A risk score for prediction of venous thromboembolism in gynecologic cancer: The Thrombogyn score

• Main Authors: Lucy A. Norris, Mark P. Ward, Sharon A. O'Toole, Zibi Marchocki, Nadia Ibrahim, Ali S. Khashan, Feras Abu Saadeh, Noreen Gleeson
• Format: Article
• Language: English
• Published: Wiley 2020-07-01
• Series: Research and Practice in Thrombosis and Haemostasis
• Subjects: biomarkers; cancer; risk; thrombin; venous thromboembolism; women
• Online Access: https://doi.org/10.1002/rth2.12342

Abstract Background Gynecologic cancers are associated with high rates of venous thromboembolism (VTE), which is exacerbated by pelvic surgery and chemotherapy. Objectives The aim of this study was to develop and validate a risk score for VTE in patients with gynecologic cancer and to test the predictive ability of the score following addition of procoagulant biomarker data. Patients and methods Clinical and laboratory variables were used to develop a risk score for the prediction of VTE in patients with gynecological cancer (n = 616), which was validated in a separate cohort of patients (n = 406). Endogenous thrombin potential and D‐dimer levels were determined in a subset (n = 290) of patients and used to produce an extended score in the validation cohort. Results Multivariable regression analysis identified BMI >30, hemoglobin <11.5 g/dL and chemotherapy as independent predictors of VTE, which formed the Thrombogyn score. Following competing risk regression analysis, subdistribution hazard ratios (SHRs), adjusted for cancer stage, were 8.16 (95% confidence interval [CI], 1.69‐43.77) in the high‐risk group (score = 2‐3) and 4.12 (95% CI, 0.85‐20.15) in the intermediate‐risk group (score = 1) compared with the low‐risk group (score = 0). SHRs for the validation cohort were 6.26 (95% CI, 1.24‐31.39) and 3.00 (95% CI, 0.67‐13.32), respectively. Cumulative incidence of VTE in the validation cohort high‐risk group was 10.34% (95% CI, 6.51‐16.41) per women‐years compared with 1.06% (95% CI, 0.26‐4.26) in the low‐risk group. Using the extended Thrombogyn score, adjusted SHRs were 16.83 (95% CI, 4.20‐67.37) in the high‐risk group with a cumulative incidence of 21.15% (95% CI, 10.32‐45.24). External validation of the score is required. Conclusions The Thrombogyn score identifies patients with gynecologic cancer at high and low risk of VTE. Addition of biomarker data improves the predictive power of the score.