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Ala-Seppälä HM, Ukkonen MT, Laurikka JO, Khan JA. The early and long-term occurrence of symptomatic venous thromboembolism after lung cancer surgery without extended thromboprophylaxis-a single center experience with 435 patients. J Thorac Dis 2024; 16:4329-4339. [PMID: 39144340 PMCID: PMC11320238 DOI: 10.21037/jtd-24-308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/31/2024] [Indexed: 08/16/2024]
Abstract
Background The incidence of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), after lung cancer resections varies in the literature, and there is limited evidence regarding the optimal duration of thromboprophylaxis. This study aimed at determining the early and long-term occurrence of thromboembolic complications in patients who received in-hospital thromboprophylaxis and underwent resective surgery for lung cancer. Methods The study included all patients who underwent lung cancer surgery at Tampere University Hospital between 2004 and 2016. Postoperative thromboprophylaxis was administered for the duration of the hospitalization. Data on subsequent episodes of VTE and survival were obtained from national registries. The results were compared to a demographically matched reference population. Results The study comprised 435 patients and 4,338 individuals in the reference population. The overall occurrence of VTE in patients and the reference group was 0.3% vs. 0.2% at 90 days (P=0.56), 3.5% vs. 0.7% at 1 year (P<0.001), 9.2% vs. 2.2% at 3 years (P<0.001), and 18.7% and 3.9% at 5 years (P<0.001), respectively. The majority of cases represented PE. The overall mortality at 5 years was 44.4% vs. 11.6% (P<0.001). No associations between patient characteristics and the occurrence of VTE during follow-up were detected. Conclusions Patients undergoing lung cancer surgery and who receive in-hospital medical thromboprophylaxis do not seem to be in high risk for symptomatic VTE during the early postoperative period. However, during long-term follow-up the occurrence of symptomatic VTE was significant.
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Affiliation(s)
- Henna Maria Ala-Seppälä
- Department of Cardio-Thoracic Surgery, Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Mika Tapani Ukkonen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jari Olavi Laurikka
- Department of Cardio-Thoracic Surgery, Heart Hospital, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jahangir Ari Khan
- Department of Cardio-Thoracic Surgery, Heart Hospital, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Gomez-Rosas P, Giaccherini C, Russo L, Verzeroli C, Gamba S, Tartari CJ, Bolognini S, Ticozzi C, Schieppati F, Barcella L, Sarmiento R, Masci G, Tondini C, Petrelli F, Giuliani F, D’Alessio A, Minelli M, De Braud F, Santoro A, Labianca R, Gasparini G, Marchetti M, Falanga A. A New Risk Prediction Model for Venous Thromboembolism and Death in Ambulatory Lung Cancer Patients. Cancers (Basel) 2023; 15:4588. [PMID: 37760562 PMCID: PMC10527104 DOI: 10.3390/cancers15184588] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Venous thromboembolism (VTE) is a frequent complication in ambulatory lung cancer patients during chemotherapy and is associated with increased mortality. (2) Methods: We analyzed 568 newly diagnosed metastatic lung cancer patients prospectively enrolled in the HYPERCAN study. Blood samples collected before chemotherapy were tested for thrombin generation (TG) and a panel of hemostatic biomarkers. The Khorana risk score (KRS), new-Vienna CATS, PROTECHT, and CONKO risk assessment models (RAMs) were applied. (3) Results: Within 6 months, the cumulative incidences of VTE and mortality were 12% and 29%, respectively. Patients with VTE showed significantly increased levels of D-dimer, FVIII, prothrombin fragment 1 + 2, and TG. D-dimer and ECOG performance status were identified as independent risk factors for VTE and mortality by multivariable analysis and utilized to generate a risk score that provided a cumulative incidence of VTE of 6% vs. 25%, death of 19% vs. 55%, and in the low- vs. high-risk group, respectively (p < 0.001). While all published RAMs significantly stratified patients for risk of death, only the CATS and CONKO were able to stratify patients for VTE. (4) Conclusions: A new prediction model was generated to stratify lung cancer patients for VTE and mortality risk, where other published RAMs failed.
