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Kouvela M, Livanou ME, Stefanou DT, Vathiotis IA, Sarropoulou F, Grammoustianou M, Dimakakos E, Syrigos N. Efficacy and Safety of Tinzaparin Thromboprophylaxis in Lung Cancer Patients with High Thromboembolic Risk: A Prospective, Observational, Single-Center Cohort Study. Cancers (Basel) 2024; 16:1442. [PMID: 38611118 PMCID: PMC11011428 DOI: 10.3390/cancers16071442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The aim of this study was to record and assess the efficacy and safety ofthromboprophylaxis with an intermediate dose of Tinzaparin in lung cancer patients with high thrombotic risk. METHODS This was a non-interventional, single-arm, prospective cohort study of lung cancer patients who received thromboprophylaxis with Tinzaparin 10.000 Anti-Xa IU in 0.5 mL, OD, used in current clinical practice. Enrolled ambulatory patients signed informed consent. Anti-Xa levels were tested. RESULTS In total, 140 patients were included in the study, of which 81.4% were males. The histology of the tumor was mainly adenocarcinoma. Lung cancer patients with high thrombotic risk based on tumor, patient, treatment, and laboratory-related factors were enrolled. Only one patient experienced a thrombotic event (0.7%), and 10 patients had bleeding events (7.1%), including only one major event. Anti-Xa levels measured at 10 days and 3 months did not differ significantly between patients who developed hemorrhagic events and those who did not (p = 0.26 and p = 0.32, respectively). CONCLUSION Thromboprophylaxis with an intermediate Tinzaparin dose in high thrombotic-risk lung cancer patients is a safe and effective choice for the prevention of VTE.
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Affiliation(s)
- Marousa Kouvela
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.E.L.); (I.A.V.); (F.S.); (M.G.); (E.D.); (N.S.)
| | - Maria Effrosyni Livanou
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.E.L.); (I.A.V.); (F.S.); (M.G.); (E.D.); (N.S.)
| | - Dimitra T. Stefanou
- First Department of Internal Medicine, Laikon General Hospital, School of Medicine, National Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Ioannis A. Vathiotis
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.E.L.); (I.A.V.); (F.S.); (M.G.); (E.D.); (N.S.)
| | - Fotini Sarropoulou
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.E.L.); (I.A.V.); (F.S.); (M.G.); (E.D.); (N.S.)
| | - Maria Grammoustianou
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.E.L.); (I.A.V.); (F.S.); (M.G.); (E.D.); (N.S.)
| | - Evangelos Dimakakos
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.E.L.); (I.A.V.); (F.S.); (M.G.); (E.D.); (N.S.)
| | - Nikolaos Syrigos
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.E.L.); (I.A.V.); (F.S.); (M.G.); (E.D.); (N.S.)
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Ruiz-Artacho P, Lecumberri R, Trujillo-Santos J, Font C, López-Núñez JJ, Peris ML, Díaz Pedroche C, Lobo JL, López Jiménez L, López Reyes R, Jara Palomares L, Pedrajas JM, Mahé I, Monreal M. Cancer Histology and Natural History of Patients with Lung Cancer and Venous Thromboembolism. Cancers (Basel) 2022; 14:cancers14174127. [PMID: 36077663 PMCID: PMC9454710 DOI: 10.3390/cancers14174127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Cancer is a widely heterogeneous disease, and the natural history of patients with cancer-associated thrombosis may differ according to the cancer site. Lung cancer is the most common malignancy, and a leading cause of death. A number of studies in the literature suggest that patients with adenocarcinoma may have a worse outcome than those with squamous or other types of lung cancer. The aim of the current study was to assess the potential impact of lung cancer histology on the incidence rates of VTE recurrences, major bleeding, or death appearing during the course of anticoagulation, in patients with lung cancer and VTE. Our findings, obtained from a large series of consecutive patients with lung cancer and VTE (482 patients), reveal important differences between patients with adenocarcinoma vs. other histologies in their outcomes during anticoagulation. This might likely help to design better therapeutic strategies for patients with lung cancer. Abstract Background: In patients with lung cancer and venous thromboembolism (VTE), the influence of cancer histology on outcome has not been consistently evaluated. Methods: We used the RIETE registry (Registro Informatizado Enfermedad TromboEmbólica) to compare the clinical characteristics and outcomes during anticoagulation in patients with lung cancer and VTE, according to the histology of lung cancer. Results: As of April 2022, there were 482 patients with lung cancer and VTE: adenocarcinoma 293 (61%), squamous 98 (20%), small-cell 44 (9.1%), other 47 (9.8%). The index VTE was diagnosed later in patients with squamous cancer than in those with adenocarcinoma (median, 5 vs. 2 months). In 50% of patients with adenocarcinoma, the VTE appeared within the first 90 days since cancer diagnosis. During anticoagulation (median 106 days, IQR: 45–214), 14 patients developed VTE recurrences, 15 suffered major bleeding, and 218 died: fatal pulmonary embolism 10, fatal bleeding 2. The rate of VTE recurrences was higher than the rate of major bleeding in patients with adenocarcinoma (11 vs. 6 events), and lower in those with other cancer types (3 vs. 9 events). On multivariable analysis, patients with adenocarcinoma had a non-significantly higher risk for VTE recurrences (hazard ratio [HR]: 3.79; 95%CI: 0.76–18.8), a lower risk of major bleeding (HR: 0.29; 95%CI: 0.09–0.95), and a similar risk of mortality (HR: 1.02; 95%CI: 0.76–1.36) than patients with other types of lung cancer. Conclusions: In patients with lung adenocarcinoma, the rate of VTE recurrences outweighed the rate of major bleeding. In patients with other lung cancers, it was the opposite.
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Affiliation(s)
- Pedro Ruiz-Artacho
- Department of Internal Medicine, Clínica Universidad de Navarra, 28027 Madrid, Spain
- Interdisciplinar Teragnosis and Radiosomics Research Group (INTRA-Madrid), Universidad de Navarra, 28027 Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-9135-31920
| | - Ramón Lecumberri
- Hematology Service, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- CIBERCV, Instituto de Salud Carlos III, 28220 Madrid, Spain
| | - Javier Trujillo-Santos
- Department of Internal Medicine, Hospital General Universitario Santa Lucía, Universidad Católica de Murcia, 30107 Murcia, Spain
| | - Carme Font
- Department of Medical Oncology, Hospital Clínic, 08036 Barcelona, Spain
| | - Juan J. López-Núñez
- Department of Internal Medicine, Hospital Germans Trias i Pujol, 08916 Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Institut de Recerca Germans Trias i Pujol, 08916 Badalona, Spain
| | - María Luisa Peris
- Department of Internal Medicine, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon, Spain
- Medicine Department, CEU Cardenal Herrera University, 46115 Valencia, Spain
| | - Carmen Díaz Pedroche
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - José Luis Lobo
- Department of Pneumonology, Hospital Universitario Araba, 01009 Vitoria-Gasteiz, Spain
| | - Luciano López Jiménez
- Department of Internal Medicine, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain
| | - Raquel López Reyes
- Department of Pneumonology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Luis Jara Palomares
- Department of Pneumonology, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - José María Pedrajas
- Department of Internal Medicine, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Isabelle Mahé
- Department of Internal Medicine, Hôpital Louis Mourier, Colombes (APHP), University Paris 7, 75013 Paris, France
| | - Manuel Monreal
- CIBER Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM–Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain
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Bazarbashi S, Alkhaldi T, Aseafan M, Melaibari M, Almuhisen S, Alharbi S, Alghabban A, Aljumaa J, Eldali A, Maraiki F, Owaidah T, Alzahrani H. Thromboembolic Events Burden in Patients With Solid Tumors and Their Predisposing Factors. Cureus 2022; 14:e23624. [PMID: 35386484 PMCID: PMC8967125 DOI: 10.7759/cureus.23624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction: The relationship between cancers and thromboembolic events is well established. In our study, we aim to determine the burden of thromboembolic events in patients with solid tumors and identify the risk factors related to their development. Materials & Methods: Data on patients with solid tumors and thromboembolism between January 2013 and September 2014 were collected and analyzed. Results: During the study period 174 patients were identified. Of which, 172 (98.9%) had venous thrombus embolism, 137 (79%) were diagnosed with deep vein thromboses, 67 (38.5%) with pulmonary embolism, 84 (48.3%) were symptomatic and 90 (51.7) were incidental at diagnosis. The most common patients and disease characteristics were female sex, high body mass index (BMI), metastatic stage, colorectal and breast primaries, and anti-neoplastic therapy. Conclusion: Our study confirmed the high burden of thromboembolic events in cancer patients and the relevant factors associated with its development.
