Ou Wei-Fan, Liao Pei-Ya, Hsu Yu-Wei, Huang Yen-Hsiang, Hsu Kuo-Hsuan, Tseng Jeng-Sen, Chang Gee-Chen, Yang Tsung-Ying
Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Cancer Prevention and Control Center, Taichung Veterans General Hospital, Taichung, Taiwan.
Cancer Manag Res. 2023 Nov 6;15:1251-1262. doi: 10.2147/CMAR.S430868. eCollection 2023.
Antiangiogenetic therapy and lung cancer, per se, are associated with an increased risk of thromboembolic events (TE). We aim to evaluate the pattern and outcome of TE as well as its influence on survival time of advanced non-small cell lung cancer (NSCLC) patients receiving antiangiogenic therapy.
This was a retrospective cohort study, which included advanced NSCLC patients receiving antiangiogenic therapy. All TE were confirmed by objective image studies. We disclosed the presentation and risk factors of TE and evaluated its influence on outcome.
A total of 427 patients were included. TE occurred in 43 patients (10.1%). Deep vein thrombosis (DVT) was the most common TE (n = 20). Up to 46.2% of DVT did not occur in the typical lower extremities. Two patients died of TE. Among patients with continuous use or reuse of antiangiogenetic therapy, 18.2% had recurrent TE events. At the occurrence of TE, 28 patients experienced progressive disease (TE with PD), while tumor status remained stable in another 15 patients (TE without PD). The post-TE survival of patients without and with PD were 8.9 months (95% CI 3.9-13.9) vs 2.2 months (95% CI 0.1-4.3), P = 0.012. As compared with patients without TE (31.4 months [95% CI 27.1-35.7]), TE with PD patients experienced a significantly shorter overall survival (20.1 months [95% CI 15.5-24.6]), but TE without PD patients had comparable survival time (32.7 months [95% CI 7.4-28.1]) (P = 0006). The use of hormone analogue and proteinuria predicted the events among TE with PD group (aOR 2.79 [95% CI 1.13=6.92]; P = 0.027) and TE without PD group (aOR 4.30 [95% CI 1.13-16.42]; P = 0.033), respectively.
Owing to the different risk factors and influences on the survival time, TE with and without PD may be two different disease entities.
抗血管生成治疗本身与肺癌患者血栓栓塞事件（TE）风险增加相关。我们旨在评估TE的发生模式、结局及其对接受抗血管生成治疗的晚期非小细胞肺癌（NSCLC）患者生存时间的影响。
这是一项回顾性队列研究，纳入接受抗血管生成治疗的晚期NSCLC患者。所有TE均通过客观影像检查确诊。我们揭示了TE的表现和危险因素，并评估了其对结局的影响。
共纳入427例患者。43例（10.1%）发生TE。深静脉血栓形成（DVT）是最常见的TE（n = 20）。高达46.2%的DVT并非发生在典型的下肢。2例患者死于TE。在持续使用或重复使用抗血管生成治疗的患者中，18.2%发生复发性TE事件。在TE发生时，28例患者出现疾病进展（TE伴疾病进展），而另外15例患者的肿瘤状态保持稳定（TE不伴疾病进展）。TE不伴疾病进展和伴疾病进展患者的TE后生存期分别为8.9个月（95%CI 3.9 - 13.9）和2.2个月（95%CI 0.1 - 4.3），P = 0.012。与未发生TE的患者（31.4个月[95%CI 27.1 - 35.7]）相比，TE伴疾病进展的患者总生存期显著缩短（20.1个月[95%CI 15.5 - 24.6]），但TE不伴疾病进展的患者生存时间相当（32.7个月[95%CI 7.4 - 28.1]）（P = 0.006）。激素类似物的使用和蛋白尿分别是TE伴疾病进展组（调整后比值比[aOR] 2.79 [95%CI 1.13 = 6.92]；P = 0.027）和TE不伴疾病进展组（aOR 4.30 [95%CI 1.13 - 16.42]；P = 0.033）TE事件的预测因素。
由于危险因素不同以及对生存时间的影响不同，TE伴疾病进展和不伴疾病进展可能是两种不同的疾病实体。
