Abstract：
BACKGROUND: Venous thromboembolism is the leading cause of death in cancer patients, second only to tumor progression. The Khorana score is recommended by clinical guidelines for identifying ambulatory cancer patients at high risk of venous thromboembolism during chemotherapy. However, its predictive performance is debated among cancer patients.
OBJECTIVE: To map the applicability of the Khorana score in cancer patients and to assess its predictive performance across various cancer types, providing guidance for clinicians and nurses to use it more appropriately.
METHODS: Systematic review and meta-analysis.
METHODS: A comprehensive literature search of the electronic database was first conducted on August 30, 2023, and updated on May 20, 2024. Studies examining the Khorana score\'s predictive performance (including but not limited to the areas under the curve, C-index, and calibration plot) in cancer patients were included. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was applied to evaluate the methodological quality of the included studies. Data synthesis was achieved via random-effects meta-analysis using the R studio software. The subgroup analysis was performed according to the study design, clinical setting, cancer type, anti-cancer treatment stage, and country.
RESULTS: The review incorporated 67 studies, including 58 observational studies and nine randomized controlled trials. All included studies assessed the Khorana score\'s discrimination, with the C-index ranging from 0.40 to 0.84. The pooled C-index for randomized controlled trials was 0.61 (95 % CI 0.51-0.70), while observational studies showed a pooled C-index of 0.59 (95 % CI 0.57-0.60). Subgroup analyses revealed the pooled C-index for lung cancer, lymphoma, gastrointestinal cancer, and mixed cancer patients as 0.60 (95 % CI 0.53-0.67), 0.56 (95 % CI 0.51-0.61), 0.59 (95 % CI 0.39-0.76), and 0.60 (95 % CI 0.58-0.61), respectively. Inpatient and outpatient settings had the pooled C-index of 0.60 (95 % CI 0.58-0.63) and 0.58 (95 % CI 0.55-0.61), respectively. Calibration was assessed in only four studies. All included studies were identified to have a high risk of bias according to PROBAST.
CONCLUSIONS: The Khorana score has been widely validated in various types of cancer patients; however, it exhibited poor capability (pooled C-index<0.7) in accurately discriminating VTE risk among most types of cancer patients either in inpatient or outpatient settings. The Khorana score should be used with caution, and high-quality studies are needed to further validate its predictive performance.
BACKGROUND: The protocol for this study is registered with PROSPERO (registration number: CRD42023470320).
OBJECTIVE: To map the applicability of the Khorana score in cancer patients and to assess its predictive performance across various cancer types, providing guidance for clinicians and nurses to use it more appropriately.
METHODS: Systematic review and meta-analysis.
METHODS: A comprehensive literature search of the electronic database was first conducted on August 30, 2023, and updated on May 20, 2024. Studies examining the Khorana score\'s predictive performance (including but not limited to the areas under the curve, C-index, and calibration plot) in cancer patients were included. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was applied to evaluate the methodological quality of the included studies. Data synthesis was achieved via random-effects meta-analysis using the R studio software. The subgroup analysis was performed according to the study design, clinical setting, cancer type, anti-cancer treatment stage, and country.
RESULTS: The review incorporated 67 studies, including 58 observational studies and nine randomized controlled trials. All included studies assessed the Khorana score\'s discrimination, with the C-index ranging from 0.40 to 0.84. The pooled C-index for randomized controlled trials was 0.61 (95 % CI 0.51-0.70), while observational studies showed a pooled C-index of 0.59 (95 % CI 0.57-0.60). Subgroup analyses revealed the pooled C-index for lung cancer, lymphoma, gastrointestinal cancer, and mixed cancer patients as 0.60 (95 % CI 0.53-0.67), 0.56 (95 % CI 0.51-0.61), 0.59 (95 % CI 0.39-0.76), and 0.60 (95 % CI 0.58-0.61), respectively. Inpatient and outpatient settings had the pooled C-index of 0.60 (95 % CI 0.58-0.63) and 0.58 (95 % CI 0.55-0.61), respectively. Calibration was assessed in only four studies. All included studies were identified to have a high risk of bias according to PROBAST.
CONCLUSIONS: The Khorana score has been widely validated in various types of cancer patients; however, it exhibited poor capability (pooled C-index<0.7) in accurately discriminating VTE risk among most types of cancer patients either in inpatient or outpatient settings. The Khorana score should be used with caution, and high-quality studies are needed to further validate its predictive performance.