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Xiong W, Zhao Y, Du H, Wang Y, Xu M, Guo X. Optimal authoritative risk assessment score of Cancer-associated venous thromboembolism for hospitalized medical patients with lung Cancer. Thromb J 2021; 19:95. [PMID: 34863189 PMCID: PMC8642841 DOI: 10.1186/s12959-021-00339-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/26/2021] [Indexed: 12/20/2022] Open
Abstract
Background Cancer-associated venous thromboembolism (VTE) is common in patients with primary lung cancer. It has been understudied which authoritative risk assessment score of cancer-associated VTE is optimal for the assessment of VTE development in hospitalized medical patients with lung cancer. Methods Patients with lung cancer who had undergone computed tomography pulmonary angiography (CTPA), compression ultrasonography (CUS) of lower and upper extremities, and/or planar ventilation/perfusion (V/Q) scan to confirm the presence or absence of VTE during a medical hospitalization were retrospectively reviewed. Based on the actual prevalence of VTE among all patients, the possibility of VTE were reassessed with the Khorana score, the PROTECHT score, the CONKO score, the ONKOTEV score, the COMPASS-CAT score, and the CATS/MICA score, to compare their assessment accuracy for VTE development. Results A total of 1263 patients with lung cancer were incorporated into the final analysis. With respect to assessment efficiency for VTE occurrence, the scores with adjusted agreement from highest to lowest were the ONKOTEV score (78.6%), the PROTECHT score (73.4%), the CONKO score (72.1%), the COMPASS-CAT score (71.7%), the Khorana score (70.9%), and the CATS/MICA score (60.3%). The ONKOTEV score had the highest Youden index which was 0.68, followed by the PROTECHT score (0.58), the COMPASS-CAT score (0.56), the CONKO score (0.55), the Khorana score (0.53), and the CATS/MICA score (0.23). Conclusions Among the Khorana score, the PROTECHT score, the CONKO score, the ONKOTEV score, the COMPASS-CAT score, and the CATS/MICA score which are approved by authoritative guidelines, the ONKOTEV score is optimal for the assessment of VTE development in hospitalized medical patients with lung cancer.
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Affiliation(s)
- Wei Xiong
- Department of Pulmonary and Critical Care Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine,Shanghai, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China.
| | - Yunfeng Zhao
- Department of Pulmonary and Critical Care Medicine, Punan Hospital, Pudong New District, Shanghai, China
| | - He Du
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yanmin Wang
- Department of Pulmonary and Critical Care Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine,Shanghai, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Mei Xu
- Department of General Medicine, North Bund Community Health Service Center, Hongkou District, Shanghai, China.
| | - Xuejun Guo
- Department of Pulmonary and Critical Care Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine,Shanghai, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China.
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Bagchi A, Khan MS, Saraswat A, Ansari A, Nai Q, Iyer V, Hamouda D, Khuder S, Verghese C. Increased Incidence of Thrombotic Complications With Non-small Cell Lung Cancer Necessitates Consideration of Prophylactic Anticoagulation in Young Individuals. Cureus 2021; 13:e17769. [PMID: 34659980 PMCID: PMC8494503 DOI: 10.7759/cureus.17769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/30/2022] Open
Abstract
Venous thromboembolism (VTE) is a common complication in cancer patients and is associated with increased morbidity and mortality. Lung cancer is commonly associated with VTE including pulmonary embolism. We did a retrospective analysis from the 2013 Healthcare Cost and Utilization Project data to determine the role of age as a factor in the development of VTE in this patient group. Patients were selected using the International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes for metastatic lung cancer and VTE. The patients were stratified by age, sex, race/ethnicity, and site of VTE. There was a total of 16,577 VTE events detected out of a total of 182,863 cases of metastatic lung cancer, representing 9% of the total cases. In patients under 65 years of age, there were 356.82 more cases of pulmonary embolism per 100,000 individuals compared to those older than 65 years (p<0.0001). The same age group also showed 374.83 more upper extremity VTE, 286.94 more non-pulmonary thoracic VTE, and 263.97 more abdominal VTE events per 100,000 individuals (p<0.0001). In conclusion, we found that patients under the age of 65 years had a significantly higher incidence of VTE, pulmonary embolism, upper extremity VTE as well as abdominal and non-pulmonary VTE.
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Affiliation(s)
- Arindam Bagchi
- Oncology, Beckley Appalachian Regional Healthcare (ARH) Hospital, Beckley, USA
| | - Mohammad Saud Khan
- Cardiology, University of Kentucky College of Medicine, Bowling Green, USA
| | - Arti Saraswat
- Internal Medicine, University of Kentucky College of Medicine, Bowling Green, USA
| | - Affan Ansari
- Internal Medicine, Vasantrao Pawar Medical College and Hospital, Nashik, IND
| | - Qiang Nai
- Oncology, Massachusetts General Cancer Center, Boston, USA
| | - Veena Iyer
- Oncology, Brigham and Women Hospital, Boston, USA
| | - Danae Hamouda
- Oncology, University of Toledo Medical Center, Toledo, USA
| | - Sadik Khuder
- Internal Medicine, University of Toledo Medical Center, Toledo, USA
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Liu Y, Wang W, Wu F, Gao G, Xu J, Li X, Zhao C, Yang S, Mao S, Pan Y, Jia K, Shao C, Chen B, Ren S, Zhou C. High discrepancy in thrombotic events in non-small cell lung cancer patients with different genomic alterations. Transl Lung Cancer Res 2021; 10:1512-1524. [PMID: 33889526 PMCID: PMC8044490 DOI: 10.21037/tlcr-20-1290] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Acute complications, such as venous thromboembolism (VTE), are common in patients with advanced severe lung cancers. However, current VTE risk scores cannot adequately identify high-risk patients with non-small cell lung cancer (NSCLC). The study proposed to elucidated the incidence of thromboembolism (TE) in patients with different oncogenic aberrations and the impact of these aberrations on the efficacy of targeted therapy in patients with NSCLC. Methods A systemic review was conducted in Web of Science, PubMed, Embase and the Cochrane Library to evaluate the incidence of TE in different molecular subtypes of NSCLC. Data from patients diagnosed of advanced NSCLC who harboring anaplastic lymphoma kinase (ALK) or ROS proto-oncogene 1 receptor tyrosine kinase (ROS1) rearrangements since 2016 to 2019 were also retrospectively collected. A meta-analysis with random-effects model, sensitivity analysis and publication bias were performed. The principal summary measure was incidence of thrombotic events in NSCLC patients. And the efficacy of tyrosine kinase inhibitor (TKI) therapy was compared between the two subgroups. Results A total of 5,767 cases from 20 studies were included in the analysis of the incidence of thrombosis in patients with different oncogenic alterations. The pooled analysis showed a higher risk of thrombosis in ROS1-fusion types (41%, 95% CI: 35-47%) and ALK-fusion types (30%, 95% CI: 24-37%) than in EGFR-mutation (12%, 95% CI: 8-17%), KRAS-mutation (25%, 95% CI: 13-50%), and wild-type (14%, 95% CI: 10-20%) cases. A high prevalence of thrombosis (ALK: 24.4%; ROS1: 32.6%) was observed in the Shanghai Pulmonary Hospital (SPH) cohort of 224 patients with ALK or ROS1 fusion. Furthermore, patients with embolism had significantly shorter progression-free survival (PFS) after TKI therapy than those without embolism, both in the ALK+ cohort (5.6 vs. 12.9 months, P<0.0001) and in the ROS1+ cohort (9.6 vs. 17.6 months, P=0.0481). Conclusions NSCLC patients with ALK/ROS1 rearrangements are more likely to develop thrombosis than patients with other oncogenic alterations. Thrombosis may also be associated with an inferior response and PFS after TKI therapy.
