Dong Hai-Yang, Tong Min-Si, Wang Juan, Liu Yuan, Tao Guang-Yu, Petersen René Horsleben, Jara-Palomares Luis, Wang Yi, Sun Yan-Bing, Chen Jie
Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Gastroenterology, Yang Pu Hospital, Tong Ji University, Shanghai, China.
Transl Lung Cancer Res. 2023 Jul 31;12(7):1539-1548. doi: 10.21037/tlcr-23-346. Epub 2023 Jul 19.
There is growing evidence that misdiagnosis contributes to the high mortality rate in lung cancer patients complicated with pulmonary embolism (PE). This current study analyzed predictors of PE in lung cancer patients with lower extremity deep venous thrombosis (DVT) with the aim of personalizing the treatment and management of patients with PE.
This retrospective case-control study included lung cancer patients with DVT at the emergency department of Shanghai Chest Hospital from January 2018 to December 2019. Patients were classified as having DVT with or without PE. The following characteristics were examined, including age, gender, smoking, hypertension, surgical trauma, hyperlipidemia, long-term bedridden status, calf swelling, coronary heart disease, chronic pulmonary disease, DVT location, DVT type, prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen, and D-dimer, and univariate and multivariate analyses were performed.
A total of 90 patients with lung cancer and DVT were analyzed, of whom 60% (54/90) had PE. Those variables independently associated to PE were hypertension [odds ratio (OR): 7.883, 95% confidence interval (CI): 2.038-30.495, P=0.003], long-term bedridden status (OR: 4.166, 95% CI: 1.236-14.044, P=0.021), and D-dimer levels (OR: 2.123, 95% CI: 1.476-3.053, P=0.000) were identified as independent risk factors for PE. The cut-off value of the receiver operating characteristic (ROC) curve for predicting PE by presented scoring system according to the risk factors was 1.5 and the area under the curve (AUC) was 0.84 (P<0.001).
Hypertension, being bedridden for an extended period, and elevated serum D-dimer levels were independent risk factors of PE in lung cancer patients with lower extremity DVT. Novel strategies for patient management should be developed to decrease the risk of PE.
越来越多的证据表明，误诊导致肺癌合并肺栓塞（PE）患者的高死亡率。本研究分析了下肢深静脉血栓形成（DVT）的肺癌患者发生PE的预测因素，旨在实现PE患者治疗和管理的个性化。
这项回顾性病例对照研究纳入了2018年1月至2019年12月在上海胸科医院急诊科就诊的DVT肺癌患者。患者被分为有或无PE的DVT患者。检查了以下特征，包括年龄、性别、吸烟、高血压、手术创伤、高脂血症、长期卧床状态、小腿肿胀、冠心病、慢性肺病、DVT部位、DVT类型、凝血酶原时间（PT）、国际标准化比值（INR）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原和D-二聚体，并进行了单因素和多因素分析。
共分析了90例肺癌合并DVT患者，其中60%（54/90）发生PE。与PE独立相关的变量为高血压[比值比（OR）：7.883，95%置信区间（CI）：2.038 - 30.495，P = 0.003]、长期卧床状态（OR：4.166，95% CI：1.236 - 14.044，P = 0.021）和D-二聚体水平（OR：2.123，95% CI：1.476 - 3.053，P = 0.000），这些被确定为PE的独立危险因素。根据危险因素建立的预测PE的评分系统的受试者工作特征（ROC）曲线的截断值为1.5，曲线下面积（AUC）为0.84（P < 0.001）。
高血压、长期卧床和血清D-二聚体水平升高是下肢DVT肺癌患者发生PE的独立危险因素。应制定新的患者管理策略以降低PE风险。
