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Validating Khorana Risk Score in gastric cancer patients on immune checkpoint inhibitors and chemotherapy
Junmin Song1, Ahmed Ashraf Morgan1, Jaeun Ahn2
1Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Introduction:
Patients with gastric cancer are at a high risk of venous thromboembolism (VTE), and immune checkpoint inhibitors (ICIs) may further increase this risk. While the Khorana Risk Score (KRS) has been validated primarily in chemotherapy-treated populations, its utility in ICI-treated patients remains unclear.
Methods:
Using the TriNetX Global Collaborative Network, we analyzed data from 2782 patients with gastric cancer treated with ICIs. Patients were stratified into high-risk (KRS ≥3) and intermediate-risk (KRS = 2) groups based on pre-treatment laboratory values and BMI. Cox proportional-hazards analyses were performed to evaluate the association between KRS and outcomes, including VTE, all-cause mortality, and arterial thrombosis, over a one-year follow-up period.
Results:
High-risk patients had a 26% higher risk of VTE (HR: 1.26, [95% CI: 1.06-1.50]) and a 43% higher risk of all-cause mortality (HR: 1.43, [95% CI: 1.27-1.62]) compared to intermediate-risk patients. The incidence of deep vein thrombosis (DVT) was also significantly higher in the high-risk group (HR: 1.27, [95% CI: 1.01-1.59]), but no significant differences were observed for pulmonary embolism (PE) or arterial thrombosis.
Conclusion:
These findings suggest the KRS may effectively stratify VTE risk and mortality in gastric cancer patients treated with ICIs.