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Affiliation(s)
- Yiwei Liu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wanying Wang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fengying Wu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Guanghui Gao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jian Xu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xuefei Li
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chao Zhao
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shuo Yang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shiqi Mao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yingying Pan
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Keyi Jia
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chuchu Shao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bin Chen
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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Howlett J, Benzenine E, Cottenet J, Foucher P, Fagnoni P, Quantin C. Could venous thromboembolism and major bleeding be indicators of lung cancer mortality? A nationwide database study. BMC Cancer 2020; 20:461. [PMID: 32448219 PMCID: PMC7245783 DOI: 10.1186/s12885-020-06930-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/05/2020] [Indexed: 02/06/2023] Open
Abstract
Background Venous thromboembolism (VTE) is highly prevalent in cancer patients and can cause severe morbidity. VTE treatment is essential, but anticoagulation increases the risk of major bleeding. The purpose was to evaluate the impact of VTE and major bleeding on survival and to identify significant risk factors for these events in lung cancer patients. Methods Data were extracted from a permanent sample of the French national health information system (including hospital and out-of-hospital care) from 2009 to 2016. All episodes of VTE and major bleeding events within one year after cancer diagnosis were identified. A Cox model was used to analyse the effect of VTE and major bleeding on the patients’ one-year survival. VTE and major bleeding risk factors were analysed with a Fine and Gray survival model. Results Among the 2553 included patients with lung cancer, 208 (8%) had a VTE episode in the year following diagnosis and 341 (13%) had major bleeding. Almost half of the patients died during follow-up. Fifty-six (60%) of the patients presenting with pulmonary embolism (PE) died, 48 (42%) of the patients presenting with deep vein thrombosis (DVT) alone died and 186 (55%) of those presenting with a major bleeding event died. The risk of death was significantly increased following PE and major bleeding events. VTE concomitant with cancer diagnosis was associated with an increased risk of VTE recurrence beyond 6 months after the first VTE event (sHR = 4.07 95% CI: 1.57–10.52). Most major bleeding events did not appear to be related to treatment. Conclusion VTE is frequent after a diagnosis of lung cancer, but so are major bleeding events. Both PE and major bleeding are associated with an increased risk of death and could be indicators of lung cancer mortality.
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Affiliation(s)
- Jennifer Howlett
- CHRU Dijon, Pharmacy, F-21000, Dijon, France.,Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Eric Benzenine
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.,INSERM, CIC 1432, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon University Hospital, Dijon, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.,INSERM, CIC 1432, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon University Hospital, Dijon, France
| | | | - Philippe Fagnoni
- CHRU Dijon, Pharmacy, F-21000, Dijon, France.,Unité INSERM U866, Dijon University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France. .,INSERM, CIC 1432, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon University Hospital, Dijon, France. .,Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France.
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Khorana AA, McCrae KR, Milentijevic D, Laliberté F, Lejeune D, Crivera C, Lefebvre P. Healthcare resource utilization and costs associated with venous thromboembolism recurrence in patients with cancer. J Med Econ 2020; 23:323-329. [PMID: 31818164 DOI: 10.1080/13696998.2019.1703190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: Patients with cancer are at high risk for developing primary but also recurrent venous thromboembolism (VTE). This study examined healthcare utilization (HRU) and costs related to VTE recurrence among cancer patients.Methods: Medical and pharmacy claims from the Humana Database were used to compare HRU (outpatient visits, emergency room visits, hospitalizations, and hospitalization days) and healthcare costs among cancer patients with a single VTE event (between 01/2013 and 06/2015) and those with recurrent VTE during the follow-up period (from initiation of anticoagulant therapy until end of eligibility or data availability). All-cause and VTE-related HRU and costs were evaluated using Poisson regression, and healthcare costs were compared using mean differences reported as per-patient-per-year (PPPY).Results: Of 2,428 newly diagnosed cancer patients who developed VTE, 413 (17.1%) experienced recurrent VTE during the follow-up period (mean = 9 months). Patients with recurrent VTE had higher all-cause and VTE-related HRU and costs compared to those without recurrence. Patients with recurrent VTE also had over 3.19-times more VTE-related hospitalizations (RR [95% CI] = 3.19 [2.93-3.47]), and 3.88-times more VTE-related hospitalization days (RR [95% CI] = 3.88 [3.74-4.02]) than patients without a VTE recurrence. Total VTE-related healthcare costs were $39,641 PPPY among patients with recurrent VTE, $29,142 higher compared to those without recurrence ($10,499 PPPY). This difference was mainly driven by hospitalization costs.Conclusion: Recurrent VTE among cancer patients is associated with significant HRU and healthcare costs, notably hospitalizations. Strategies to reduce VTE recurrence in patients with cancer can contribute to reducing healthcare cost.
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Affiliation(s)
- Alok A Khorana
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Keith R McCrae
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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9
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Sun Y, Li H. [Perioperative Venous Thromboembolism (VTE) Prophylaxis in Thoracic Cancer Patients: Chinese Experts Consensus - Interpretation of Epidemiological Characteristics]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:741-746. [PMID: 31874667 PMCID: PMC6935037 DOI: 10.3779/j.issn.1009-3419.2019.12.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
胸部恶性肿瘤患者围术期静脉血栓栓塞症(venous thromboembolism, VTE)是一种需要引起重视的胸外科围术期并发症,中国胸外科静脉血栓栓塞研究协作组针对胸部恶性肿瘤患者围术期VTE的预防,发布了国际首部《胸部恶性肿瘤围术期静脉血栓栓塞症预防中国专家共识》(2018版)。本文将对其中胸部恶性肿瘤围术期VTE的流行病学特征、国内外面临的挑战及预防现状进行解读,以助于更好地理解共识相关内容。
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Affiliation(s)
- Yixin Sun
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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10
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Dou F, Zhang Y, Yi J, Zhu M, Zhang S, Zhang D, Zhang Y. Association of ALK rearrangement and risk of venous thromboembolism in patients with non-small cell lung cancer: A prospective cohort study. Thromb Res 2019; 186:36-41. [PMID: 31864154 DOI: 10.1016/j.thromres.2019.12.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/08/2019] [Accepted: 12/14/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Isolated reports are inconsistent regarding the risk of venous thromboembolism (VTE) in patients with anaplastic lymphoma kinase (ALK) rearranged non-small cell lung cancer (NSCLC). This study examined whether ALK rearrangement could have an influence on VTE in a prospective cohort. METHODS In a cohort of 836 consecutive patients with NSCLC, patients with epidermal growth factor receptor (EGFR) or kitten rat sarcoma (KRAS) mutations were ruled out for VTE interference. Finally, 341 qualified patients were observed. The median follow up period is 7.5 months (3.1-15.4m). ALK rearrangement was detected by fluorescence in situ hybridization at baseline. RESULTS Overall VTE events occurred in 37 (10.9%) of 341 patients. In multivariable analysis including age, sex, tumor histology, tumor stage, performance status, and ALK status, ALK rearrangement (sub-distribution hazard radio 2.47, 95% confidence interval 1.04-5.90) was associated with the increased risk of VTE. The cumulative incidence of VTE was 26.9% and 9.2% in the patients with and without ALK rearrangement after 6 months. After 1 year the corresponding cumulative incidence was 26.9% and 9.7% respectively (Gray test P = .005). CONCLUSIONS The presence of ALK rearrangement is associated with increased risk of VTE in patients with NSCLC.
