The Khorana score as a predictor of mortality in lung adenocarcinoma

Background: Venous thromboembolism (VTE) is one of the most common complications in lung cancer. Khorana score is an established tool for thromboembolic risk stratification of ambulatory cancer patients undergoing outpatient chemotherapy. Aims and objectives: We aimed to further investigate the value of the Khorana score as a predictor of early cancer-related mortality in patients with lung adenocarcinoma receiving first line or adjuvant chemotherapy. Methods: Medical records of 130 lung adenocarcinoma patients treated with first line or adjuvant chemotherapy in Sotiria General Hospital, Athens, Greece, from June 2013 to May 2015 were retrospectively reviewed. Demographic and clinicopathological features, including disease stage at diagnosis, line of treatment, occurrence of VTE and VTE symptoms were recorded; Khorana risk score was calculated and correlated with VTE events. All variables were correlated with survival. Results: VTE occurred in13 patients (10.0%). Occurrence of thromboembolic events was significantly correlated with reduced survival during treatment period (HR 3.24; 95% CI 1.11-9.49; P = 0.032). VTE rates did not present statistically significant difference between different Khorana score groups (P = 0.96). In univariate analysis, the risk of death was 3.75 times higher in high versus intermediate risk patients (95% CI 1,36-10,36; p=0,001) and 2.25 times higher per point increase in the Khorana score (95% CI: 1,36-3,73; p=0,002); the above results were also confirmed in multivariate analysis. Conclusions: High-risk Khorana score may represent an independent predictor of reduced survival in lung adenocarcinoma patients receiving first line or adjuvant chemotherapy.