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Affiliation(s)
- Patricia Gomez-Rosas
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.G.-R.); (C.V.); (S.B.); (C.T.); (F.S.); (A.F.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Hospital de Oncologia, Unidad Medica de Alta Especialidad (UMAE), Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City 06720, Mexico
| | - Cinzia Giaccherini
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.G.-R.); (C.V.); (S.B.); (C.T.); (F.S.); (A.F.)
| | - Laura Russo
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.G.-R.); (C.V.); (S.B.); (C.T.); (F.S.); (A.F.)
| | - Cristina Verzeroli
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.G.-R.); (C.V.); (S.B.); (C.T.); (F.S.); (A.F.)
| | - Sara Gamba
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.G.-R.); (C.V.); (S.B.); (C.T.); (F.S.); (A.F.)
| | - Carmen Julia Tartari
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.G.-R.); (C.V.); (S.B.); (C.T.); (F.S.); (A.F.)
| | - Silvia Bolognini
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.G.-R.); (C.V.); (S.B.); (C.T.); (F.S.); (A.F.)
| | - Chiara Ticozzi
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.G.-R.); (C.V.); (S.B.); (C.T.); (F.S.); (A.F.)
| | - Francesca Schieppati
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.G.-R.); (C.V.); (S.B.); (C.T.); (F.S.); (A.F.)
| | - Luca Barcella
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.G.-R.); (C.V.); (S.B.); (C.T.); (F.S.); (A.F.)
| | | | - Giovanna Masci
- Oncology Unit, IRCCS Humanitas Institute, 20089 Rozzano, Italy
| | - Carlo Tondini
- Oncology Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Fausto Petrelli
- Oncology Unit, Hospital Treviglio-Caravaggio, 24047 Treviglio, Italy
| | - Francesco Giuliani
- Oncology Unit, IRCCS Cancer Institute Giovanni Paolo II, 70124 Bari, Italy
| | - Andrea D’Alessio
- Medical Oncology and Internal Medicine, Policlinico San Marco, Gruppo San Donato Zingonia-Bergamo, 24046 Zingonia, Italy
| | - Mauro Minelli
- Oncology Unit, Hospital San Giovanni Addolorata, 00184 Rome, Italy
| | - Filippo De Braud
- Oncology Unit, IRCCS National Cancer Institute, 20133 Milan, Italy
| | - Armando Santoro
- Oncology Unit, IRCCS Humanitas Institute, 20089 Rozzano, Italy
| | | | | | - Marina Marchetti
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.G.-R.); (C.V.); (S.B.); (C.T.); (F.S.); (A.F.)
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
| | - Anna Falanga
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.G.-R.); (C.V.); (S.B.); (C.T.); (F.S.); (A.F.)
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
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Anderson R, Rapoport BL, Steel HC, Theron AJ. Pro-Tumorigenic and Thrombotic Activities of Platelets in Lung Cancer. Int J Mol Sci 2023; 24:11927. [PMID: 37569299 PMCID: PMC10418868 DOI: 10.3390/ijms241511927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
Aside from their key protective roles in hemostasis and innate immunity, platelets are now recognized as having multifaceted, adverse roles in the pathogenesis, progression and outcome of many types of human malignancy. The most consistent and compelling evidence in this context has been derived from the notable association of elevated circulating platelet counts with the onset and prognosis of various human malignancies, particularly lung cancer, which represents the primary focus of the current review. Key topics include an overview of the association of lung cancer with the circulating platelet count, as well as the mechanisms of platelet-mediated, pro-tumorigenic immunosuppression, particularly the role of transforming growth factor beta 1. These issues are followed by a discussion regarding the pro-tumorigenic role of platelet-derived microparticles (PMPs), the most abundant type of microparticles (MPs) in human blood. In this context, the presence of increased levels of PMPs in the blood of lung cancer patients has been associated with tumor growth, invasion, angiogenesis and metastasis, which correlate with disease progression and decreased survival times. The final section of the review addresses, firstly, the role of cancer-related platelet activation and thrombosis in the pathogenesis of secondary cardiovascular disorders and the associated mortality, particularly in lung cancer, which is second only to disease progression; secondly, the review addresses the potential role of antiplatelet agents in the adjunctive therapy of cancer.