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Affiliation(s)
- Feifei Dou
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China
| | - Yuan Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China
| | - Jiawen Yi
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China
| | - Min Zhu
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China
| | - Shu Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China
| | - Di Zhang
- Department of Clinical Epidemiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Yuhui Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China.
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11
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Ząbczyk M, Królczyk G, Czyżewicz G, Plens K, Prior S, Butenas S, Undas A. Altered fibrin clot properties in advanced lung cancer: strong impact of cigarette smoking. Med Oncol 2019; 36:37. [PMID: 30891644 DOI: 10.1007/s12032-019-1262-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Dense fibrin networks resistant to lysis have been reported in patients at high risk of thromboembolism. Little is known about fibrin clot properties in cancer. We investigated fibrin clot properties and their determinants in patients with inoperable lung cancer. METHODS We enrolled 150 patients with advanced lung cancer prior to therapy and 90 control subjects matched by age, sex, cardiovascular disease, and diabetes. Plasma clot permeability (Ks), turbidimetric analysis of clot formation, clot lysis time (CLT), microparticle-associated tissue factor (MP-TF) activity, thrombin generation, and serum cotinine levels were determined. RESULTS Lung cancer patients, compared with controls, formed at a faster rate (- 8.1% lag phase) denser plasma fibrin networks (- 27.2% Ks) that displayed impaired lysis (+ 26.5% CLT), along with 19.5% higher MP-TF activity and 100% higher peak thrombin generated, also after adjustment for potential confounders. Cotinine levels were associated with fibrin maximum absorbance (r = 0.20, p = 0.016) and Ks (r = - 0.50, p < 0.0001) in cancer patients. On multivariate regression analysis, an increase in cotinine levels was a predictor of low Ks (the lower quartile, < 5.8 × 10-9 cm2; odds ratio = 1.21 per 10 ng/ml, 95% confidence interval 1.02-1.46), but not CLT. CONCLUSION Advanced lung cancer is associated with the prothrombotic plasma clot phenotype largely driven by smoking.
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Affiliation(s)
- Michał Ząbczyk
- Institute of Cardiology, Jagiellonian University Medical College, 80 Prądnicka Str. 31-202, Kraków, Poland.,Center for Research and Medical Technology, John Paul II Hospital, Pradnicka 80, 31-202, Kraków, Poland
| | - Grzegorz Królczyk
- Institute of Cardiology, Jagiellonian University Medical College, 80 Prądnicka Str. 31-202, Kraków, Poland.,Oncology Ward, John Paul II Hospital, Pradnicka 80, 31-202, Kraków, Poland
| | - Grzegorz Czyżewicz
- Oncology Ward, John Paul II Hospital, Pradnicka 80, 31-202, Kraków, Poland
| | | | - Shannon Prior
- Department of Biochemistry, University of Vermont, 360 South Park Drive, Colchester, VT, USA
| | - Saulius Butenas
- Department of Biochemistry, University of Vermont, 360 South Park Drive, Colchester, VT, USA
| | - Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College, 80 Prądnicka Str. 31-202, Kraków, Poland. .,Center for Research and Medical Technology, John Paul II Hospital, Pradnicka 80, 31-202, Kraków, Poland. .,Faculty of Medicine and Health Sciences, Jan Kochanowski University, IX Wiekow Kielc 19A, 25-317, Kielce, Poland.
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12
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Królczyk G, Ząbczyk M, Czyżewicz G, Plens K, Prior S, Butenas S, Undas A. Altered fibrin clot properties in advanced lung cancer: impact of chemotherapy. J Thorac Dis 2018; 10:6863-6872. [PMID: 30746232 DOI: 10.21037/jtd.2018.11.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Faster formation of dense and poorly lyzable fibrin networks have been reported in patients at risk of thromboembolism, including cancer patients. We sought to investigate whether chemotherapy affects plasma fibrin clot properties and their determinants in lung cancer patients. Methods In this observational study we enrolled 83 consecutive patients with advanced inoperable lung cancer. Plasma fibrin clot permeability (Ks), turbidimetric analysis of clot formation, clot lysis time (CLT), microparticle-associated tissue factor (MP-TF) activity, and thrombin generation parameters were investigated at enrolment and 3-4 months after standard chemotherapy. Results Lung cancer patients after 4 (range, 4-5) cycles of chemotherapy had 35.6% higher D-dimer, 22.1% lower MP-TF activity, and unaltered fibrinogen compared with baseline. Chemotherapy resulted also in 7.5% increased Ks, 8.6% prolonged lag phase, and 5.4% shortened CLT, while thrombin generation was unchanged. Chemotherapy-related differences in clot structure were confirmed by scanning electron microscopy images. Fibrin clot properties after chemotherapy did not differ among histological types of lung cancer, cancer stages or chemotherapy regimens. Interestingly, never smoking (n=13, 16%) was associated with looser post-treatment fibrin structure as reflected by 12.3% higher Ks. Multiple linear regression showed that more advanced cancer stage, higher peak thrombin generation, and higher white blood cell count determined post-treatment change in Ks, while active smoking was associated with change in CLT. Conclusions Three-month chemotherapy in lung cancer patients improves clot properties despite unaffected thrombin generation, suggesting that anticancer treatment might quickly produce antithrombotic actions.
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Affiliation(s)
- Grzegorz Królczyk
- Oncology Ward, John Paul II Hospital, Cracow, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Cracow, Poland
| | - Michał Ząbczyk
- Institute of Cardiology, Jagiellonian University Medical College and John Paul II Hospital, Cracow, Poland
| | | | | | - Shannon Prior
- Department of Biochemistry, University of Vermont, Burlington, VT, USA
| | - Saulius Butenas
- Department of Biochemistry, University of Vermont, Burlington, VT, USA
| | - Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College and John Paul II Hospital, Cracow, Poland.,Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
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Muhsin-Sharafaldine MR, McLellan AD. Apoptotic vesicles: deathly players in cancer-associated coagulation. Immunol Cell Biol 2018; 96:723-732. [PMID: 29738615 DOI: 10.1111/imcb.12162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 12/27/2022]
Abstract
Although cancer is associated with coagulation disorders, it is still unclear how the combination of tumor cell and host factors enhance the hypercoagulable state of cancer patients. Emerging evidence points to a central role for tumor endosomal and plasma membrane-derived vesicular components in the pathogenesis of cancer-related thrombosis. In particular, tumor cell membranes and extracellular vesicles (EV) harbor lipids and proteinaceous coagulation factors able to initiate multiple points within the coagulation matrix. The impact of chemotherapy upon a host already burdened with a hypercoagulable state increases the risk of pathological coagulation. We argue that chemotherapy-induced EV harbor the most active components for cancer related thrombosis and discuss how membrane components of the host and tumor act to initiate coagulation to enhance thrombotic risk in cancer patients.
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14
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Muhsin-Sharafaldine MR, McLellan AD. Tumor-Derived Apoptotic Vesicles: With Death They Do Part. Front Immunol 2018; 9:957. [PMID: 29780392 PMCID: PMC5952256 DOI: 10.3389/fimmu.2018.00957] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/17/2018] [Indexed: 12/21/2022] Open
Abstract
Tumor cells release lipid particles known as extracellular vesicles (EV) that contribute to cancer metastasis, to the immune response, and to thrombosis. When tumors are exposed to radiation or chemotherapy, apoptotic vesicles (ApoVs) are released in abundance as the plasma membrane delaminates from the cytoskeleton. Recent studies have suggested that ApoVs are distinct from the EVs released from living cells, such as exosomes or microvesicles. Depending on their treatment conditions, tumor-released ApoV have been suggested to either enhance or suppress anti-cancer immunity. In addition, tumor-derived ApoV possess procoagulant activity that could increase the thrombotic state in cancer patients undergoing chemotherapy or radiotherapy. Since ApoVs are one of the least appreciated type of EVs, we focus in this review on the distinctive characterization of tumor ApoVs and their proposed mechanistic effects on cancer immunity, coagulation, and metastasis.
