Zaborowska-Szmit Magdalena, Szmit Sebastian, Olszyna-Serementa Marta, Zajda Katarzyna, Janowicz-Żebrowska Anna, Jaśkiewicz Piotr, Kowalski Dariusz M, Krzakowski Maciej
Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
Department of Cardio-Oncology, Chair of Hematology and Transfusion Medicine, Centre of Postgraduate Medical Education, Warsaw, Poland.
Cardiooncology. 2024 Nov 9;10(1):79. doi: 10.1186/s40959-024-00281-7.
Venous thromboembolic events (VTE) are often diagnosed in ALK-positive lung cancer although it has not been demonstrated how their co-occurrence affects patients' survival.
The study included patients with ALK-positive lung cancer recognized in metastatic stage in the period 2017-2022. All received treatment with ALK inhibitors at The Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw. The main aim of the study was to assess overall survival (OS) in relation to VTE occurrence. The additional purpose was to define predictors of VTE and OS.
The study included 54 patients in median age 60 years, men were a minority (25 / 46.3%). VTE was diagnosed in 12 (22.2%) patients: 9 (16.7%) cases with pulmonary embolism (PE), 2 cases with thrombosis in vena cava superior, one case with deep vein thrombosis and thrombosis in vena cava inferior. Among patients with PE: 2 patients died directly due to the first PE episode and one due to a recurrent PE. Patients with VTE had significantly shorter overall survival (median 11.7 vs. 37.4 months, log-rank test p = 0.003). The risk of all-cause mortality was increased significantly in both: VTE (HR = 3.47; 95%CI: 1.61-7.49; p = 0.0016) or alone PE (HR = 2.41; 95%CI: 1.06-5.50; p = 0.037). The risk of VTE diagnosis was significantly increased during active treatment with crizotinib (HR = 8.72; p = 0.0004) or alectinib (HR = 21.47; p = 0.000002). Metastases to liver and baseline leukocyte count > 11 × 10⁹/L were significant predictors of VTE and OS. Khorana score ≥ 3 points predicted OS (HR = 2,66; 95%CI: 1,05-6,75; p = 0,04), but remained insignificant for VTE.
The diagnosis of any type of VTE or alone PE was associated with significantly worse overall survival in patients with ALK-positive non-small cell lung cancer.
静脉血栓栓塞事件（VTE）在ALK阳性肺癌中常被诊断出来，尽管尚未证实它们的同时出现如何影响患者的生存。
该研究纳入了2017年至2022年期间在转移阶段被确诊为ALK阳性肺癌的患者。所有患者均在华沙的玛丽亚·斯克洛多夫斯卡-居里国家肿瘤研究所接受ALK抑制剂治疗。该研究的主要目的是评估与VTE发生相关的总生存期（OS）。另一个目的是确定VTE和OS的预测因素。
该研究纳入了54例患者，中位年龄为60岁，男性占少数（25例/46.3%）。12例（22.2%）患者被诊断为VTE：9例（16.7%）为肺栓塞（PE），2例为上腔静脉血栓形成，1例为深静脉血栓形成和下腔静脉血栓形成。在PE患者中：2例患者直接死于首次PE发作，1例死于复发性PE。VTE患者的总生存期明显较短（中位生存期为11.7个月对37.4个月，对数秩检验p = 0.003）。VTE（HR = 3.47；95%CI：1.61 - 7.49；p = 0.0016）或单独的PE（HR = 2.41；95%CI：1.06 - 5.50；p = 0.037）患者的全因死亡风险均显著增加。在使用克唑替尼（HR = 8.72；p = 0.0004）或阿来替尼（HR = 21.47；p = 0.000002）进行积极治疗期间，VTE诊断风险显著增加。肝转移和基线白细胞计数>11×10⁹/L是VTE和OS的显著预测因素。Khorana评分≥3分可预测OS（HR = 2.66；95%CI：1.05 - 6.75；p = 0.04），但对VTE仍无显著意义。
任何类型的VTE或单独的PE诊断与ALK阳性非小细胞肺癌患者的总生存期显著较差相关。
