Published online Oct 15, 2023. doi: 10.4251/wjgo.v15.i10.1784
Peer-review started: June 15, 2023
First decision: August 7, 2023
Revised: August 21, 2023
Accepted: September 18, 2023
Article in press: September 18, 2023
Published online: October 15, 2023
The incidence of and mortality associated with gastric and colorectal cancers have reached the top five positions in Japan. Cancer-associated thrombosis is one of the most dangerous complications and is directly related to patient prognosis. The Khorana risk score (KRS) is a risk scoring tool and has been internally and externally validated for stratifying thrombotic risks in patients with cancer.
Studies on the relationship between KRS and all-cause mortality are limited. In addition, investigations in Asian populations are especially lacking, and the follow-up observation time for predicting early mortality is not long, which does not exclude the possibility that KRS possesses the ability to predict long-term survival.
We performed a retrospective analysis to investigate whether KRS was independently related to all-cause mortality in Japanese patients with gastric and colorectal cancer after adjusting for other covariates and to shed light on its temporal validity.
This retrospective study was conducted using data from the Dryad database. Patient's KRS obtained at baseline prior to chemotherapy served as the independent variable, and all-cause mortality (dichotomous variable: Death = 1; survival = 0) served as the dependent (target) variable. The KRS was categorized into three groups: low-risk group, intermediate-risk group, and high-risk group. All analyses were performed using the statistical software packages R 3.3.2 and Free Statistics software version 1.7.
In our study, a total of 500 participants were selected for the final data analysis . Their median follow-up time was 22.0 mo. The average age was 68.9 (62.5 ± 75.9) years, and 38.8% were women. There were 194 participants in the KRS low-risk group, 218 in the moderate-risk group, and 88 in the high-risk group. The risk of death within 6 mo was 2.17 times higher in the KRS intermediate-risk group than in the low-risk group (95%CI: 1.01-4.67; P = 0.047) and 2.37 times higher in the KRS high-risk group than in the low-risk group (95%CI: 0.89-3.29; P = 0.083). At the same time, the risk of death within 2 years was 1.45 times higher in the intermediate-risk group than in the low-risk group (95%CI: 1.02-2.06; P = 0.041) and 2.02 times higher in the high-risk group than in the low-risk group (95%CI: 1.26-3.24; P = 0.004). Men and patients with Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥ 2 displayed a higher 2-year risk of death than women and those with ECOG PS 0-1 in the intermediate/high risk group for KRS.
The overall survival of each patient was recorded via real-world follow-up and retrospective observations, and this study yielded the overall relationship between KRS and all-cause mortality. In Japanese patients with gastric and colorectal cancer, the prechemotherapy baseline of KRS was independently associated with all-cause mortality within 2 years. The higher the score, the higher the risk of early death; however, the relevance of this independent prediction decreased with longer survival.
A concept of time-sensitive management needs to be established for clinicians and community workers as well, i.e., the earlier the stratified intervention for patients with intermediate/high KRS, the more likely long-term survival benefit will be achieved. Further study with large sample size and more comprehensive prognostic information is desired to verify our findings.