Pulmonary hypertension is common among patients with advanced lung cancer and Khorana score is the predictive indicator

Abstract

Introduction: Pulmonary hypertension (PHT) has been reported to be prevalent across various stages of lung cancer patients and associated with adverse outcomes. This study was aimed to determine prevalence among patients with advanced lung cancer and its association with dyspnea symptom and survival and. Methods Patients with stage IV lung cancer were recruited. PHT was diagnosed, if mean arterial pulmonary pressure (mPAP) was above 20 mmHg as determined by echocardiography. Baseline demographics including age, sex, smoking status, histologic types, performance status (PS), extent of pulmonary involvement, Khorana score, presenting symptoms, systemic cancer therapy, cancer dyspnea score (CDS) and 1-year survival were collected. Results There were 69 eligible patients. Thirty-four patients (49.28%) had PHT. Only high Khorana risk score was the independent predictive factor of development of PHT at baseline (ORadj = 48.71 (95% C.I. 1.51-1569.17); p = 0.028). History of smoking had a trend towards a predictor (ORadj = 4.36 (95% C.I. 0.83–22.87); p = 0.081). Furthermore, those with PHT had a trend towards shorter survival than those without (1-year OS, 55.23% vs 88.69%; p = 0.003); however, ECOG 2 (HRadj = 6.66 (95% C.I., 1.91–19.82); p = 0.002), non-adenocarcinoma cell types (HRadj = 5.33 (95% C.I., 1.18–24.10); p = 0.03), anemia (HRadj = 4.59 (95% C.I., 1.12–18.74); p = 0.034), and abnormal PT (HRadj = 5.52 (95% C.I., 1.60-19.09); p = 0.007) were the independent prognostic factors of short survival. Higher degree of PHT was also correlated with higher CDS (Pearson correlation, r = 0.458; 95% C.I. 0.25–0.63; p < 0.001). Conclusion In line with the historical reports, PHT is quite prevalent in patients with advanced lung cancer. Due to its co-relation with CDS, any agents which can lessen the degree of PHT should be further investigated for the purpose of improving patients’ symptom burden before the systemic therapy takes its action.