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Affiliation(s)
| | - Alexander D McLellan
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
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15
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Evaluation of risk factors and assessment models for predicting venous thromboembolism in lung cancer patients. Med Oncol 2018; 35:63. [PMID: 29616356 PMCID: PMC5882764 DOI: 10.1007/s12032-018-1120-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/30/2018] [Indexed: 02/07/2023]
Abstract
The aim of the study was to investigate the prognostic significance of selected risk assessment models (RAMs) for predicting venous thromboembolism (VTE) events in patients undergoing outpatient chemotherapy for lung cancer. We evaluated the following VTE-risk assessment tools: Khorana risk score (KRS), PROTECHT score, CONKO score and COMPASS-cancer-associated thrombosis score (COMPASS-CAT). Retrospective analyses were performed on 118 patients with lung cancer, 20 of whom developed VTE with a median of 2.5 months from diagnosis. Patients receiving gemcitabine-based regimen (25%), patients with a history of atrial fibrillation (AF) and patients with chronic kidney disease developed VTE more often than other patients. In the multivariate analysis, high COMPASS-CAT score (OR 8.73; 95% CI 1.01–75.22, P = 0.049), gemcitabine chemotherapy (OR 3.37; 95% CI 1.09–10.39, P = 0.035) and AF (OR 7.19; 95% CI 1.89–27.33, P = 0.004) were all significantly associated with VTE development. VTE occurred in; 13% (n = 2) of the KRS high-risk group, 17.7% (n = 11) of the PROTECHT high-risk group, 15% (n = 4) of the CONKO high-risk group and 23.8% (n = 20) of the COMPASS-CAT high-risk group (n = 84). Only the COMPASS-CAT score was able to identify 100% of patients who developed VTE, and best discriminated between patients with high and low risk of VTE development (C statistic 0.89). The ROC analysis indicated a cutoff value of 11 points (95% CI 0.821–0.962) for COMPASS-CAT for VTE development in patients with lung cancer. In conclusion, in our study of all the VTE–RAMs analyzed, the COMPASS-CAT model was the most accurate predictor of VTE development in patients with lung cancer.
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16
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Lee YG, Lee E, Bang SM, Kang C, Kim Y, Kim H, Wu HG, Kim Y, Kim T, Lee KW, Lee SH, Kim DW, Heo D, Kim I. Risk factors and prognostic impact of venous thromboembolism in Asian patients with non-small cell lung cancer. Thromb Haemost 2017; 111:1112-20. [DOI: 10.1160/th13-11-0956] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/19/2014] [Indexed: 12/21/2022]
Abstract
SummaryAlthough the overall risk of venous thromboembolism (VTE) is high in patients with non-small cell lung cancer (NSCLC), risk identification is limited. The goal of this study was to estimate the incidence, risk factors and prognostic implications of VTE, and to evaluate a genetic link between oncogenes and the risk of VTE in Asian patients with NSCLC. A total of 1,998 consecutive patients with NSCLC were enrolled and analysed retrospectively. Since the effects of therapeutics on VTE development were modified by stage, stratified analyses were performed. When comparing overall survival in terms of VTE development, a propensity score-matching method was adopted to minimise potential confounding. The six-month and two-year cumulative incidences of VTE were 4.2% and 6.4%, respectively. The risk of VTE increased 2.45-fold with each advancing stage in NSCLC (p<0.001). The independent predictors of VTE were advanced age, pneumonectomy and palliative radiotherapy in localised NSCLC and ineligibility for surgery and palliative radiotherapy in locally advanced NSCLC. Adenocarcinoma histology (vs squamous cell) and former/current smoking status were significant predictors of VTE in metastatic NSCLC. A significant association between VTE and decreased survival was observed only among patients with localised NSCLC. EGFR mutations (p=0.170) and ALK rearrangements (p=0.159) were not associated with VTE development in lung adenocarcinoma. In conclusion, the two-year cumulative incidence of VTE is 6.4% in Asian patient with NSCLC. The significant predictors of VTE are different across stages of NSCLC. The prognostic impact of VTE on poor survival was limited to localised NSCLC.
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17
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Dimakakos E, Livanios K, Gkiozos I, Charpidou A, Ntalakou E, Kainis L, Syrigos K. New data for venous thromboembolism in patients with small cell lung cancer: A review. Phlebology 2017; 33:517-522. [PMID: 29059023 DOI: 10.1177/0268355517737670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Malignancy is an important predisposing factor for thromboembolic disease. Patients with malignancy display 4 to 10 times greater risk than the general population. As for lung cancer, that risk seems to further increase and become up to 20 times higher. The aim of this article is to review the International literature in order to highlight for the first time, the correlation between thromboembolic disease and small cell lung cancer. PubMed, Medline and Embase databases were searched from 1990 up to 2016, for retrospective and prospective studies that investigate the correlation between thromboembolic disease and small cell lung cancer. The incidence rate of thromboembolic disease found in these studies ranged between 6.8% and 11.5%. Thromboembolic disease is associated with a reduced survival in patients with small cell lung cancer and six factors seemed to increase the risk of thromboembolism: chemotherapy, cisplatin treatment, smoking, extensive disease, the infiltration of the superior vena cava and multiple concomitant diseases. Thromboembolic disease shows an increased incidence in patients with small cell lung cancer and more research with well-designed studies is required in order to study in detail the anticoagulation treatment and the survival in small cell lung cancer patients.
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Affiliation(s)
- Evangelos Dimakakos
- School of Medicine, Oncology Unit GPP, Sotiria General Hospital, Athens, Greece
| | | | - Ioannis Gkiozos
- School of Medicine, Oncology Unit GPP, Sotiria General Hospital, Athens, Greece
| | - Adriani Charpidou
- School of Medicine, Oncology Unit GPP, Sotiria General Hospital, Athens, Greece
| | - Eleutheria Ntalakou
- School of Medicine, Oncology Unit GPP, Sotiria General Hospital, Athens, Greece
| | - Llias Kainis
- School of Medicine, Oncology Unit GPP, Sotiria General Hospital, Athens, Greece
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18
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Mechanistic insight into the procoagulant activity of tumor-derived apoptotic vesicles. Biochim Biophys Acta Gen Subj 2016; 1861:286-295. [PMID: 27864149 DOI: 10.1016/j.bbagen.2016.11.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/09/2016] [Accepted: 11/14/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Chemotherapy induces the release of apoptotic vesicles (ApoV) from the tumor plasma membrane. Tumor ApoV may enhance the risk of thrombotic events in cancer patients undergoing chemotherapy. However, the relative contribution of ApoV to coagulation and the pathways involved remain poorly characterized. In addition, this study sets out to compare the procoagulant activity of chemotherapy-induced ApoV with their cell of origin and to determine the mechanisms of ApoV-induced coagulation. METHODS We utilized human and murine cancer cell lines and chemotherapeutic agents to determine the requirement for the coagulation factors (tissue factor; TF, FII, FV, FVII, FVIII, FIX and phosphatidylserine) in the procoagulant activity of ApoV. The role of previously identified ApoV-associated FV was determined in a FV functional assay. RESULTS ApoV were significantly more procoagulant per microgram of protein compared to parental living or dying tumor cells. In the phase to peak fibrin generation, procoagulant activity was dependent on phosphatidylserine, TF expression, FVII and the prothrombinase complex. However, the intrinsic coagulation factors FIX and FVIII were dispensable. ApoV-associated FV could not support coagulation in the absence of supplied, exogenous FV. CONCLUSIONS ApoV are significantly more procoagulant than their parental tumor cells. ApoV require the extrinsic tenase and prothrombinase complex to activate the early phase of coagulation. Endogenous FV identified on tumor ApoV is serum-derived and functional, but is non-essential for ApoV-mediated fibrin generation. GENERAL SIGNIFICANCE This study clarifies the mechanisms of procoagulant activity of vesicles released from dying tumor cells.
