International journal of nursing studies · 2025
Comparison of modified Khorana scores for prediction of venous thromboembolism in cancer patients: A systematic review and network meta-analysis.
Сравнительное исследованиеСтатьяNetwork Meta-AnalysisСистематический обзорНазвание и аннотация: Перевод пока не подготовлен
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Chen Hongxiu, Wang Yilin, Huang Xuan, Pu Lihui, Zhang Shuai, Li Qingqing, Zhang Xiaoxia, Li Yong, Wang Guan, Hu Xiuying
Аннотация
BACKGROUND: The Khorana score is a guideline-recommended tool for identifying cancer patients at high risk of venous thromboembolism (VTE), while recent evidence indicates that it fails to distinguish low- and high-risk patients accurately. Increasingly, modified Khorana scores are being proposed to improve VTE risk prediction, yet their predictive performance remains uncertain.
OBJECTIVES: This study aimed to systematically evaluate and compare the predictive performance of the modified Khorana scores with the original Khorana score, thereby assisting clinicians in selecting the most appropriate tool for clinical practice.
DESIGN: Systematic review and network meta-analysis.
METHODS: Eight databases were last searched on February 1, 2025, to identify studies that developed or validated the modified Khorana scores. The Prediction Model Risk of Bias Assessment Tool was used to evaluate the risk of bias and applicability concerns of the included studies. Both pairwise and Bayesian network meta-analysis were employed using random effects model to synthesize available data on predictive performances and thoroughly compare the modified and original Khorana scores.
RESULTS: Twenty-eight studies were included, identifying 12 modified versions of the Khorana score. Among these, PROTECHT, CONKO, ONKOTEV, and Vienna CATS were the most extensively validated, with pooled C-indices of 0.59 (95 % confidence interval [CI] 0.56, 0.62), 0.57 (95 % CI 0.54, 0.60), 0.70 (95 % CI 0.56, 0.81), and 0.63 (95 % CI 0.13, 0.95), respectively. In pairwise meta-analysis, no modified Khorana scores were significantly superior to the original Khorana score, while leave-one-out sensitivity analyses showed significantly better performance for CONKO (mean difference [MD] = 0.02, 95 % CI 0.00, 0.04) compared with the original Khorana score. Bayesian network meta-analysis demonstrated that none of the comparisons (PROTECHT, CONKO, ONKOTEV, Vienna CATS, and the original Khorana score) was significantly different (P > 0.05). Calibration performance was rarely reported across the modified scores. The majority of included studies (96.4 %) were identified to have a high risk of bias.
CONCLUSION: Many modified Khorana scores have been developed and validated in different settings and cancer populations. Modified Khorana scores showed limited discriminative ability and were not superior to the original Khorana score. Given the pervasive high risk of bias of included studies and the poor pooled discriminative ability of the modified Khorana scores, the Khorana score and its modifications did not currently meet clinically desirable standards of evidence quality and predictive accuracy. Further large-scale, high-quality validation studies are warranted to validate them comprehensively.
REGISTRATION: The protocol for this study is registered with PROSPERO (registration number: CRD42024601258).
OBJECTIVES: This study aimed to systematically evaluate and compare the predictive performance of the modified Khorana scores with the original Khorana score, thereby assisting clinicians in selecting the most appropriate tool for clinical practice.
DESIGN: Systematic review and network meta-analysis.
METHODS: Eight databases were last searched on February 1, 2025, to identify studies that developed or validated the modified Khorana scores. The Prediction Model Risk of Bias Assessment Tool was used to evaluate the risk of bias and applicability concerns of the included studies. Both pairwise and Bayesian network meta-analysis were employed using random effects model to synthesize available data on predictive performances and thoroughly compare the modified and original Khorana scores.
RESULTS: Twenty-eight studies were included, identifying 12 modified versions of the Khorana score. Among these, PROTECHT, CONKO, ONKOTEV, and Vienna CATS were the most extensively validated, with pooled C-indices of 0.59 (95 % confidence interval [CI] 0.56, 0.62), 0.57 (95 % CI 0.54, 0.60), 0.70 (95 % CI 0.56, 0.81), and 0.63 (95 % CI 0.13, 0.95), respectively. In pairwise meta-analysis, no modified Khorana scores were significantly superior to the original Khorana score, while leave-one-out sensitivity analyses showed significantly better performance for CONKO (mean difference [MD] = 0.02, 95 % CI 0.00, 0.04) compared with the original Khorana score. Bayesian network meta-analysis demonstrated that none of the comparisons (PROTECHT, CONKO, ONKOTEV, Vienna CATS, and the original Khorana score) was significantly different (P > 0.05). Calibration performance was rarely reported across the modified scores. The majority of included studies (96.4 %) were identified to have a high risk of bias.
CONCLUSION: Many modified Khorana scores have been developed and validated in different settings and cancer populations. Modified Khorana scores showed limited discriminative ability and were not superior to the original Khorana score. Given the pervasive high risk of bias of included studies and the poor pooled discriminative ability of the modified Khorana scores, the Khorana score and its modifications did not currently meet clinically desirable standards of evidence quality and predictive accuracy. Further large-scale, high-quality validation studies are warranted to validate them comprehensively.
REGISTRATION: The protocol for this study is registered with PROSPERO (registration number: CRD42024601258).