Cancer Histology and Natural History of Patients with Lung Cancer and Venous Thromboembolism
Por:
Ruiz-Artacho, P, Lecumberri, R, Trujillo-Santos, J, Font, C, Lopez-Nunez, JJ, Peris, ML, Pedroche, CD, Lobo, JL, Jimenez, LL, Reyes, RL, Palomares, LJ, Pedrajas, JM, Mahe, I and Monreal, M
Publicada:
1 sep 2022
Resumen:
Simple Summary Cancer is a widely heterogeneous disease, and the natural history of patients with cancer-associated thrombosis may differ according to the cancer site. Lung cancer is the most common malignancy, and a leading cause of death. A number of studies in the literature suggest that patients with adenocarcinoma may have a worse outcome than those with squamous or other types of lung cancer. The aim of the current study was to assess the potential impact of lung cancer histology on the incidence rates of VTE recurrences, major bleeding, or death appearing during the course of anticoagulation, in patients with lung cancer and VTE. Our findings, obtained from a large series of consecutive patients with lung cancer and VTE (482 patients), reveal important differences between patients with adenocarcinoma vs. other histologies in their outcomes during anticoagulation. This might likely help to design better therapeutic strategies for patients with lung cancer. Background: In patients with lung cancer and venous thromboembolism (VTE), the influence of cancer histology on outcome has not been consistently evaluated. Methods: We used the RIETE registry (Registro Informatizado Enfermedad TromboEmbolica) to compare the clinical characteristics and outcomes during anticoagulation in patients with lung cancer and VTE, according to the histology of lung cancer. Results: As of April 2022, there were 482 patients with lung cancer and VTE: adenocarcinoma 293 (61%), squamous 98 (20%), small-cell 44 (9.1%), other 47 (9.8%). The index VTE was diagnosed later in patients with squamous cancer than in those with adenocarcinoma (median, 5 vs. 2 months). In 50% of patients with adenocarcinoma, the VTE appeared within the first 90 days since cancer diagnosis. During anticoagulation (median 106 days, IQR: 45-214), 14 patients developed VTE recurrences, 15 suffered major bleeding, and 218 died: fatal pulmonary embolism 10, fatal bleeding 2. The rate of VTE recurrences was higher than the rate of major bleeding in patients with adenocarcinoma (11 vs. 6 events), and lower in those with other cancer types (3 vs. 9 events). On multivariable analysis, patients with adenocarcinoma had a non-significantly higher risk for VTE recurrences (hazard ratio [HR]: 3.79; 95%CI: 0.76-18.8), a lower risk of major bleeding (HR: 0.29; 95%CI: 0.09-0.95), and a similar risk of mortality (HR: 1.02; 95%CI: 0.76-1.36) than patients with other types of lung cancer. Conclusions: In patients with lung adenocarcinoma, the rate of VTE recurrences outweighed the rate of major bleeding. In patients with other lung cancers, it was the opposite.
Filiaciones:
Ruiz-Artacho, P:
Clin Univ Navarra, Dept Internal Med, Madrid 28027, Spain
Univ Navarra, Interdisciplinar Teragnosis & Radios Res Grp INTR, Madrid 28027, Spain
CIBER Enfermedades Resp CIBERES, Madrid 28029, Spain
Lecumberri, R:
Clin Univ Navarra, Hematol Serv, Pamplona 31008, Spain
Inst Salud Carlos III, CIBERCV, Madrid 28220, Spain
Trujillo-Santos, J:
Univ Catolica Murcia, Hosp Gen Univ Santa Lucia, Dept Internal Med, Murcia 30107, Spain
Font, C:
Hosp Clin Barcelona, Dept Med Oncol, Barcelona 08036, Spain
:
Hosp Badalona Germans Trias & Pujol, Dept Internal Med, Badalona 08916, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona 08193, Spain
Inst Recerca Germans Trias & Pujol, Badalona 08916, Spain
Peris, ML:
Consorcio Hosp Prov Castellon, Dept Internal Med, Castellon de La Plana 12002, Spain
CEU Cardenal Herrera Univ, Med Dept, Valencia 46115, Spain
Pedroche, CD:
Hosp Univ 12 Octubre, Dept Internal Med, Madrid 28041, Spain
Lobo, JL:
Hosp Univ Araba, Dept Pneumonol, Vitoria 01009, Spain
Jimenez, LL:
Hosp Univ Reina Sofia, Dept Internal Med, Cordoba 14004, Spain
Reyes, RL:
Hosp Univ & Politecn La Fe, Dept Pneumonol, Valencia 46026, Spain
Palomares, LJ:
Hosp Univ Virgen Rocio, Dept Pneumonol, Seville 41013, Spain
Pedrajas, JM:
Hosp Clin San Carlos, Dept Internal Med, Madrid 28040, Spain
Mahe, I:
Univ Paris 07, Hop Louis Mourier, Colombes AP HP, Dept Internal Med, F-75013 Paris, France
Monreal, M:
CIBER Enfermedades Resp CIBERES, Madrid 28029, Spain
UCAM Univ Catolica San Antonio Murcia, Fac Hlth Sci, Chair Study Thromboembol Dis, Murcia 30107, Spain
Green Published, gold
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