Risk Factors for Venous Thromboembolism in Advanced Non-Small Cell Lung Cancer: A Nationwide Administrative Database Study.

Abstract

Background: Non-small cell lung cancer (NSCLC) is associated with a high risk of venous thromboembolism (VTE). However, data on specific risk factors for VTE in patients with advanced NSCLC remain limited.

Methods and results: Using a Japanese nationwide administrative database, we analyzed 20,206 patients aged ≥18 years with advanced NSCLC who received first-line chemotherapy between January 2016 and January 2023. VTE events were identified through International Classification of Diseases, Tenth Revision codes and imaging studies. Risk factors were evaluated using Cox proportional hazards models with time-dependent covariates. The cumulative incidence of VTE was 4.2% and 6.1% at 365 and 730 days after the first date of chemotherapy for NSCLC, respectively. Several significant risk factors for VTE were identified, including female sex (hazard ratio [HR] 1.374; 95% confidence interval [CI] 1.157-1.631), higher body mass index (HR 1.029 per 1-kg/m² increase; 95% CI 1.009-1.048), previous VTE (HR 2.707; 95% CI 1.907-3.843), platinum-based chemotherapy (HR 1.217; 95% CI 1.051-1.410), anti-vascular endothelial growth factor agent (HR 1.763; 95% CI 1.458-2.132), heart failure (HR 1.677; 95% CI 1.432-1.965), and stroke/transient ischemic attack (HR 1.296; 95% CI 1.055-1.593).

Conclusions: This large-scale study identified several significant risk factors for VTE in patients with advanced NSCLC. The findings suggest the need for risk-stratified monitoring and prophylactic strategies to reduce VTE-related complications in high-risk patients.