The Kagoshima-DVT Score Is a Useful Predictive Model for Cancer-Associated Thrombosis in Patients With Gastrointestinal Cancer

Abstract

Background: Cancer-associated thrombosis (CAT) is a common complication of cancer and has received increasing attention; the Khorana Risk Score (KRS) is a recommended but insufficient risk assessment model for CAT. We propose a novel Kagoshima-DVT score (KDS) to predict preoperative deep vein thrombosis (DVT). This scoring method scores D-dimer ≥1.5 μg/mL, age ≥60 years, female sex, ongoing glucocorticoids, cancer with high risk of DVT, and prolonged immobility. The purpose of this study was to compare the performance of the KDS and KRS in predicting CAT in patients with gastrointestinal cancer. Methods and Results: In all, 250 patients without a history of thrombosis who received their first chemotherapy for gastrointestinal cancer were divided into low- (48.0%), intermediate- (38.8%), and high-risk (13.2%) groups for CAT development by the KDS. The patients' median age was 67 years and 63.2% were men. In all, 61 (27.1%) patients developed CAT (17.6%, 35.3%, and 36.4% of patients in the low-, intermediate, and high-risk groups, respectively; log-rank P=0.006). The area under the time-dependent receiver operating characteristic curve for CAT occurrence within 1 year was larger for the KDS than KRS (0.653 vs. 0.494). Conclusions: A high KDS at the start of first chemotherapy is a risk indicator for CAT development during chemotherapy. Moreover, the KDS is more useful than the KRS in predicting CAT risk.

Keywords: Cancer-associated thrombosis; Kagoshima-DVT score; Khorana risk score.

Figure 1.

Study flowchart. The median observation period, with interquartile range, is indicated.

Figure 2.

Computed tomography measurement before the start of chemotherapy of psoas muscle volume, L3-level psoas muscle area, the psoas muscle index (PMI), subcutaneous fat area at the umbilical level, and internal fat area at the umbilical level using image analysis software (SYNAPSE VINCENT, ver. 4.6; FUJIFILM Medical Co., Tokyo, Japan). The psoas muscle is shown in green, visceral fat in red, and subcutaneous fat in blue.

Figure 3.

Distribution of Kagoshima-DVT scores (KDS). Patients were divided into low-, intermediate-, and high-risk groups for developing deep venous thrombosis (DVT) based on KDS of 0–2, 3–4, and 5–7, respectively.

Figure 4.

Kaplan-Meier curves showing the cancer-associated thrombosis (CAT)-free rate over time in patients in the low-, intermediate-, and high-risk groups based on the Kagoshima-DVT score (KDS). The KDS is evaluated considering D-dimer ≥1.5 μg/mL, age ≥60 years, female sex, ongoing glucocorticoids, cancer with a high risk of deep venous thrombosis (DVT), and prolonged immobility. A KDS of 0–2 is defined as low risk, a KDS of 3–4 is defined as intermediate risk, and a KDS of 5–7 is defined as high risk.

Figure 5.

Time-dependent receiver operating characteristic curves for cancer-associated thrombosis (CAT) events within 1 year for the Khorana risk score (KRS) and Kagoshima-DVT score (KDS). AUC, area under curve.