Prognostic assessment for patients with cancer and incidental pulmonary embolism

Abstract

BackgroundAn incidental/unsuspected diagnosis of pulmonary embolism (IPE) in cancer patients is a frequent occurrence. This single-institution analysis of uniformly managed patients investigates short and long-term outcomes and proposes a prognostic risk score, aiming to assist clinical decision-making.MethodsData from a prospectively recorded cohort of 234 consecutive cancer patients with IPE were analysed. Multivariate logistic regression and the Cox regression survival methods were used to identify factors with independent association with early (30-day, 3-month, 6-month) mortality and survival. Receiver operator characteristic analysis (ROC) was used to assess appropriate cut-offs for continuous variables and the fitness of prognostic scoring.Results30-day, 3-month and 6-month mortality was 3.4% (n = 8), 15% (n = 35) and 31% (n = 72) respectively. Recurrence during anticoagulation occurred in 2.6% (n = 6) and major haemorrhage in 2.1% (n = 5) of the patients. A prognostic score incorporating performance status (0 vs 1–2 vs 3–4) and the presence of new or worsening symptoms, with and without the consideration of the presence of incurable malignancy, correlated with overall survival (p < .001 respectively) as well as early mortality (AUC = .821, p = .004 and AUC = .805, p = 0.006, respectively).ConclusionA simple prognostic score incorporating basic oncologic clinical assessment and self-reported symptomatology could reliably stratify the mortality risk of ambulant cancer patients and IPE.Trial registrationAudit registration No. 2013.287, Hull and East Yorkshire Hospitals Trust, 29/11/2013.Electronic supplementary materialThe online version of this article (10.1186/s12959-017-0157-x) contains supplementary material, which is available to authorized users.

High D-dimer is a predictor for short-term mortality in patients with active cancer and acute pulmonary embolism

“…In the EPIPHANY study, the mortality rate was 14% in 30 days. However, the mortality risk increased in inpatient settings, symptomatic or suspicious PE, and abnormal vital signs [21,22]. In the current study, the enrolled patients had inpatient settings and suspicious PE.…”

“…Nevertheless, high-risk PESI scores were significantly associated with three times higher mortality than in intermediate-risk PESI scores. In the previous studies, PESI tended to have a discriminatory power in cancer patients with PE [21]. However, the prognostic accuracy of PESI in patients with cancer diminished compared with its accuracy in the whole population [8].…”

“…Similarly, cancer patients with venous thromboembolism (VTE) have been shown to have a poorer prognosis compared to those without VTE [19]. Cancer patients with acute PE had higher mortality compared to non-cancer patients in recent studies [20,21]. In a meta-analysis, the overall 30-day mortality rate was 2.3% in the low-risk group and 11.4% in the highrisk group among cancer patients with incidental PE [17].…”

Correction to: Prognostic assessment for patients with cancer and incidental pulmonary embolism

“…Following the publication of this study [ 1 ] the authors identified the following errors inadvertently introduced during the production process: Within Table 1, under the sub-heading “Setting”, the numbers for the categories “Radical/adjuvant” and “Metastatic/incurable” were erroneously inversed. The correct numbers are: Radical/adjuvant: 20 (46) Metastatic/incurable: 80 (188) In Table 3, the values in the HR(95%CI) column were misaligned in the WCC rows; The value “1” should be aligned with the <11.3x10 9 row and the value 1.1 (.7, 1.8) should be aligned with the > 11.3x10 9 row.…”

Concurrence of Gastric Cancer and Incidental Pulmonary Embolism May Be a Prognostic Factor for Advanced Gastric Cancer Patients with Incidental Pulmonary Embolism

“…[5][6][7][8][9] Recent retrospective research in cancer patients indicates that the embolic burden in IPE is similar to that in symptomatic PE. [10][11][12][13][14] Currently, all major guidelines recommend that the treatment of cancer patients with IPE should refer to the treatment of cancer patients with symptomatic PE. [15][16][17] Interestingly, the 2016 American College of Chest Physicians guideline suggests low-risk patients with isolated subsegmental PE (SSPE) receive no treatment in cases with normal bilateral ultrasonography of the legs (Grade 2C).…”