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Affiliation(s)
- Ronald Anderson
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
| | - Bernardo L. Rapoport
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
- The Medical Oncology Centre of Rosebank, Johannesburg 2196, South Africa
| | - Helen C. Steel
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
| | - Annette J. Theron
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
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Zhang Y, Shi Z, Yi J, Zhao J, Zhang S, Feng W, Zhu M, Hu B, Zhang Y. Correlation between clinicopathological characteristics of lung adenocarcinoma and the risk of venous thromboembolism. Thorac Cancer 2021; 13:247-256. [PMID: 34862856 PMCID: PMC8758430 DOI: 10.1111/1759-7714.14260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/27/2022] Open
Abstract
Background Patients with primary lung adenocarcinoma are at increased risk of venous thromboembolism (VTE). However, lung adenocarcinoma characteristics differ across histological subtypes. Therefore, we performed comprehensive analyses on the clinicopathological characteristics of lung adenocarcinoma and risk of VTE. Methods A total of 952 surgically resected lung adenocarcinoma cases were reviewed and classified according to criteria of the International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS) /European Respiratory Society (ERS). The correlation between this classification and VTE risk was retrospectively analyzed. The risks of other clinicopathological features including pleural invasion, vascular invasion and associated surgical intervention risks were also assessed. Results Of the 952 patients, 100 (10.4%) cases experienced VTE events during the follow‐up period. Among those with VTE, 28 (28%) were found before surgery, 47 (47%) were found within 1 month after surgery, and 91 (91%) were found in hospital. Univariate analysis revealed that ages, extent of resection and presence of micropapillary features were predictive of VTE risk. Furthermore, multivariable analysis demonstrated that the presence of micropapillary features (subdistribution hazard ratio [SHR] 1.560, 95% CI: 1.043–2.330) and age >60 (SHR: 2.270, 95% CI:1.491–3.470) were associated with increased risk of VTE. After one year, the probability of developing VTE was 13.1% and 8.3% in patients with micropapillary features and those without, respectively. Conclusions VTE is a common complication for lung adenocarcinoma patients who undergo surgery, especially during the perioperative process and hospitalization. Presence of micropapillary subtype and age are positively associated with VTE risk.
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Affiliation(s)
- Yuan Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhongyue Shi
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiawen Yi
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jin Zhao
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shu Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wei Feng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Min Zhu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuhui Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Nichetti F, Ligorio F, Zattarin E, Signorelli D, Prelaj A, Proto C, Galli G, Marra A, Apollonio G, Porcu L, de Braud F, Lo Russo G, Ferrara R, Garassino MC. Is There an Interplay between Immune Checkpoint Inhibitors, Thromboprophylactic Treatments and Thromboembolic Events? Mechanisms and Impact in Non-Small Cell Lung Cancer Patients. Cancers (Basel) 2019; 12:cancers12010067. [PMID: 31881699 PMCID: PMC7016680 DOI: 10.3390/cancers12010067] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/14/2022] Open
Abstract
PD-1 pathway blockade has been shown to promote proatherogenic T-cell responses and destabilization of atherosclerotic plaques. Moreover, preclinical evidence suggests a potential synergy of antiplatelet drugs with immune checkpoint inhibitors (ICIs). We conducted an analysis within a prospective observational protocol (APOLLO study) to investigate the rates, predictors, and prognostic significance of thromboembolic events (TE) and thromboprophylaxis in patients with advanced NSCLC treated with ICIs. Among 217 patients treated between April 2014 and September 2018, 13.8% developed TE events. Current smoking status (HR 3.61 (95% CI 1.52–8.60), p = 0.004) and high (>50%) PD-L1 (HR 2.55 (95% CI 1.05–6.19), p = 0.038) resulted in being independent TE predictors. An increased risk of death following a diagnosis of TE (HR 2.93; 95% CI 1.59–5.42; p = 0.0006) was observed. Patients receiving antiplatelet treatment experienced longer progression-free survival (PFS) (6.4 vs. 3.4 months, HR 0.67 (95% CI 0.48–0.92), p = 0.015) and a trend toward better OS (11.2 vs. 9.6 months, HR 0.78 (95% CI 0.55–1.09), p = 0.14), which were not confirmed in a multivariate model. No impact of anticoagulant treatment on patients’ outcomes was observed. NSCLC patients treated with ICIs bear a consistent risk for thrombotic complications, with a detrimental effect on survival. The impact of antiplatelet drugs on ICIs efficacy deserves further investigation in prospective trials.
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Affiliation(s)
- Federico Nichetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
- Correspondence: ; Tel.: +39-022-390-3066
| | - Francesca Ligorio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Emma Zattarin
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Arsela Prelaj
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Giulia Galli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Antonio Marra
- Department of Medical Oncology, Istituto Europeo di Oncologia, 20141 Milan, Italy;
| | - Giulia Apollonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Luca Porcu
- Department of Oncology, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, 20156 Milan, Italy;
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Roberto Ferrara
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
| | - Marina Chiara Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.L.); (E.Z.); (D.S.); (A.P.); (C.P.); (G.G.); (G.A.); (F.d.B.); (G.L.R.); (R.F.); (M.C.G.)
