Differential clinical manifestations and clinical outcome of cancer-related pulmonary embolism
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Background/Aims: Although acute pulmonary embolism (PE) adversely impacts survival and should be treated regardless of cancer, the treatment rate of cancer- related PE is relatively low. We aimed to compare clinical characteristics and long term prognosis of PE in patients with or without cancer. Methods: From March 2010 to December 2013, patients with newly diagnosed PE were analyzed. Baseline demographics, comorbidities, cancer status and clinical manifestations of PE were recorded. We defined primary composite outcome as recurrent venous thromboembolism (VTE) and death from PE. Results: Among a total of 976 patients with PE, the 703 (72.0%) had cancer-related PE. Cancer-related PE group was more frequently asymptomatic (54.5% vs. 13.2%, p < 0.001), less extensive (involvement of bilateral pulmonary arteries: 42.8% vs. 51.3%, p = 0.017; lung infarction: 5.3% vs. 10.3%, p = 0.005) and less likely to accompany right ventricular dysfunction (10.3% vs. 27.2%, p < 0.001) compared with the non-cancer PE group. Anticoagulation was less frequently underwent in patients with cancer-related PE than those without cancer (62.0% vs. 81.7%, p < 0.001). A composite of recurrent VTE and death from PE was significantly higher in the cancer-related PE group (14.4% vs. 6.6%, p = 0.001). Conclusions: Although PE in cancer patients were seem to be less aggressive initially, compared to those without cancer, they had significantly poor prognosis. Given a high rate of recurrent VTE and relatively similar risk of anticoagulation associated bleeding events in cancer patients, more active treatment of PE is warranted in cancer patients.
Abstract
Background/Aims: Although acute pulmonary embolism (PE) adversely impacts survival and should be treated regardless of cancer, the treatment rate of cancer- related PE is relatively low. We aimed to compare clinical characteristics and long term prognosis of PE in patients with or without cancer. Methods: From March 2010 to December 2013, patients with newly diagnosed PE were analyzed. Baseline demographics, comorbidities, cancer status and clinical manifestations of PE were recorded. We defined primary composite outcome as recurrent venous thromboembolism (VTE) and death from PE. Results: Among a total of 976 patients with PE, the 703 (72.0%) had cancer-related PE. Cancer-related PE group was more frequently asymptomatic (54.5% vs. 13.2%, p < 0.001), less extensive (involvement of bilateral pulmonary arteries: 42.8% vs. 51.3%, p = 0.017; lung infarction: 5.3% vs. 10.3%, p = 0.005) and less likely to accompany right ventricular dysfunction (10.3% vs. 27.2%, p < 0.001) compared with the non-cancer PE group. Anticoagulation was less frequently underwent in patients with cancer-related PE than those without cancer (62.0% vs. 81.7%, p < 0.001). A composite of recurrent VTE and death from PE was significantly higher in the cancer-related PE group (14.4% vs. 6.6%, p = 0.001). Conclusions: Although PE in cancer patients were seem to be less aggressive initially, compared to those without cancer, they had significantly poor prognosis. Given a high rate of recurrent VTE and relatively similar risk of anticoagulation associated bleeding events in cancer patients, more active treatment of PE is warranted in cancer patients.
참고문헌 (20)
- Khorana AA, "Assessing risk of venous thromboembolism in the patient with cancer", J Clin Oncol, 27, pp.4839~4847 (2009)
- Heit JA, "Relative impact of risk factors for deep vein thrombosis and pulmonary embolism : a population-based study", Arch Intern Med, 162, pp.1245~1248 (2002)
- Levine MN, "The thrombogenic effect of anticancer drug therapy in women with stage II breast cancer", N Engl J Med, 318, pp.404~407 (1988)
- Rodeghiero F, "Thalidomide and thrombosis", Pathophysiol Haemost Thromb, 33(Suppl 1), pp.15~18 (2003)
- Schimmel KJ, "Cardiotoxicity of cytotoxic drugs", Cancer Treat Rev, 30, pp.181~191 (2004)
- Albini A, "Cardiotoxicity of anticancer drugs : the need for cardio-oncology and cardio-oncological prevention", J Natl Cancer Inst, 102, pp.14~25 (2010)
- Pruthi RK, "Review of the American College of Chest Physicians 2012 guidelines for anticoagulation therapy and prevention of thrombosis", Semin Hematol, 50, pp.251~258 (2013)
- Cesarman-Maus G, "News in the indications of direct oral anticoagulants according to the American College of Chest Physicians 2016 guidelines", Curr Drug Metab, 18, pp.651~656 (2017)
- Sun JM, "Unsuspected pulmonary emboli in lung cancer patients : the impact on survival and the significance of anticoagulation therapy", Lung Cancer, 69, pp.330~336 (2010)
- Schulman S, "Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients", J Thromb Haemost, 3, pp.692~694 (2005)
- van der Hulle T, "Risk of recurrent venous thromboembolism and major hemorrhage in cancer-associated incidental pulmonary embolism among treated and untreated patients : a pooled analysis of 926 patients", J Thromb Haemost, 14, pp.105~113 (2016)
- Sahut D’Izarn M, "Risk factors and clinical outcome of unsuspected pulmonary embolism in cancer patients: a case-control study", J Thromb Haemost, 10, pp.2032~2038 (2012)
- Douma RA, "Incidental venous thromboembolism in cancer patients : prevalence and consequence", Thromb Res, 125, pp.e306~e309 (2010)
- Shin SH, "Lack of association between airflow limitation and recurrence of venous thromboembolism among cancer patients with pulmonary embolism", Int J Chron Obstruct Pulmon Dis, 13, pp.937~943 (2018)
- Blom JW, "Incidence of venous thrombosis in a large cohort of 66, 329 cancer patients : results of a record linkage study", J Thromb Haemost, 4, pp.529~535 (2006)
- Levitan N, "Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data", Medicine (Baltimore), 78, pp.285~291 (1999)
- Khorana AA, "Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients", Cancer, 110, pp.2339~2346 (2007)
- Chew HK, "Incidence of venous thromboembolism and its effect on survival among patients with common cancers", Arch Intern Med, 166, pp.458~464 (2006)
- Moore MA, "Cancer epidemiology in mainland South-East Asia: past, present and future", Asian Pac J Cancer Prev, 11(Suppl 2), pp.67~80 (2010)
- Wang H, "Clinical analysis of tumor and non-tumor patients complicated with pulmonary embolism", Int J Clin Exp Med, 8, pp.18729~18736 (2015)