Khorana score and thromboembolic risk in stage II-III colorectal cancer patients: a post hoc analysis from the adjuvant TOSCA trial

Sandro Barni, Gerardo Rosati, Sara Lonardi, Nicoletta Pella, Maria Banzi, Maria G Zampino, Katia F Dotti, Lorenza Rimassa, Paolo Marchetti, Evaristo Maiello, Fabrizio Artioli, Daris Ferrari, Roberto Labianca, Paolo Bidoli, Alberto Zaniboni, Alberto Sobrero, Vincenzo Iaffaioli, Sabino De Placido, Gian Luca Frassineti, Andrea CiarloAngela Buonadonna, Nicola Silvestris, Elena Piazza, Lorenzo Pavesi, Mauro Moroni, Mario Clerico, Massimo Aglietta, Paolo Giordani, Francesca Galli, Fabio Galli, Fausto Petrelli

Research output: Contribution to journalArticlepeer-review


Background: The risk of venous thromboembolic events (VTE) during adjuvant chemotherapy for colorectal cancer (CRC) is unknown. We aim to evaluate if the Khorana score (KS) can predict this risk, and if it represents a prognostic factor for overall survival (OS) through a post hoc analysis of the phase III TOSCA trial of different durations (3- versus 6-months) of adjuvant chemotherapy.Methods: A logistic regression model was used to test the associations between the risk of VTE and the KS. The results are expressed as odds ratios (OR) with 95% confidence intervals (95% CI). To assess the effect of the KS on OS, multivariable analyses using Cox regression models were performed. The results are expressed as hazard ratios (HR) with 95% CI.Results: Among 1380 CRC patients with available data, the VTE risk (n = 72 events: 5.2%) was similar in the two duration arms (5.5% versus 4.9%), with 0.2% of patients belonging to the high-risk KS group. Rates of VTE were similar in the low- and intermediate-risk groups (4.8% versus 6.4%). KS did not represent an independent predictive factor for VTE occurrence. Chemotherapy duration was not associated with VTE risk. In addition, KS was not prognostic for OS in multivariate analysis (HR: 0.92, 95% CI, 0.63-1.36; p = 0.6835).Conclusions: The use of the KS did not predict VTEs in a low-moderate thromboembolic risk population as CRC. These data did not support the use of KS to predict VTE during adjuvant chemotherapy, and suggest that other risk assessment models should be researched.
Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalTherapeutic Advances in Medical Oncology
Publication statusPublished - Jan 20 2020


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