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19
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Risk of venous thromboembolism in people with lung cancer: a cohort study using linked UK healthcare data. Br J Cancer 2016; 115:115-21. [PMID: 27253177 PMCID: PMC4931366 DOI: 10.1038/bjc.2016.143] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/09/2016] [Accepted: 04/26/2016] [Indexed: 02/07/2023] Open
Abstract
Background: Venous thromboembolism (VTE) is a potentially preventable cause of death in people with lung cancer. Identification of those most at risk and high-risk periods may provide the opportunity for better targeted intervention. Methods: We conducted a cohort study using the Clinical Practice Research Datalink linked to Hospital Episode Statistics and Cancer Registry data. Our cohort comprises 10 598 people with lung cancer diagnosed between 1997 and 2006 with follow-up continuing to the end of 2010. Cox regression analysis was performed to determine which demographic, tumour and treatment-related factors (time-varying effects of chemotherapy and surgery) independently affected VTE risk. We also determined the effect of a VTE diagnosis on the survival of people with lung cancer. Results: People with lung cancer had an overall VTE incidence of 39.2 per 1000 person-years (95% confidence interval (CI), 35.4–43.5), though rates varied depending on the patient group and treatment course. Independent factors associated with increased VTE risk were metastatic disease (hazard ratio (HR)=1.9, CI 1.2–3.0 vs local disease); adenocarcinoma subtype (HR=2.0, CI 1.5–2.7, vs squamous cell; chemotherapy administration (HR=2.1, CI 1.4–3.0 vs outside chemotherapy courses); and diagnosis via emergency hospital admission (HR=1.7, CI 1.2–2.3 vs other routes to diagnosis). Patients with VTE had an approximately 50% higher risk of mortality than those without VTE. Conclusions: People with lung cancer have especially high risk of VTE if they have advanced disease, adenocarcinoma or are undergoing chemotherapy. The presence of VTE is an independent risk factor for death.
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Advanced nodal stage predicts venous thromboembolism in patients with locally advanced non-small cell lung cancer. Lung Cancer 2016; 96:41-7. [PMID: 27133748 DOI: 10.1016/j.lungcan.2016.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/29/2016] [Accepted: 03/10/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Patients with non-small cell lung cancer (NSCLC) are known to be at high risk for venous thromboembolism (VTE), but previous studies have not specifically analyzed locally advanced disease. We performed a retrospective VTE risk analysis in a cohort of locally advanced NSCLC treated with definitive intent including radiation therapy. MATERIALS AND METHODS The cohort consisted of 629 patients with stage II-III NSCLC treated at a single institution from January 2003 to December 2012. All patients received treatment with curative intent, including radiation therapy. Fine and Gray's competing-risks regression model, accounting for death and distant metastasis as competing risks, was used to identify significant predictors of VTE risk, and cumulative incidence estimates were generated using the competing-risks model. RESULTS AND CONCLUSION At a median follow-up of 31 months, 127 patients developed a VTE, with 80% of events occurring in the first year after treatment initiation. 1-year and 3-year overall cumulative incidence estimates were 13.5% and 15.4%, respectively. On univariate analysis, stage IIIB and N3 nodal disease were associated with increased VTE risk. In the final multivariable model, N3 nodal disease was associated with increased VTE risk (Hazard ratio 1.64; 95% CI 1.06-2.54; p=0.027). In conclusion, patients with locally advanced NSCLC are at high risk for VTE, especially in the first year after treatment initiation, with a 1-year cumulative incidence of 13.5%. N3 nodal staging was associated with significantly higher VTE risk compared to N0-N2 staging.
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Hewes PD, Hachey KJ, Zhang XW, Tripodis Y, Rosenkranz P, Ebright MI, McAneny D, Fernando HC, Litle VR. Evaluation of the Caprini Model for Venothromboembolism in Esophagectomy Patients. Ann Thorac Surg 2015; 100:2072-8. [DOI: 10.1016/j.athoracsur.2015.05.098] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/11/2015] [Accepted: 05/26/2015] [Indexed: 11/30/2022]
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22
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Salla E, Dimakakos EP, Tsagkouli S, Giozos I, Charpidou A, Kainis E, Syrigos KN. Venous Thromboembolism in Patients Diagnosed With Lung Cancer. Angiology 2015; 67:709-24. [PMID: 26553057 DOI: 10.1177/0003319715614945] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Considering the high prevalence of lung cancer, our purpose was to summarize the existing literature to identify the several factors that contribute to the increased risk of venous thromboembolism (VTE) in patients with lung cancer and to analyze the current recommendations for thromboprophylaxis and treatment of VTE in those patients. METHODS We searched the Medline and EMBASE databases from February 1985 to February 2014 to identify retrospective and prospective randomized controlled studies that investigate one or more risk factors for VTEs in patients with lung cancer. RESULTS A VTE is a major complication for patients diagnosed with lung cancer. The risk factors for VTE events in patients with lung cancer consist of cancer-related (histological type and stage of cancer), treatment-related (surgery, chemotherapy, angiogenic agents, and supportive care agents), and patient-related factors (comorbidities, immobility, performance status, and prior thrombosis). Low-molecular-weight heparins are recommended for long-term treatment of cancer-associated thrombosis. Duration of anticoagulant therapy beyond 6 months should be based on individual clinical evaluation. Thromboprophylaxis for patients with lung cancer during hospitalization and immediate postoperative period is well established. CONCLUSIONS Efforts to assess thrombotic risk in patients with lung cancer may improve therapeutic and preventive strategies in the future, with final goal to minimize the burden and consequences of thrombotic events in patients with lung cancer.
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Affiliation(s)
- E Salla
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece
| | - Evangelos P Dimakakos
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece
| | - S Tsagkouli
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece
| | - I Giozos
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece
| | - A Charpidou
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece
| | - E Kainis
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece
| | - K N Syrigos
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece Yale School of Medicine, New Haven, CT, USA
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Verso M, Chiari R, Mosca S, Franco L, Fischer M, Paglialunga L, Bennati C, Scialpi M, Agnelli G. Incidence of Ct scan-detected pulmonary embolism in patients with oncogene-addicted, advanced lung adenocarcinoma. Thromb Res 2015; 136:924-7. [DOI: 10.1016/j.thromres.2015.09.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 09/03/2015] [Accepted: 09/04/2015] [Indexed: 01/09/2023]
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24
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Kourlaba G, Relakis J, Kontodimas S, Holm MV, Maniadakis N. A systematic review and meta-analysis of the epidemiology and burden of venous thromboembolism among pregnant women. Int J Gynaecol Obstet 2015; 132:4-10. [DOI: 10.1016/j.ijgo.2015.06.054] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 06/03/2015] [Accepted: 09/28/2015] [Indexed: 11/29/2022]
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25
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Vitale C, D'Amato M, Calabrò P, Stanziola AA, Mormile M, Molino A. Venous thromboembolism and lung cancer: a review. Multidiscip Respir Med 2015; 10:28. [PMID: 26380084 PMCID: PMC4570636 DOI: 10.1186/s40248-015-0021-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 07/27/2015] [Indexed: 12/03/2022] Open
Abstract
Venous thromboembolism (VTE) is a common complication of malignancies and epidemiological studies suggest that lung cancer belonged to the group of malignancies with the highest incidence rates of VTE. Risk factors for VTE in lung cancer patients are adenocarcinoma, NSCLC in comparison with SCLC, advanced disease, pneumonectomy, chemotherapy including antiangiogenic therapy. Other risk factors are pretreatment platelet counts and increased release of TF-positive microparticles. Elevated D-dimer levels do not necessarily indicate an increased risk of VTE but have been shown to be predictive for a worse clinical outcome in lung cancer patients. Mechanisms responsible for the increase in venous thrombosis in patients with lung cancer are not understood. Currently no biomarker is recognized as a predictor for VTE in lung cancer patients. Although several clinical trials have reported the efficacy of antithrombotic prophylaxis in patients with lung cancer who are receiving chemotherapy, further trials are needed to assess the clinical benefit since these patients are at an increased risk of developing a thromboembolism.
