Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2023; 15(10): 1784-1795
Published online Oct 15, 2023. doi: 10.4251/wjgo.v15.i10.1784
Association between the Khorana risk score and all-cause mortality in Japanese patients with gastric and colorectal cancer: A retrospective cohort study
Yu-Feng Zhang, Guo-Dong Wang, Min-Guang Huang, Zhao-Qi Qiu, Jia Si, Mao-Yi Xu
Yu-Feng Zhang, Guo-Dong Wang, Min-Guang Huang, Zhao-Qi Qiu, Department of Oncology Radiotherapy, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji 311800, Zhejiang Province, China
Jia Si, Department of Electrocardiography, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji 311800, Zhejiang Province, China
Mao-Yi Xu, Department of Oncology, The First Hospital of Jiaxing (Affiliated Hospital of Jiaxing University), Jiaxing 314000, Zhejiang Province, China
Author contributions: Xu MY contributed to the study design and manuscript composition; Zhang YF and Si J helped to perform and check the statistical analysis; Qiu ZQ contributed to data collection and analysis; Wang GD and Huang MG contributed to proofreading and final approval of the article.
Supported by the Key Medical Disciplines Jointly Established by the Zhejiang Province and Jiaxing City: Oncology, No. 2023-SSGJ-001; and Jiaxing Key Laboratory of Tumor Radiotherapy, No. 2021-zlzdsys.
Institutional review board statement: The institutional review board of Affiliated Hospital of Jiaxing University approved this study (Approval No. 2023-LY-244).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mao-Yi Xu, MD, Doctor, Department of Oncology, The First Hospital of Jiaxing (Affiliated Hospital of Jiaxing University), No. 1882 South Central Road, Jiaxing 314000, Zhejiang Province, China. maoyixu1991@163.com
Received: June 15, 2023
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
Processing time: 116 Days and 16.6 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.