Division of Hematology/Oncology, Department of Internal Medicine, Melvin Bren and Simon Cancer Center, Indianapolis, IN.
Division of Hematology and Medical Oncology, Department of Medicine, Houston Methodist Cancer Center, Houston, TX; and.
Blood Adv. 2021 Feb 23;5(4):1050-1058. doi: 10.1182/bloodadvances.2020003136.
In the cancer population, patients diagnosed with venous thromboembolism (VTE) are considered to have a threefold increased risk of mortality compared with those without VTE. With the advent of modern computed tomography (CT), the rate of diagnosis of subsegmental pulmonary embolism (SSPE) has increased, likely as a result of improved visualization of the peripheral pulmonary arteries. The clinical significance of SSPE remains unclear because of the lack of randomized controlled clinical trials. The aim of this study was to identify the incidence and risk factors of recurrent proximal PE within 12 months of diagnosis of SSPE in cancer. We performed a retrospective analysis of 206 adult cancer patients who were diagnosed with SSPE from 2014 to 2016 at the University of Texas MD Anderson Cancer Center. At the time of SSPE diagnosis, the majority had metastatic cancer, 108 patients (53.2%) were undergoing chemotherapy, and 23 patients (11.2%) had a history of VTE. Most patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2. Sixty-seven percent of SSPE was discovered incidentally on restaging CT scans, with the majority being a single and isolated event (70.9%). Within 12 months of SSPE diagnosis, 18 patients (8.7%) were found to have a recurrent PE. The patients treated with anticoagulation had a lower rate of PE recurrence (8% vs 13% in those not treated with anticoagulation). Treatment with anticoagulation did not appear to have a significant impact on overall survival (P = .48) when adjusted for ECOG performance status and cancer stage.
在癌症患者中，与无静脉血栓栓塞症 (VTE) 的患者相比，诊断为静脉血栓栓塞症的患者的死亡率增加了三倍。随着现代计算机断层扫描 (CT) 的出现，亚段性肺栓塞 (SSPE) 的诊断率有所增加，这可能是由于外周肺动脉可视化得到改善的结果。由于缺乏随机对照临床试验，SSPE 的临床意义仍不清楚。本研究的目的是确定癌症患者诊断为 SSPE 后 12 个月内近端 PE 复发的发生率和危险因素。我们对 2014 年至 2016 年在德克萨斯大学 MD 安德森癌症中心诊断为 SSPE 的 206 例成年癌症患者进行了回顾性分析。在 SSPE 诊断时，大多数患者患有转移性癌症，108 例患者（53.2%）正在接受化疗，23 例患者（11.2%）有 VTE 病史。大多数患者的东部合作肿瘤学组 (ECOG) 体能状态为 0 至 2 级。67%的 SSPE 是在重新分期 CT 扫描时偶然发现的，其中大多数为单一孤立事件（70.9%）。在 SSPE 诊断后 12 个月内，18 例患者（8.7%）发现有复发性 PE。接受抗凝治疗的患者 PE 复发率较低（抗凝治疗组为 8%，未抗凝治疗组为 13%）。调整 ECOG 体能状态和癌症分期后，抗凝治疗对总生存率似乎没有显著影响（P =.48）。