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Affiliation(s)
- Carolina Vitale
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Maria D'Amato
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Paolo Calabrò
- Department of Cardiology, High Speciality Hospital "V. Monaldi", Second University of Naples, Naples, Italy
| | - Anna Agnese Stanziola
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Mauro Mormile
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Antonio Molino
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
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The humanistic and economic burden of venous thromboembolism in cancer patients: a systematic review. Blood Coagul Fibrinolysis 2015; 26:13-31. [PMID: 25202884 DOI: 10.1097/mbc.0000000000000193] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to present evidence on the epidemiology, health outcomes and economic burden of cancer-related venous thromboembolism (VTE). Medline, Cochrane Central Register of Controlled Trials, Econlit, Science Direct, JSTOR, Oxford Journals and Cambridge Journals were searched. The systematic literature search was limited to manuscripts published from January 2000 to December 2012. On the basis of the literature, cancer patients experience between two-fold and 20-fold higher risk of developing VTE than noncancer patients. They are more likely to experience a VTE event during the first 3-6 months after cancer diagnosis. In addition, an increased risk of VTE in patients with distant metastases and certain types of cancer (i.e. pancreatic or lung) was revealed. VTE was found to be a leading cause of mortality in cancer patients. The annual average total cost for cancer patients with VTE was found to be almost 50% higher than that of cancer patients without VTE. Inpatient care costs accounted for more than 60% of total cost. The existing evidence assessed in the present review demonstrated the significant health and economic consequences of cancer-related VTE, which make a strong case for the importance of its proper and efficient prevention and management.
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Zhang X, Li H, Chen W, Yang Y, Wang C, Zhang Y. Efficacy and safety of chemotherapy for newly diagnosed advanced non-small cell lung cancer with venous thromboembolism. Thorac Cancer 2015; 6:772-7. [PMID: 26557917 PMCID: PMC4632931 DOI: 10.1111/1759-7714.12278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 04/20/2015] [Indexed: 11/30/2022] Open
Abstract
Background Venous thromboembolism (VTE) is a serious complication in patients with lung cancer. The benefit of chemotherapy for lung cancer patients with VTE remains unknown. This study was conducted to elucidate the efficacy and safety of chemotherapy for advanced non-small cell lung cancer (NSCLC) in patients with VTE. Methods Newly diagnosed patients with advanced (i.e. stage IIIB and IV) NSCLC with VTE who received systemic chemotherapy were studied. Response rates, progression-free survival (PFS), overall survival (OS), and toxicity were retrospectively analyzed. Results In this study, 21 patients who received chemotherapy plus anticoagulation therapy between December 2009 and February 2011 were included. The objective response and disease control rates within the first regimen were 14.29% (3/21) and 76.19 %(16/21), respectively. The median PFS, one-year survival rate, and median OS were 5.50 months, 33.30%, and 8.70 months, respectively. The main grade 3/4 toxicities observed included neutropenia (28.57%), nausea 4 (19.05%), and anemia 2 (9.52%). Major bleeding was not observed. Conclusion Chemotherapy for newly diagnosed patients with advanced NSCLC and VTE was feasible and had acceptable toxicity; however, the survival of these patients remained inferior to that of patients without VTE.
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Affiliation(s)
- Xueli Zhang
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University Beijing, China ; Department of Respiratory Medicine, Beijing Shunyi District Hospital, China Medical University Beijing, China
| | - Huiqiao Li
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University Beijing, China
| | - Wenhui Chen
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University Beijing, China
| | - Yuanhua Yang
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University Beijing, China
| | - Chen Wang
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University Beijing, China
| | - Yuhui Zhang
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University Beijing, China
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Prognostic significance of the absolute monocyte counts in lung cancer patients with venous thromboembolism. Tumour Biol 2015; 36:7631-9. [PMID: 25921284 DOI: 10.1007/s13277-015-3475-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 04/16/2015] [Indexed: 01/24/2023] Open
Abstract
We investigated the clinical significance of the absolute monocyte count (AMC) as a predictor of the response to anticoagulation and survival in lung cancer patients with venous thromboembolism (VTE). We retrospectively reviewed 1707 patients with pathologically proven lung cancer who visited the hospital between July 2008 and May 2014. Among them, the clinical data of patients newly diagnosed with VTE and treated with anticoagulation were compared between the low and high AMC groups according to the median value of AMC (640/μL) at the time of VTE diagnosis. The incidence of VTE was 7.9 % during the study period. Most of the patients had non-small-cell lung cancer (82.1 %), stage IV (64.2 %), and pulmonary thromboembolism (76.1 %) and were incidentally diagnosed with VTE (76.9 %). The patients' characteristics and laboratory values were not significantly different between the low and high AMC groups. Among patients available for evaluation of the response to anticoagulation, the high AMC group was significantly more refractory to anticoagulation than the low AMC group (no response to anticoagulation, 21.7 vs. 6.8 %, respectively; p = 0.044). Additionally, the high AMC group showed worse overall survival (OS) than the low AMC group (median, 9.6 vs. 5.9 months; p = 0.038). On multivariate analysis, high AMC, low albumin, and advanced stage were independent poor prognostic factors for OS. High AMC is associated with refractoriness to anticoagulation and poor prognosis in lung cancer patients with VTE.
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Steuer CE, Behera M, Kim S, Patel N, Chen Z, Pillai R, Saba NF, Shin DM, Owonikoko TK, Khuri FR, Ramalingam SS. Predictors and outcomes of venous thromboembolism in hospitalized lung cancer patients: A Nationwide Inpatient Sample database analysis. Lung Cancer 2015; 88:80-4. [PMID: 25726042 DOI: 10.1016/j.lungcan.2015.01.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 01/21/2015] [Accepted: 01/25/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with lung cancer are at high risk of developing venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism. We sought to characterize the clinical factors associated with development of VTE and the impact of VTE on outcomes for hospitalized lung cancer patients. METHODS We analyzed data captured in the Nationwide Inpatient Sample (NIS) database of the Agency of Healthcare Research and Quality (AHRQ). The study included all lung cancer patients hospitalized between 2006 and 2010 who had VTE captured as one of the top three discharge diagnoses. Demographics and outcomes of this population were compared to those of inpatient lung cancer patients without a VTE diagnosis. All analyses were performed using SAS version 9.3. RESULTS Out of 570,304 lung cancer hospitalizations, 20,672 had a clinically relevant diagnosis of VTE, accounting for 3.6% of all events. The median age of lung cancer patients with VTE was 68 years; 48% were females, 79% were Caucasians, and 43% had metastatic disease. When compared to a lung cancer cohort without VTE (n=502,153), patients with VTE had significantly longer length of stay (LOS) (7.15 days vs. 6.05 days, OR 1.12), higher inpatient mortality (10.03% vs. 8.69%, OR 1.06), higher total hospital charges ($43,800 vs. $37,800, OR 1.07), and greater likelihood of moderate to severe disability upon discharge (55% vs. 49%, OR 1.23). CONCLUSIONS VTE in hospitalized lung cancer patients is associated with longer LOS, higher inpatient mortality rates, increased cost and greater disability upon discharge compared to other inpatient lung cancer patients.