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Van Haren RM, Rajaram R, Correa AM, Mehran RJ, Antonoff MB, Hofstetter WL, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Rice DC, Roth JA. Preoperative Heparin for Lung Cancer Resection Increases Risk of Reoperation for Bleeding. Semin Thorac Cardiovasc Surg 2019; 32:337-343. [PMID: 31857153 DOI: 10.1053/j.semtcvs.2019.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
Lung cancer patients are at risk for venous thromboembolism (VTE). Preoperative heparin administration may increase the risk of bleeding requiring reoperation. The purpose of this study was to evaluate preoperative heparin's effect on reoperation for bleeding. A retrospective review compared outcomes for patients undergoing pulmonary resection for primary lung cancer from January 2006 to April 2018. Preoperative heparin was administered at the discretion of the attending surgeon. Comparisons were performed between preoperative subcutaneous heparin (5000 U) and no heparin groups. A total of 3325 lung resections were reviewed, 1.4% (n = 48) required reoperation for bleeding. VTE occurred in 1.1% (n = 38). Four hundred sixty-four patients (14.0%) did not receive preoperative heparin. The preoperative heparin group had increased rates of prior thoracic surgery (5.1% [n = 146] vs 1.7% [n = 8], P < 0.001), minimally invasive approach (40.2% [n = 1150] vs 10.6% [n = 49], P < 0.001), and sublobar resections (17.7% [n = 506] vs 10.6% [n = 49], P < 0.001). There were no differences in blood loss/transfusions. Reoperation for bleeding was significantly increased in the preoperative heparin group (1.6% [n = 47] vs 0.2% [n = 1], P = 0.017). There were no differences in VTE (1.5% [n = 7] vs 1.1% [n = 31], P = 0.424). On logistic regression, preoperative heparin was independently associated with increased reoperation for bleeding (odds ratio 8.13, P = 0.039); however, preoperative heparin was not independently associated with VTE. Preoperative heparin was associated with increased reoperation for bleeding. VTE rates are low after pulmonary resection for lung cancer and are not decreased by preoperative heparin. Preoperative heparin use should be determined by risk factor stratification for VTE and reoperation for bleeding in patients undergoing lung cancer resection.
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Affiliation(s)
- Robert M Van Haren
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
| | - Ravi Rajaram
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Arlene M Correa
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
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7
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Shen Q, Dong X, Tang X, Zhou J. Risk factors and prognosis value of venous thromboembolism in patients with advanced non-small cell lung cancer: a case-control study. J Thorac Dis 2017; 9:5068-5074. [PMID: 29312712 DOI: 10.21037/jtd.2017.11.116] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Venous thromboembolism (VTE) is the well-known complication of cancer, especially among lung cancer patients. The objective of this study is to identify the incidence, risk factors and prognosis of VTE in the patients with non-small cell lung cancer (NSCLC) in an advanced or metastatic stage (stage III or IV). We hypothesized that NSCLC patients associated with VTE may lead to poor prognosis. Methods From 2012 to 2015, we retrospectively investigated 1,560 patients diagnosed with lung cancer in stage III or IV. Each VTE patient was matched with three control patients according to gender, age, pathology, clinical stage and the diagnosed time. Univariate and multivariate analyses were used in the study. Results Among the 1,560 patients in our study, 32 (2.0%) developed VTE in locally advanced or metastatic stage lung cancer. Weight loss, serous effusion, the absence of the EGFR mutation, poor performance status (PS), hypoalbuminemia, hyponatremia, long prothrombin time (PT), and elevated levels of C-reaction-protein (CRP) and D-dimer were found to be associated with an increased risk of VTE by univariate analyses. The multivariate analyses revealed that weight loss, poor PS, increased CRP and long PT were significantly related to VTE. Overall survival (OS) from diagnosis was significantly shorter in patients with VTE (medians 14.2 vs. 24.4 months; P<0.001). Conclusions The incidence of VTE was high among advanced NSCLC patients, particularly for those with weight loss, poor PS, increased CRP and long PT. Moreover, the patients with VTE complications may have a poorer prognosis.
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Affiliation(s)
- Qian Shen
- Department of Respiratory Disease, First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Xiaoqi Dong
- Department of Respiratory Disease, First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Xiaoping Tang
- Department of Respiratory Disease, First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jianying Zhou
- Department of Respiratory Disease, First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310003, China
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