Risk Factors and Outcomes of Subsegmental versus More Central Pulmonary Embolism in Patients with Lung Cancer

Delun Yang; Jiajun Deng; Shenghao Huang; Hua He; Chenyang Dai; Deping Zhao; Chang Chen

doi:10.1055/a-2661-2326

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost
DOI: 10.1055/a-2661-2326

Stroke, Systemic or Venous Thromboembolism

Risk Factors and Outcomes of Subsegmental versus More Central Pulmonary Embolism in Patients with Lung Cancer

Authors

Delun Yang

¹Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
Jiajun Deng

¹Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
Shenghao Huang

¹Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
Hua He

²Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, People's Republic of China
Chenyang Dai^*

¹Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
Deping Zhao^*

¹Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
Chang Chen^*

¹Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China

Abstract

Background

The clinical significance of lung cancer-associated subsegmental pulmonary embolism (PE) remains unclear.

Methods

This study retrospectively included 902 patients with lung cancer-associated PE (160 subsegmental PE, 742 more central PE). Cox proportional hazards regression was used to assess the risk of all-cause death. Fine-Gray tests and competing risk models were applied to evaluate the risks (hazard ratio [HR] [95% confidence interval]) of venous thromboembolism (VTE) recurrence and major bleeding. All-cause death was treated as a competing event for both VTE recurrence and major bleeding.

Results

Compared with the more central PE group, the subsegmental PE group showed no significant differences in the adjusted risks of VTE recurrence (HR 0.99 [0.62–1.57], p = 0.95) and all-cause death (HR 0.83 [0.52–1.34], p = 0.45), and this finding was consistent across subgroups. Compared with patients with subsegmental PE without anticoagulation, those with anticoagulation had a lower adjusted risk of VTE recurrence (HR 0.16 [0.05–0.53], p = 0.003). The adjusted risks of major bleeding (HR 0.30 [0.05–1.70], p = 0.18) and all-cause death (HR 0.43 [0.13–1.42], p = 0.17) did not reach statistical significance. Independent predictors of VTE recurrence included symptomatic deep vein thrombosis (HR 2.71 [1.63–4.52], p < 0.001), tumor–node–metastasis stage (HR 2.07 [1.19–3.60], p = 0.010), EGFR mutations (HR 0.62 [0.39–0.98], p = 0.041), and anticoagulation (HR 0.32 [0.20–0.52], p < 0.001).

Conclusion

The risk of recurrent VTE is not miniscule in patients with lung cancer-associated subsegmental PE.

Keywords

subsegmental pulmonary embolism - lung cancer - ROS Proto-oncogene 1 (ROS1) - epidermal growth factor receptor (EGFR) - anticoagulant therapy

Full Text

References

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