Ruiz-Artacho Pedro, Lecumberri Ramón, Trujillo-Santos Javier, Font Carme, López-Núñez Juan J, Peris María Luisa, Díaz Pedroche Carmen, Lobo José Luis, López Jiménez Luciano, López Reyes Raquel, Jara Palomares Luis, Pedrajas José María, Mahé Isabelle, Monreal Manuel
Department of Internal Medicine, Clínica Universidad de Navarra, 28027 Madrid, Spain.
Interdisciplinar Teragnosis and Radiosomics Research Group (INTRA-Madrid), Universidad de Navarra, 28027 Madrid, Spain.
Cancers (Basel). 2022 Aug 26;14(17):4127. doi: 10.3390/cancers14174127.
In patients with lung cancer and venous thromboembolism (VTE), the influence of cancer histology on outcome has not been consistently evaluated. We used the RIETE registry (Registro Informatizado Enfermedad TromboEmbólica) to compare the clinical characteristics and outcomes during anticoagulation in patients with lung cancer and VTE, according to the histology of lung cancer. 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. 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.
在肺癌合并静脉血栓栓塞症（VTE）患者中，癌症组织学对预后的影响尚未得到一致评估。我们使用RIETE注册中心（静脉血栓栓塞症信息注册中心），根据肺癌的组织学类型，比较肺癌合并VTE患者抗凝治疗期间的临床特征和预后。截至2022年4月，有482例肺癌合并VTE患者：腺癌293例（61%），鳞癌98例（20%），小细胞癌44例（9.1%），其他47例（9.8%）。鳞癌患者的首次VTE诊断时间晚于腺癌患者（中位时间分别为5个月和2个月）。在50%的腺癌患者中，VTE在癌症诊断后的前90天内出现。在抗凝治疗期间（中位时间106天，四分位间距：45 - 214天），14例患者出现VTE复发，15例发生大出血，218例死亡：致命性肺栓塞10例，致命性出血2例。腺癌患者的VTE复发率高于大出血率（分别为11次和6次事件），而其他癌症类型患者的VTE复发率则低于大出血率（分别为3次和9次事件）。多变量分析显示，与其他类型肺癌患者相比，腺癌患者VTE复发风险无显著升高（风险比[HR]：3.79；95%置信区间：0.76 - 18.8），大出血风险较低（HR：0.29；95%置信区间：0.09 - 0.95），死亡风险相似（HR：1.02；95%置信区间：0.76 - 1.36）。在肺腺癌患者中，VTE复发率超过大出血率。在其他肺癌患者中，情况则相反。