BACKGROUND: The protocol for this study is registered with PROSPERO (registration number: CRD42023470320).
摘要：
背景：静脉血栓栓塞是癌症患者死亡的主要原因，仅次于肿瘤进展。临床指南建议使用Khorana评分来识别化疗期间静脉血栓栓塞高风险的门诊癌症患者。然而,其预测性能在癌症患者中存在争议。
目的：绘制Khorana评分在癌症患者中的适用性，并评估其在各种癌症类型中的预测性能，为临床医生和护士更恰当地使用它提供指导。
方法：系统评价和荟萃分析。
方法：电子数据库的全面文献检索首次于2023年8月30日进行，并于2024年5月20日进行了更新。检查Khorana分数的预测性能的研究(包括但不限于曲线下的面积，C指数，和校准图）包括癌症患者。采用偏倚风险预测模型评估工具(PROBAST)对纳入研究的方法学质量进行评价。使用Rstudio软件通过随机效应荟萃分析实现数据合成。根据研究设计进行亚组分析，临床设置，癌症类型,抗癌治疗阶段，和国家。
结果：该综述纳入了67项研究，包括58项观察性研究和9项随机对照试验.所有纳入的研究都评估了Khorana评分的歧视，C指数范围从0.40到0.84。随机对照试验的合并C指数为0.61(95%CI0.51-0.70)，而观察性研究显示合并C指数为0.59（95%CI0.57-0.60）。亚组分析显示肺癌的合并C指数，淋巴瘤胃肠道癌,混合癌患者为0.60（95%CI0.53-0.67），0.56（95%CI0.51-0.61），0.59（95%CI0.39-0.76），和0.60（95%CI0.58-0.61），分别。住院和门诊设置的合并C指数为0.60（95％CI0.58-0.63）和0.58（95％CI0.55-0.61），分别。仅在四项研究中评估校准。根据PROBAST，所有纳入的研究均被确定为具有较高的偏倚风险。
结论：Khorana评分已在各种类型的癌症患者中得到广泛验证；然而，在大多数类型的癌症患者中,无论是住院患者还是门诊患者,其VTE风险辨别能力均较差(合并C指数<0.7).Khorana分数应该谨慎使用，需要高质量的研究来进一步验证其预测性能。
背景：本研究的方案已在PROSPERO注册（注册号：CRD42023470320）。
目的：绘制Khorana评分在癌症患者中的适用性，并评估其在各种癌症类型中的预测性能，为临床医生和护士更恰当地使用它提供指导。
方法：系统评价和荟萃分析。
方法：电子数据库的全面文献检索首次于2023年8月30日进行，并于2024年5月20日进行了更新。检查Khorana分数的预测性能的研究(包括但不限于曲线下的面积，C指数，和校准图）包括癌症患者。采用偏倚风险预测模型评估工具(PROBAST)对纳入研究的方法学质量进行评价。使用Rstudio软件通过随机效应荟萃分析实现数据合成。根据研究设计进行亚组分析，临床设置，癌症类型,抗癌治疗阶段，和国家。
结果：该综述纳入了67项研究，包括58项观察性研究和9项随机对照试验.所有纳入的研究都评估了Khorana评分的歧视，C指数范围从0.40到0.84。随机对照试验的合并C指数为0.61(95%CI0.51-0.70)，而观察性研究显示合并C指数为0.59（95%CI0.57-0.60）。亚组分析显示肺癌的合并C指数，淋巴瘤胃肠道癌,混合癌患者为0.60（95%CI0.53-0.67），0.56（95%CI0.51-0.61），0.59（95%CI0.39-0.76），和0.60（95%CI0.58-0.61），分别。住院和门诊设置的合并C指数为0.60（95％CI0.58-0.63）和0.58（95％CI0.55-0.61），分别。仅在四项研究中评估校准。根据PROBAST，所有纳入的研究均被确定为具有较高的偏倚风险。
结论：Khorana评分已在各种类型的癌症患者中得到广泛验证；然而，在大多数类型的癌症患者中,无论是住院患者还是门诊患者,其VTE风险辨别能力均较差(合并C指数<0.7).Khorana分数应该谨慎使用，需要高质量的研究来进一步验证其预测性能。
背景：本研究的方案已在PROSPERO注册（注册号：CRD42023470320）。
