Early Venous Thromboembolic Events Are Associated With Worse Prognosis in Patients With Lung Cancer

Kourelis, Theodoros; Wysokinska, Ewa M.; Wang, Y.; Yang, Pei‐Chi; Tafur, Alfonso; Mansfield, Aaron S.

doi:10.1016/j.ijrobp.2014.08.295

Cited by 12 publications

(17 citation statements)

References 15 publications

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“…Indeed, cancer‐associated thrombosis is a leading cause of death among patients with cancer . Patients with lung cancer and early occurrence of VTE have a worse survival than patients who do not develop VTE, even after adjusting for stage, co‐morbidities and performance status . Cancer‐associated thrombosis is a potentially preventable disease; however, primary prevention is not currently a validated strategy .…”

Section: Introductionmentioning

confidence: 99%

Predictors of active cancer thromboembolic outcomes: validation of the Khorana score among patients with lung cancer

Mansfield

Tafur

Wang

et al. 2016

Journal of Thrombosis and Haemostasis

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Objectives Lung cancer is strongly associated with venous thromboembolism (VTE), but primary prevention against VTE is not a validated management strategy. Risk assessment models will be necessary for efficient implementation of preventative strategies. Materials and methods Utilizing a prospectively collected lung cancer database, we aimed to validate the Khorana Risk Score (KRS) in the prediction of VTE among patients with lung cancer. VTE events were retrospectively identified by reviewers unaware of the clinical prediction score calculation. The association between KRS and the risk of VTE was examined using cumulative incidence function with competing risks models. Mortality prediction was evaluated as secondary outcome. Results We included 719 patients in our review. The patients were predominantly older males with NSCLC and 40% had metastatic disease at inception. The median follow up was 15.2 months. There were 83 VTEs (11.5%) and 568 (78.8%) patients died. A high KRS (Cumulative Incidence 12.4%, 95% Confidence Interval 6.4-20.5%) was not associated with VTE compared to an intermediate score (Cumulative Incidence 12.1%, 95% Confidence Interval 9.5-15.0%)) in both univariate and multivariable analyses. However, a high KRS was a predictor of mortality (HR 1.7 95% CI 1.4 - 2.2). Conclusions Among patients with lung cancer the KRS did not stratify the patients at the highest risk of VTE. Improved risk stratification methods are needed for this group of patients prior to implementing a primary prevention strategy.

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Section: Introductionmentioning

confidence: 99%

Predictors of active cancer thromboembolic outcomes: validation of the Khorana score among patients with lung cancer

Mansfield

Tafur

Wang

et al. 2016

Journal of Thrombosis and Haemostasis

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121

123

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“…Nevertheless, the next comparison encompassing histopathology, stage, oncological therapy and the level of D‐Dimer as well as CEA demonstrated that, concomitance group had more adenocarcinoma, metastasis, chemotherapy and severer thrombosis as well as tumor markers by contrast with the other two, especially DVT group. Since adenocarcinoma, metastasis, chemotherapy, elevated D‐Dimer as well as CEA are all facilitating factors for VTE because of lung cancer, obviously no wonder concomitance group manifested both presentations of VTE, whereas DVT group merely presented the mildest and stablest appearance of VTE. From another perspective, concomitance of DVT and PE represented the severest condition of lung cancer and highest risk of VTE, conversely did the DVT group.…”

Section: Discussionmentioning

confidence: 99%

“…Then we performed a comparison analysis between chemotherapy group and non‐chemotherapy group since chemotherapy was the major regimen after the diagnosis of VTE, the results demonstrated that, notwithstanding the K‐M curve of chemotherapy group was slightly higher than that of non‐chemotherapy group, the cumulative survival rates were statistically similar between the two groups. In a serial of previous studies, chemotherapy has been well acknowledged as a promoting factor in the development of VTE because of lung cancer for a long time, however, the role of chemotherapy in lung cancer with developed VTE was seldom defined. In this study, the results indicated that by contrast with non‐chemotherapy group, chemotherapy was not beneficial to achieve a better survival in patients with VTE because of lung cancer.…”

