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Cholangiocarcinoma News

The Khorana Score Not Predictive of Thrombotic Events in Patients with Biliary Tract Cancer

December 2020, Vol 1, No 3

Cancer-related venous thromboembolism (VTE) is a significant cause of morbidity and mortality.1,2 There is a paucity of studies characterizing VTE in patients with biliary tract cancer; however, a few retrospective analyses suggest an incidence of VTE of up to 23%.3-5

The Khorana score is a validated, frequently used tool to help predict the risk for VTE in patients with cancer in the ambulatory setting.6 However, this score has not been assessed in patients with biliary tract cancer.

Sandra Algaze, MD, Hematology-Oncology Chief Fellow, Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, and colleagues, have recently conducted a retrospective chart review to characterize thrombotic events and clinical risk factors for VTE in 369 patients with biliary tract cancer at tertiary care centers and to evaluate the benefit of the Khorana score in this patient population.

No differences were observed between low-, intermediate-, and high-risk Khorana score. When the components of the Khorana score were analyzed separately, there was a significantly greater proportion of patients with VTE and a leukocyte count of more than 11,000 (P = .016).

“The Khorana score was not quite predictive of VTE in patients with biliary tract cancers, in our cohort at least,” Dr Algaze said. “We were not able to find a difference when we compared the VTE to the non-VTE group and low-, intermediate-, or high-risk groups. However, when stratifying them to their components, we did see the patients with VTE did have significantly greater (>11,000 white blood cells per microliter) leukocyte counts. Development of an applicable VTE risk model in this population is desirable,” she noted.


  1. Noble S, Pasi J. Epidemiology and pathophysiology of cancer-associated thrombosis. Br J Cancer. 2010;102(suppl 1):S2-S9.
  2. Sørensen HT, Mellemkjær L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Engl J Med. 2000;343:1846-1850.
  3. Meier A, Khorana AA, Sohal DPS. Incidence of venous thromboembolism in patients with resected biliary tract cancers. Blood. 2016;128:5004.
  4. Jeon HK, Kim DU, Baek DH, et al. Venous thromboembolism in patients with cholangiocarcinoma: focus on risk factors and impact on survival. Eur J Gastroenterol Hepatol. 2012;24:444-449.
  5. Lu CD, Wang K, Zhang CZ, et al. Outcomes of intrahepatic cholangiocarcinoma with portal vein tumor thrombus following hepatic resection. J Gastroenterol Hepatol. 2016;31:1330-1335.
  6. Khorana AA, Kuderer NM, Culakova E, et al. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008;111:4902-4907.

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