study evaluates how well the Khorana Score predicts blood clots in lung cancer patients and finds it's not very effective, suggesting new risk factors should be considered.

## Contribution

Identifies limitations of the Khorana Score in lung cancer and highlights new clinical factors associated with venous thromboembolism risk.

## Key findings

- The Khorana Score did not significantly predict venous thromboembolism (VTE) incidence in lung cancer patients.
- NSCLC histology, Black race, and oncogenic driver mutations were associated with increased VTE risk.
- No significant survival differences were found between patients with and without VTE.

## Abstract

Venous thromboembolism (VTE) occurrence in patients with lung cancer is associated with significant morbidity and mortality. The Khorana Score (KRS) is a validated risk stratification tool developed to estimate risk of VTE in patients with cancer that incorporates clinical and laboratory parameters to calculate individual risk. However, limitations of the KRS in lung cancer have been reported, and identification of other risk factors associated with increased risk of VTE are needed in this population.

We retrospectively evaluated 485 patients with advanced non-small cell lung cancer (NSCLC) and 67 patients with small cell lung cancer (SCLC) treated at our institution between March 2015 and April 2023 to assess the performance of the KRS in estimating risk of VTE in multiple clinically distinct subtypes of lung cancer.

The median patient age at diagnosis was 66 years (range, 30-94 years). Patients were predominantly male (51.1%), Caucasian (81%), and had a history of smoking (79.4%). VTE events were observed in 123 patients (22.3%); 51 patients had DVT (41.5%), 50 patients had PE (40.7%), 13 patients had concurrent DVT and PE (7.3%), and other VTE occurred in 9 patients (7.3%). 478 patients (86.6%) had low-risk KRS (score = 0-2) and 74 patients (13.4%) had high-risk KRS (score ≥3). No statistically significant difference in VTE incidence was observed based on baseline KRS. Clinical factors that were noted to be associated with increased risk of VTE were NSCLC histology, Black race, and the presence of an oncogenic driver mutation. No significant differences in overall survival were noted in patients that experienced VTE.

This study highlights the limitations of the KRS in predicting risk of development of VTE in patients with NSCLC and SCLC and identifies multiple clinical parameters associated with increased risk of VTE. Development of further risk stratification tools incorporating these clinical factors in addition to those in the KRS should be considered.