Salinger Sonja, Kozic Aleksandra, Dzudovic Boris, Subotic Bojana, Matijasevic Jovan, Benic Marija, Miloradovic Vladimir, Jevtic Ema, Kovacevic-Preradovic Tamara, Kos Ljiljana, Bulatovic Nebojsa, Bozovic Bjanka, Mitevska Irena, Bosevski Marijan, Kovacevic-Kuzmanovic Ana, Svircev Milos, Neskovic Aleksandar, Mitrovic Bojan, Kafedzic Srdjan, Obradovic Slobodan
Clinic of Cardiology, Clinical Center Nis, Nis, Serbia.
Faculty of Medicine, University of Nis, Nis, Serbia.
Cancer Med. 2025 May;14(9):e70886. doi: 10.1002/cam4.70886.
Newly or already diagnosed cancer might significantly influence the clinical presentation, outcome, and therapy of acute pulmonary embolism (PE).
Out of 1745 patients with acute PE, 66 patients were diagnosed with cancer during an initial hospitalization due to acute PE (where PE was the first clinical manifestation of cancer), 165 patients had known cancer treated in the last 6 months, and 1514 patients had acute PE without known or suspected cancer. The primary end-point of the present study was all-cause hospital death. The secondary end-points were the proportion of patients treated with thrombolysis and who had severe disease, and the ocurrence of major or clinically relevant nonmajor bleeding.
Patients with PE as the first presentation of cancer had the highest hospital mortality rate compared to the other two groups (HR for the mortality rate in patients without cancer as a reference, adjusted to four-stratum mortality risk, and Charlson's comorbidity index was 3.440; 95% confidence interval (CI), 1.795-6.591; p < 0.001). Patients with known cancer before PE had a significantly lower chance of being treated with thrombolysis than patients without cancer (OR, 0.523; 95% CI, 0.339-0.807; p = 0.003); additionally, this difference was attenuated but remained when the OR was adjusted to age (OR, 0.542; 95% CI, 0.351-0.838; p = 0.006). Patients with known cancer had a higher frequency of high-risk PE compared with patients without cancer (18.2% vs. 12.8%; p < 0.001). Patients with PE as the first manifestation of cancer had a higher frequency of intermediate-high-risk PE than those without (36.4% vs. 30.9%; p < 0.001). There was no significant difference in bleeding during hospitalization between groups.
Patients with cancer had a more severe presentation of acute PE than patients without. Furthermore, patients with PE as the first manifestation of cancer had the highest hospital mortality rate, and patients with known cancer were least likely to be treated with thrombolysis.
新诊断或已诊断的癌症可能会显著影响急性肺栓塞（PE）的临床表现、结局及治疗。
在1745例急性PE患者中，66例在因急性PE首次住院期间被诊断出患有癌症（其中PE是癌症的首发临床表现），165例在过去6个月内接受过已知癌症的治疗，1514例急性PE患者无已知或疑似癌症。本研究的主要终点是全因住院死亡。次要终点是接受溶栓治疗且患有严重疾病的患者比例，以及发生大出血或临床相关非大出血的情况。
与其他两组相比，以PE为癌症首发表现的患者住院死亡率最高（以无癌症患者的死亡率为参考，调整为四层死亡风险和Charlson合并症指数后的风险比为3.440；95%置信区间（CI）为1.795 - 6.591；p < 0.001）。PE发作前已知患有癌症的患者接受溶栓治疗的可能性显著低于无癌症患者（比值比，0.523；95% CI为0.339 - 0.807；p = 0.003）；此外，当比值比调整为年龄时，这种差异虽有所减弱但仍然存在（比值比，0.542；95% CI为0.351 - 0.838；p = 0.006）。已知患有癌症的患者与无癌症患者相比，高危PE的发生率更高（18.2%对12.8%；p < 0.001）。以PE为癌症首发表现的患者中高危PE的发生率高于无此表现的患者（36.4%对30.9%；p < 0.001）。各亚组间住院期间出血情况无显著差异。
与无癌症患者相比，癌症患者的急性PE表现更为严重。此外，以PE为癌症首发表现的患者住院死亡率最高，而已知患有癌症的患者接受溶栓治疗的可能性最小。
