Outcome of Patients With Cancer-Associated Pulmonary Embolism: Results From the Regional Pulmonary Embolism Registry

IF 2.9 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2025-04-25 DOI:10.1002/cam4.70886

Sonja Salinger, Aleksandra Kozic, Boris Dzudovic, Bojana Subotic, Jovan Matijasevic, Marija Benic, Vladimir Miloradovic, Ema Jevtic, Tamara Kovacevic-Preradovic, Ljiljana Kos, Nebojsa Bulatovic, Bjanka Bozovic, Irena Mitevska, Marijan Bosevski, Ana Kovacevic-Kuzmanovic, Milos Svircev, Aleksandar Neskovic, Bojan Mitrovic, Srdjan Kafedzic, Slobodan Obradovic

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Abstract

Background

Newly or already diagnosed cancer might significantly influence the clinical presentation, outcome, and therapy of acute pulmonary embolism (PE).

Methods

Out of 1745 patients with acute PE, 66 patients were diagnosed with cancer during an initial hospitalization due to acute PE (where PE was the first clinical manifestation of cancer), 165 patients had known cancer treated in the last 6 months, and 1514 patients had acute PE without known or suspected cancer. The primary end-point of the present study was all-cause hospital death. The secondary end-points were the proportion of patients treated with thrombolysis and who had severe disease, and the ocurrence of major or clinically relevant nonmajor bleeding.

Results

Patients with PE as the first presentation of cancer had the highest hospital mortality rate compared to the other two groups (HR for the mortality rate in patients without cancer as a reference, adjusted to four-stratum mortality risk, and Charlson's comorbidity index was 3.440; 95% confidence interval (CI), 1.795–6.591; p < 0.001). Patients with known cancer before PE had a significantly lower chance of being treated with thrombolysis than patients without cancer (OR, 0.523; 95% CI, 0.339–0.807; p = 0.003); additionally, this difference was attenuated but remained when the OR was adjusted to age (OR, 0.542; 95% CI, 0.351–0.838; p = 0.006). Patients with known cancer had a higher frequency of high-risk PE compared with patients without cancer (18.2% vs. 12.8%; p < 0.001). Patients with PE as the first manifestation of cancer had a higher frequency of intermediate-high-risk PE than those without (36.4% vs. 30.9%; p < 0.001). There was no significant difference in bleeding during hospitalization between groups.

Conclusion

Patients with cancer had a more severe presentation of acute PE than patients without. Furthermore, patients with PE as the first manifestation of cancer had the highest hospital mortality rate, and patients with known cancer were least likely to be treated with thrombolysis.

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癌症相关肺栓塞患者的预后：来自区域性肺栓塞登记的结果

背景新确诊或已确诊的癌症可能会对急性肺栓塞（PE）的临床表现、预后和治疗产生重大影响。方法在 1745 名急性肺栓塞患者中，有 66 名患者在因急性肺栓塞（肺栓塞是癌症的首个临床表现）而首次住院期间被诊断出患有癌症，165 名患者在过去 6 个月中曾接受过已知癌症的治疗，1514 名患者患有急性肺栓塞，但没有已知或疑似癌症。本研究的主要终点是全因住院死亡。次要终点是接受溶栓治疗且病情严重的患者比例，以及大出血或临床相关的非大出血发生率。结果与其他两组患者相比，以癌症为首发症状的 PE 患者的住院死亡率最高（以无癌症患者的死亡率为参照，根据四组死亡率风险和 Charlson 合并症指数调整后的 HR 为 3.440；95% 置信区间 (CI)，1.795-6.591；P < 0.001）。PE前已知癌症的患者接受溶栓治疗的几率明显低于未患癌症的患者（OR，0.523；95% CI，0.339-0.807；P = 0.003）；此外，当根据年龄调整OR时，这种差异有所减弱，但仍然存在（OR，0.542；95% CI，0.351-0.838；P = 0.006）。与未患癌症的患者相比，已知患有癌症的患者发生高危 PE 的频率更高（18.2% 对 12.8%；P < 0.001）。以 PE 为癌症首发表现的患者发生中高危 PE 的频率高于未患癌症的患者（36.4% 对 30.9%；P <；0.001）。两组患者在住院期间的出血量无明显差异。结论与非癌症患者相比，癌症患者的急性 PE 表现更为严重。此外，以癌症为首发表现的 PE 患者的住院死亡率最高，而已知癌症的患者接受溶栓治疗的可能性最小。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.