Section: Discussionmentioning

confidence: 99%

Comparison among different presentations of venous thromboembolism because of lung cancer

Guo

Deng

Xiong

et al. 2019

Clinical Respiratory J

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Introduction Venous thromboembolism (VTE) because of lung cancer has been sufficiently studied, nevertheless, little is known regarding the discrepancy of clinical characteristics and predictive factors among different presentations of VTE because of lung cancer. Objectives This study was designed to investigate the distinction of clinical characteristics and predictive factors among different presentations of VTE because of lung cancer. Methods All patients concomitant lung cancer and VTE were stratified into three groups: pulmonary embolism (PE) group in which patients had sole PE, deep vein thrombosis (DVT) group with sole DVT and concomitance group with both PE and DVT. Results Concomitance of PE and DVT (28.2 days) mostly occurred at the early stage after the diagnosis of lung cancer, by contrast with DVT (63.6 days) which did at the latest stage, whereas PE (36.7 days) generally developed intermediately in between (P = .02). In a Kaplan‐Meier analysis, the cumulative survival rate of DVT group was higher than that of concomitance group, whereas the rate of PE group lied in between. (P = .002) The strongest correlated factors with the development of DVT, PE and concomitance were adenocarcinoma (HR 3.27, P = .003), chemotherapy (HR 2.62, P = .005) and D‐Dimer (HR 3.88, P < .001), respectively. The strongest correlated factors with the mortality of DVT, PE and concomitance were comorbidity (HR 2.32, P = .003), metastasis (HR 3.12, P < .001), and metastasis (HR 4.29, P < .001), respectively. Conclusion Concomitance of DVT and PE represents the severest state of lung cancer, the earliest occurrence of VTE, and the worst survival rate, whereas DVT stands for the mildest condition of lung cancer and stablest pattern of VTE.

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“…The timing of VTE after diagnosis is another variable being investigated. A recent study found that early VTE within 3 months of lung cancer diagnosis was associated with worse prognosis, which suggests that the timing of thrombosis may have distinct prognostic implications …”

Section: Introductionmentioning

confidence: 99%

Postoperative venous thromboembolism and mortality in patients with pancreatic surgery

Majmudar

Quintero

Fuentes

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Pancreatic cancer is strongly associated with thrombosis. We investigated early postoperative venous thromboembolism (PVTE) mortality among patients with pancreatic surgery and compared outcomes in adenocarcinoma pancreatic cancer (ACPC) to non‐adenocarcinoma pancreatic neoplasm (NACPN). Methods We analyzed a prospectively collected database of patients who underwent pancreatic cancer or neoplasm‐related surgery. As NACPN is underrepresented in other studies, we selected NACPN patients and a random sample of ACPC patients. PVTE was defined as VTE occurring within 3 months of surgical intervention. Statistical analysis was performed using Cox proportional hazards regression. Results A total of 441 pancreatic surgery patients were included, with 331 ACPC and 110 NACPN. Median follow‐up was 449 days during which 90 (20.4%) patients developed VTE. PVTE occurred in 53 (12.0%) patients, including 41 (12.4%) ACPC patients and 12 (10.9%) NACPN patients. Those with PVTE had 60% higher mortality rate. A multivariable analysis found that PVTE is an independent predictor of increased mortality (HR Adj, 1.6; 95% CI, 1.1‐2.2; P < .01). The mortality impact was not consistent between ACPC (HR, 3.2; 95% CI, 1.3‐7.9) and NACPN groups (HR, 1.3; 95% CI, 0.9‐1.8). Conclusions Postoperative venous thromboembolism is an independent predictor of increased mortality in pancreatic surgery, specifically in adenocarcinoma pancreatic cancer surgery.

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Early Venous Thromboembolic Events Are Associated With Worse Prognosis in Patients With Lung Cancer

Cited by 12 publications

References 15 publications

Predictors of active cancer thromboembolic outcomes: validation of the Khorana score among patients with lung cancer

Predictors of active cancer thromboembolic outcomes: validation of the Khorana score among patients with lung cancer

Comparison among different presentations of venous thromboembolism because of lung cancer

Postoperative venous thromboembolism and mortality in patients with pancreatic surgery

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