Pulmonary embolism concurrent with lung cancer and central emboli predict mortality in patients with lung cancer and pulmonary embolism

Abstract

Background: Patients with lung cancer commonly experience pulmonary embolism (PE). The aim of the present study was to examine the clinical features of patients with lung cancer and PE and to investigate prognostic factors in these patients. Methods: This retrospective study divided patients with lung cancer and PE into a group of patients with PE diagnosed concomitantly with lung cancer (concurrent group) and a group with PE detected after lung cancer (sequential group), compared the clinical characteristics of patients in the two groups, and investigated prognostic factors in these patients. =2.64, 95% confidence interval (CI): 1.57-4.43, P<0.001] and central PE (HR =1.46, 95% CI: 1.02-2.10, P=0.04) were independent predictors of mortality in patients with lung cancer and PE. Conclusions: PE concurrent with lung cancer is characterized by more severe PE and infrequent small cell carcinoma. PE concurrent with lung cancer and central emboli may be independent prognostic factors in patients with lung cancer and PE. cancers (4). Lung cancer is the most commonly identified malignancy in patients with VTE (5), with an incidence of 3-13.9% in patients with VTE and that of up to 3.8% in patients with pulmonary embolism (PE) (6-9).The mechanisms of VTE in cancer patients, although not completely established, appear to be multifactorial (6,7). The occurrence of VTE in lung cancer has a prognostic implication, in that the survival of lung cancer patients with PE was shorter than that of those without PE (10). However, most deaths in patients with lung cancer and PE or VTE have been attributed to lung cancer rather than thromboembolism (11). These findings suggest that VTE may be a marker of an advanced stage cancer or of a more biologically aggressive tumor (12). A previous study including small numbers of patients demonstrated that patients with lung cancer with concurrently diagnosed PE had poorer survival than those without PE (10). In another study, no difference in survival was found between patients with PE diagnosed at less than 3 months after the diagnosis of lung cancer and those with PE diagnosed at 3 months or more following lung cancer diagnosis (13). Therefore, it is unclear whether the timing of the presentation of PE in patients with lung cancer may influence patient prognosis.Several factors that may determine short-term prognosis in patients with PE, including pulmonary embolism severity index (PESI) score, cardiac biomarkers, right ventricular (RV) dilation, and central emboli, have been proposed (14). However, information regarding these PE-related prognostic factors in patients with lung cancer and PE is lacking. The aim of the present study was to examine the clinical features of patients with lung cancer patients and PE, to compare clinical characteristics of PE found concurrently at lung cancer diagnosis and PE developed sequentially after the diagnosis of lung cancer, and to investigate the PE-related predictors of mortality in patients with lung cancer patients and PE. Methods Study designThe pre...

Epidemiology of Cancer-Associated Thrombosis in Asia: A Systematic Review

“…As these studies are very heterogeneous in methodologies and study cohorts, comparisons across studies are not feasible. As with Western studies, this review found that VTE-related deaths (range 0.7-4.2%) were mostly associated with PE and mostly from hospital-based studies (27)(28)(29)39). However, the interpretation of mortality findings was complicated by varying ways of mortality reporting over various timeframes.…”

“…Four studies reported VTE-related deaths (mostly associated with PE). The three large-scale studies with VTE-related deaths reported rates ranging from 0.7-3.3% (27)(28)(29) whereas one small-scale prospective cohort study of newly diagnosed NSCLC patients reported a 4.2% VTE-related mortality rate (39). Three large-scale studies reported all-cause mortality rates from 7.5 to 63.9% (26,28,31) while the rates reported by three small-scale studies were from 9.7 to 78.3% (25,35,41).…”

“…The only study with high warfarin use was a Korean retrospective review on lung cancer patients seen from 2008 to 2014 (33). Five studies of varying study populations and designs reported rates of prophylactic anticoagulation; these rates ranged widely from 0 to 82.4% (24,28,31,38,43). No study specifically assessed the complications of anticoagulation in terms of bleeding complications and recurrence rates while on treatment.…”

Pulmonary embolism - assessment of risk factors and emboli locations

“…Median period of time from diagnosis of lung cancer to PE was 4,5 months. The most common risk factor for pulmonary embolism in patients with lung cancer was chemotherapy with even a 3-fold increased risk [14]. 4.).…”

“…Different risks of thrombosis in four coagulation defects associated with inherited thrombophilia. Cancer is one of the most relevant risk factors for VTE, which occurs two to four times more often in patients with diagnosed malignancy.The highest prevalence of venous thromboembolism include lung, colon, and prostate cancer, whereas lung cancer is the most commonly related malignancy in patients with VTE[11][14]. According to data delivered by European Heart Journal Guidelines published in 2014, risk of venous thromboembolism episodes in patients with cancer is relevantly higher (even 46-fold comparing to healthy controls).…”