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Affiliation(s)
- Conor E Steuer
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA.
| | - Madhusmita Behera
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Sungjin Kim
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Nikita Patel
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Zhengjia Chen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Rathi Pillai
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Fadlo R Khuri
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
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Zhang Y, Yang Y, Chen W, Guo L, Liang L, Zhai Z, Wang C. Prevalence and associations of VTE in patients with newly diagnosed lung cancer. Chest 2015; 146:650-658. [PMID: 24676401 DOI: 10.1378/chest.13-2379] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The risk of VTE before anticancer therapy in patients with lung cancer is not well defined. METHODS A total of 673 hospitalized patients with newly diagnosed lung cancer were examined for VTE within 1 week after admission at five hospitals between January 2009 and January 2011. Additionally, VTE diagnoses within the last 3 months were reviewed. All VTE events were confirmed with imaging studies. Blood cell count and serum carcinoembryonic antigen (CEA) levels were measured before initial treatment. RESULTS VTE events occurred in 89 of the 673 patients (13.2%) enrolled in this study. Forty-two patients (6.2%) developed lower extremity DVT alone, 33 patients (4.9%) developed pulmonary embolism (PE) alone, and 14 patients (2.1%) developed both DVT and PE. By multivariate logistic regression analysis, distant metastasis (OR, 2.2; 95% CI, 1.2-3.9) and leukocytosis (OR, 2.8; 95% CI, 1.5-5.4) were significantly associated with DVT, adenocarcinoma (OR, 2.1; 95% CI, 1.1-4.4) and anemia (OR, 4.6; 95% CI, 1.4-14.5) were significantly associated with PE, and an elevated CEA level in tertiles was linearly associated with PE (P for trend = .06). The area under the receiver operating characteristic curve for the prognostic or diagnostic CEA values was 0.68 (95% CI, 0.59-0.76; P < .001). CONCLUSIONS The prevalence of VTE was high in patients with newly diagnosed lung cancer. In patients with lung cancer, the factors associated with DVT might be different from those associated with PE. An elevated CEA level might facilitate the identification of patients at a higher risk of developing PE.
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Affiliation(s)
- Yuhui Zhang
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuanhua Yang
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wenhui Chen
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lijuan Guo
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lirong Liang
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhenguo Zhai
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chen Wang
- Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Chung WS, Lin CL, Hsu WH, Sung FC, Li RY, Kao CH. Idiopathic venous thromboembolism: a potential surrogate for occult cancer. QJM 2014; 107:529-36. [PMID: 24472734 DOI: 10.1093/qjmed/hcu023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Several studies have indicated an association between venous thromboembolism (VTE) and a subsequent diagnosis of cancer in Western countries. However, information is scant on subsequent cancer incidence after idiopathic VTE events in Asian people. Through a nationwide cohort study, we evaluated the cancer prevalence of VTE and new cancer incidence in patients after the first episode of idiopathic VTE. METHODS To conduct a nationwide population cohort study on VTE, we retrieved data from the Taiwan National Health Insurance Database from 1998 to 2008, including a 2-year follow-up period extending to the end of 2010. The occurrence of cancer in the cohort was also determined by accessing the Registry for Catastrophic Illness Patient Database. RESULTS A total of 45,242 patients had the newly diagnosed VTE from 1998 to 2008. The incidence of VTE increased with age. Among 28,243 idiopathic VTE patients, 1944 patients (6.89%) had a subsequent cancer diagnosis within 2 years of the first idiopathic VTE episode. The three most common newly diagnosed cancers after idiopathic VTE were lung cancer, liver cancer and colorectal cancer (18.3%, 12.3% and 10.9%, respectively). Male sex and advanced age are independent risk factors of having an underlying malignant disorder among patients diagnosed with idiopathic VTE. CONCLUSION Patients with symptomatic VTE without an identifiable risk factor have a 6.89% incidence of subsequent cancer diagnosis in Taiwan. An extensive screening for an occult cancer in an idiopathic VTE patient may be warranted.
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Affiliation(s)
- W-S Chung
- From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - C-L Lin
- From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - W-H Hsu
- From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - F-C Sung
- From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - R-Y Li
- From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - C-H Kao
- From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
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Alexander M, Kirsa S, MacManus M, Ball D, Solomon B, Burbury K. Thromboprophylaxis for lung cancer patients--multimodality assessment of clinician practices, perceptions and decision support tools. Support Care Cancer 2014; 22:1915-22. [PMID: 24573603 DOI: 10.1007/s00520-014-2170-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/10/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to report the opinions and self-reported practices of clinicians, as well as the availability of decision support tools, regarding appropriate thromboprophylaxis for patients with lung cancer to identify variation in practice and/or divergence from evidence-based clinical practice guidelines (CPG). METHODS A computer-generated survey (SurveyMonkey software) was distributed to surgical, radiation and medical oncologists with lung cancer specialisation, via membership of the Australian Lung Cancer Trials Group (ALTG) from May to September 2013. RESULTS Seventy-two clinicians, from public, private, specialist and general hospitals, completed the survey (46% response rate). Hospital-endorsed CPG were widely available (91%); however, these routinely lacked robust recommendations for the ambulatory care setting (98%) and risk stratification tools (65%). Clinicians consistently identified ambulatory care treatment modalities (chemotherapy, alone or in combination with radiotherapy) as having similar (high) thrombotic risk as surgery. Timing and duration of pharmacological thromboprophylaxis prescribing among surgical oncologists varied and were divergent from guideline recommendations. Fifty-eight percent of surveyed clinicians cited a lack of high-quality data to guide preventative strategies in lung cancer patients. CONCLUSION Clinicians consistently identified patients with lung cancer as having a high thromboembolic risk in both ambulatory and surgical settings, but with differences in recommendations and variation in practice. CPG lacked robust recommendations for the ambulatory care setting, the main arena for the multimodality lung cancer treatment paradigm.
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Affiliation(s)
- M Alexander
- Pharmacy Department, Peter MacCallum Cancer Centre, Locked Bag 1 A'Beckett Street, Melbourne, VIC, 8006, Australia,
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Go SI, Lee A, Lee US, Choi HJ, Kang MH, Kang JH, Jeon KN, Park MJ, Kim SH, Lee GW. Clinical significance of the neutrophil-lymphocyte ratio in venous thromboembolism patients with lung cancer. Lung Cancer 2014; 84:79-85. [PMID: 24524817 DOI: 10.1016/j.lungcan.2014.01.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 01/18/2014] [Accepted: 01/20/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND The neutrophil-lymphocyte ratio (NLR) has been identified as a potentially useful marker for predicting clinical outcome in patients with cardiovascular disease, diabetes, and various malignancies. The aim of this study was to determine whether NLR at the time of venous thromboembolism (VTE) diagnosis is a prognostic factor for the response to anticoagulation and survival in lung cancer patients treated with anticoagulation for VTE. PATIENTS AND METHODS We retrospectively analyzed the clinical characteristics, laboratory parameters, and NLR in 114 lung cancer patients newly diagnosed with VTE, among 991 patients pathologically confirmed for lung cancer between July 2008 and August 2013. RESULTS High NLR was significantly associated with high hematocrit (p=0.028), high C-reactive protein (p=0.002), and low albumin (p=0.001). Compared with the low NLR group, stage IV non-small cell lung cancer (NSCLC) at the time of VTE diagnosis (55.6 vs. 74.6%, p=0.055), central nervous system metastasis (5.8 vs. 25.8%, p=0.004), and cancer progression (14.3 vs. 38.8%, p=0.008) at the time of VTE diagnosis were also significant in the high NLR group. Moreover, the poor response to anticoagulation was statistically correlated with patients with NSCLC (p=0.037), high NLR (p=0.004), and low albumin (p=0.029). CONCLUSIONS The results demonstrate that the NLR at the time of VTE diagnosis could be a useful biomarker for predicting the response and prognosis following anticoagulation in patients with lung cancer and VTE.
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Affiliation(s)
- Se-Il Go
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Anna Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Un Seok Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Hye Jung Choi
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Myung Hee Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jung-Hun Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Kyung Nyeo Jeon
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Mi Jung Park
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Seok-Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Gyeong-Won Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea; Gyeongsang Institute of Health Science.
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