Association of risk factors for venous thromboembolism and overall survival in lung cancer

Venous thromboembolism (VTE) is a frequent complication in patients with lung cancer, but the risk factors and incidence in different lung cancer subtypes have not been fully characterized. Despite multiple studies supporting the use of VTE prophylaxis in patients with cancer at increased risk of VTE based on the Khorana score (KS), routine use of VTE prophylaxis is uncommon in clinical practice. This study further characterizes the risk factors and incidence of VTE in patients with lung cancer at a university cancer center. Furthermore, we assessed the association of KS and its individual components with overall survival in this same group of patients. Using natural language processing and human review to detect thrombotic events in the electronic medical record, a 12-month incidence of 10.1% was identified in the 632 patients with lung cancer analyzed. Significant risk factors included age <60 years and white blood cell (WBC) count ≥11 × 10⁹/L, but KS itself was not significantly associated with VTE. The median overall survival was 12 months with VTE. The KS, age ≥60 years, stage III to IV, WBC count ≥11 × 10⁹/L, hemoglobin <10 g/dL, body mass index, surgery, and VTE were identified as significant predictors of death. These findings warrant further validation, because the KS and 2 of its individual components in this study of lung cancer were significantly associated with reduced overall survival.