癌症患者中偶发性肺栓塞与症状性肺栓塞的预后：一项中国单中心回顾性队列研究
Prognosis of incidental pulmonary embolism vs. symptomatic pulmonary embolism in cancer patients: a single-center retrospective cohort study in China.
作者信息
Wang Yanfei, Liu Zhongfen, Li Qiuyu, Xia Lina, Wang Yunyi, Jiang Danfeng, Chen Xiaoyan, Zheng Yanqun, Liu Wei, Wang Dan, Xue Dong
机构信息
Peking University Cancer Hospital and Beijing Cancer Institute, Day Oncology Unit, Key Laboratory of Malignant Tumor Pathogenesis and Transformation Research, Ministry of Education, Ministry of Education, Beijing, China.
Peking University Cancer Hospital and Beijing Cancer Institute, Department of Supportive Care, Key Laboratory of Malignant Tumor Pathogenesis and Transformation Research, Ministry of Education, Beijing, China.
出版信息
Thromb J. 2023 Jun 6;21(1):64. doi: 10.1186/s12959-023-00502-6.
BACKGROUND
The incidence of incidental pulmonary embolism (IPE) has greatly increased, but its clinical characteristics and outcomes are still controversial. This study aimed to compare the clinical characteristics and outcomes between cancer patients with IPE and patients with symptomatic pulmonary embolism (SPE).
PATIENTS/METHODS: Clinical data of 180 consecutive patients with cancer complicated with pulmonary embolism admitted to Beijing Cancer Hospital from July 2011 to December 2019 were retrospectively collected and analysed. General characteristics, diagnosis time of pulmonary embolism (PE), location of PE, concurrent deep venous thrombosis, anticoagulant treatment, impact of PE on anti-tumor treatment, recurrent venous thromboembolism, rate of bleeding after anticoagulation therapy, survival and risk factors of IPE were compared with SPE.
RESULTS
Of 180 patients, 88 (49%) had IPEs and 92 (51%) had SPEs. Patients with IPE and SPE did not differ in age, sex, tumor type, or tumor stage. Median diagnosis times of IPE and SPE after cancer were 108 (45, 432) days and 90 (7, 383) days, respectively. Compared to SPE, IPE tended to be central (44% versus 26%; P < 0.001), isolated (31.8% versus 0.0%; P < 0.001), and unilateral (67.1% versus 12.8%; P < 0.00). The rate of bleeding after anticoagulation therapy did not differ between IPE and SPE. Patients with IPE had a better prognosis than patients with SPE in terms of 30-, and 90-day mortality, as well as overall survival after diagnosis of PE (median: 314.5 vs. 192.0 days, log-rank P = 0.004) and cancer (median: 630.0 vs. 450.5 days, log-rank P = 0.018). SPE (compared to IPE) was an independent risk factor for poor survival after diagnosis of PE in multivariate analysis (hazard ratio [HR] = 1.564, 95% confidence interval [CI]: 1.008-2.425, p = 0.046).
CONCLUSIONS
IPE accounts for nearly one half of PE cases among Chinese cancer patients. With active anticoagulation treatment, IPE is expected to achieve better survival rates than SPE.
背景
偶然发现的肺栓塞（IPE）的发病率大幅上升，但其临床特征和预后仍存在争议。本研究旨在比较患有IPE的癌症患者与有症状肺栓塞（SPE）患者的临床特征和预后。
患者/方法：回顾性收集并分析了2011年7月至2019年12月期间连续入住北京肿瘤医院的180例癌症合并肺栓塞患者的临床资料。比较了IPE和SPE的一般特征、肺栓塞（PE）的诊断时间、PE的部位、并发深静脉血栓形成、抗凝治疗、PE对抗肿瘤治疗的影响、复发性静脉血栓栓塞、抗凝治疗后的出血率、生存率和IPE的危险因素。
结果
180例患者中，88例（49%）患有IPE，92例（51%）患有SPE。IPE和SPE患者在年龄、性别、肿瘤类型或肿瘤分期方面无差异。癌症后IPE和SPE的中位诊断时间分别为108（45，432）天和90（7，383）天。与SPE相比，IPE倾向于位于中央（44%对26%；P<0.001）、孤立（31.8%对0.0%；P<0.001）和单侧（67.1%对12.8%；P<0.00）。抗凝治疗后的出血率在IPE和SPE之间无差异。在30天和90天死亡率以及PE诊断后的总生存期（中位值：314.5天对192.0天，对数秩检验P=0.004）和癌症生存期（中位值：630.0天对450.5天，对数秩检验P=0.018）方面，IPE患者的预后优于SPE患者。在多变量分析中，SPE（与IPE相比）是PE诊断后生存不良的独立危险因素（风险比[HR]=1.564，95%置信区间[CI]：1.008-2.425，P=0.046）。
结论
在中国癌症患者中，IPE占PE病例的近一半。通过积极的抗凝治疗，IPE有望比SPE获得更好的生存率。
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