Dept of Medicine, Universidad Cardenal Herrera CEU, CEU Universities, Castellón, Spain.
Dept of Internal Medicine, Consorcio Hospitalario Provincial de Castellón, Castellón, Spain.
Eur Respir J. 2021 Jul 1;58(1). doi: 10.1183/13993003.02723-2020. Print 2021 Jul.
Current guidelines suggest treating cancer patients with incidental pulmonary embolism (PE) similarly to those with clinically suspected and confirmed PE. However, the natural history of these presentations has not been thoroughly compared.
We used the data from the RIETE (Registro Informatizado de Enfermedad TromboEmbólica) registry to compare the 3-month outcomes in patients with active cancer and incidental PE those with clinically suspected and confirmed PE. The primary outcome was 90-day all-cause mortality. Secondary outcomes were PE-related mortality, symptomatic PE recurrences and major bleeding.
From July 2012 to January 2019, 946 cancer patients with incidental asymptomatic PE and 2274 with clinically suspected and confirmed PE were enrolled. Most patients (95% 90%) received low-molecular-weight heparin therapy. During the first 90 days, 598 patients died, including 42 from PE. Patients with incidental PE had a lower all-cause mortality rate than those with suspected and confirmed PE (11% 22%; OR 0.43, 95% CI 0.34-0.54). Results were consistent for PE-related mortality (0.3% 1.7%; OR 0.18, 95% CI 0.06-0.59). Multivariable analysis confirmed that patients with incidental PE were at lower risk of death (adjusted OR 0.43, 95% CI 0.34-0.56). Overall, 29 (0.9%) patients developed symptomatic PE recurrences, and 122 (3.8%) had major bleeding. There were no significant differences in PE recurrences (OR 0.62, 95% CI 0.25-1.54) or major bleeding (OR 0.78, 95% CI 0.51-1.18).
Cancer patients with incidental PE had a lower mortality rate than those with clinically suspected and confirmed PE. Further studies are required to validate these findings, and to explore optimal management strategies in these patients.
目前的指南建议对偶然发现的肺栓塞（PE）患者和有临床疑似和确诊 PE 的患者采用相似的治疗方法。然而，这些表现的自然病史尚未得到充分比较。
我们利用 RIETE（血栓栓塞登记处）登记处的数据，比较了活动性癌症合并偶然无症状 PE 患者与有临床疑似和确诊 PE 的患者的 3 个月结局。主要结局为 90 天全因死亡率。次要结局为 PE 相关死亡率、有症状 PE 复发和大出血。
2012 年 7 月至 2019 年 1 月，共纳入 946 例偶然无症状 PE 的癌症患者和 2274 例有临床疑似和确诊 PE 的癌症患者。大多数患者（95% 90%）接受低分子量肝素治疗。在最初的 90 天内，598 例患者死亡，其中 42 例死于 PE。偶然无症状 PE 患者的全因死亡率低于有临床疑似和确诊 PE 的患者（11% 22%；OR 0.43，95% CI 0.34-0.54）。PE 相关死亡率的结果也一致（0.3% 1.7%；OR 0.18，95% CI 0.06-0.59）。多变量分析证实，偶然无症状 PE 患者的死亡风险较低（调整后的 OR 0.43，95% CI 0.34-0.56）。总的来说，29 例（0.9%）患者发生有症状 PE 复发，122 例（3.8%）患者发生大出血。PE 复发（OR 0.62，95% CI 0.25-1.54）或大出血（OR 0.78，95% CI 0.51-1.18）的发生率无显著差异。
偶然无症状 PE 的癌症患者的死亡率低于有临床疑似和确诊 PE 的患者。需要进一步研究来验证这些发现，并探讨这些患者的最佳管理策略。
