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COMPASS-CAT versus Khorana risk assessment model for predicting venous thromboembolic events in patients with non-small cell lung cancer on active treatment with chemotherapy and/or immunotherapy, the CK-RAM study

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Abstract

Cancer patients are at higher risk for venous thromboembolism (VTE). Several risk assessment models (RAM), including the Khorana and COMPASS-CAT, were developed to help predict the occurrence of VTE in cancer patients on active anti-cancer therapy. We aim to study the prevalence and predictors of VTE among patients with non-small cell lung cancer (NSCLC) and compare both RAMs in predicting VTE in patients with NSCLC were retrospectively reviewed. Variables known to increase the risk of VTE were collected and risk of VTE was assessed using both Khorana and COMPASS-CAT RAM. A total of 508 patients (mean age ± SD, 58.4 ± 12.2 years) were enrolled. Most (n = 357, 70.3%) patients had adenocarcinoma, and 333 (65.6%) patients had metastatic disease. VTE were confirmed in 76 (15.0%) patients. Rates were higher among patients with metastatic disease (19.8%, p < 0.001), adenocarcinoma (17.4%, p = 0.01) and those treated with immunotherapy (23.5%, p = 0.014). VTE rates were 21.2%, 14.1% and 13.9% among those with high (n = 66), intermediate (n = 341) and low (n = 101) Khorana risk scores, respectively (p = 0.126). On the other hand, 190 (37.4%) were classified as high risk by the COMPASS-CAT RAM; 52 (27.4%) of them had VTE compared to 24 (7.5%) of the remaining 318 (62.6%) classified as Low/Intermediate risk level, p < 0.001. In conclusion, patients with NSCLC are at high risk for VTE, especially those with adenocarcinoma, metastatic disease and when treated with immunotherapy. Compared to Khorana RAM, COMPASS-CAT RAM was better in identifying more patients in high-risk group, with higher VTE rate.

Key points

  • VTE rates in patients with lung cancer is relatively high; more so with metastatic disease and in patients with adenocarcinoma.

  • Molecular alterations have no effect on VTE rates; however, use of immunotherapy is associated with higher rates.

  • COMPASS-CAT RAM is better than Khorana RAM in segregating patients into different risk levels.

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Data Availability

All data and materials are available from the corresponding authors upon written request.

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Acknowledgements

The authors would like to acknowledge and thanks Mrs. Ayat Taqash for her help in preparing the statistical analysis.

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Authors and Affiliations

  1. Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan

    Hikmat Abdel-Razeq, Baha’ Sharaf, Hala Abu-Fares, Rayan Bater, Moataz Abu Shaer, Osama Salamah, Faris Tamimi, Khalid Ashouri, Tareq Salameh, Raed Zughul & Yazan Alhalaseh

  2. School of Medicine, The University of Jordan, Queen Rania Al Abdullah Street, P.O. Box: 1269, Amman, 11941, Jordan

    Hikmat Abdel-Razeq

  3. Respiratory Institute - Cleveland Clinic Foundation, Cleveland, OH, USA

    Mohammed J. Al-Jaghbeer

  4. School of Medicine, Jordan University of Science and Technology, Irbid, Jordan

    Hala Abu-Jaish

  5. Department of Radiology, King Hussein Cancer Center, Amman, Jordan

    Dima Abu Laban

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  1. Hikmat Abdel-Razeq
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Contributions

HAR and MJA conceived and designed the study. BS,HAF,RB,MAS,HAJ,DAL,OS,FT, KA,TS,RZ,YH collected the data. HAR, MJA, BS, HAF,RB analyzed and interpreted the data. HAF, RB performed the statistical analysis. HAR, BS, MJA drafted the manuscript. HAR, BS, RB supervised the study. All authors read and approved the final manuscript.

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Correspondence to Hikmat Abdel-Razeq.

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The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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This study was presented in-part as an oral presentation during the 30th Congress of the International Society on Thrombosis and Hemostasis (ISTH). London, UK. 9–13 July, 2022.

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Abdel-Razeq, H., Sharaf, B., Al-Jaghbeer, M.J. et al. COMPASS-CAT versus Khorana risk assessment model for predicting venous thromboembolic events in patients with non-small cell lung cancer on active treatment with chemotherapy and/or immunotherapy, the CK-RAM study. J Thromb Thrombolysis 56, 447–453 (2023). https://doi.org/10.1007/s11239-023-02860-4

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