Anne Gulbech Ording , Thomas Decker Christensen , Flemming Skjøth , Simon Noble , Anette Arbjerg Højen , Amalie Lambert Mørkved , Torben Bjerregaard Larsen , Rene Horsleben Petersen , Peter Meldgaard , Erik Jakobsen , Mette Søgaard
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The Aalen–Johansen estimator was used to calculate the risk of VTE after treatment commencement with chemotherapy, radiotherapy, chemoradiation, immunotherapy, and targeted therapy.</p></div><div><h3>Results</h3><p>Among the 3475 patients with stage IIIA, 4047 with stage IIIB to C, and 18,082 patients with stage IV cancer, the 1-year risk of VTE was highest in the first 6 months and varied markedly by cancer stage and cancer treatment. In stage IIIA, VTE risk was highest with chemotherapy (3.9%) and chemoradiation (4.1%). In stage IIIB to C, risks increased with chemotherapy (5.2%), immunotherapy (9.4%), and targeted therapy (6.0%). Stage IV NSCLC showed high risk with targeted therapy (12.5%) and immunotherapy (12.2%). The risk was consistently higher for pulmonary embolism than deep vein thrombosis.</p></div><div><h3>Conclusion</h3><p>VTE risks vary substantially according to cancer treatments and cancer stages. The highest risk was observed in the initial 6 months of therapy initiation. These insights emphasize the need for tailored risk assessment and vigilance in managing VTE complications in patients with NSCLC. Further research is needed to optimize individual thromboprophylaxis strategies for patients with unresectable and metastatic NSCLC.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 5","pages":"Pages 407-416.e1"},"PeriodicalIF":3.3000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1525730424000470/pdfft?md5=49daabe52b189d14e59cff5d3bb3859a&pid=1-s2.0-S1525730424000470-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Risk of Venous Thromboembolism in Patients With Stage III and IV Non–Small-Cell Lung Cancer: Nationwide Descriptive Cohort Study\",\"authors\":\"Anne Gulbech Ording , Thomas Decker Christensen , Flemming Skjøth , Simon Noble , Anette Arbjerg Højen , Amalie Lambert Mørkved , Torben Bjerregaard Larsen , Rene Horsleben Petersen , Peter Meldgaard , Erik Jakobsen , Mette Søgaard\",\"doi\":\"10.1016/j.cllc.2024.04.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Venous thromboembolism (VTE) is a common complication in patients starting cancer therapies for non–small-cell lung cancer (NSCLC). We examined the risk and timing of VTE in patients with stage IIIA, IIIB to C, and stage IV NSCLC according to received cancer treatments.</p></div><div><h3>Materials and Methods</h3><p>A nationwide registry-based cohort study of patients recorded in the Danish Lung Cancer Registry (2010-2021) followed for 1 year after entry into the registry to assess the incidence of VTE. The Aalen–Johansen estimator was used to calculate the risk of VTE after treatment commencement with chemotherapy, radiotherapy, chemoradiation, immunotherapy, and targeted therapy.</p></div><div><h3>Results</h3><p>Among the 3475 patients with stage IIIA, 4047 with stage IIIB to C, and 18,082 patients with stage IV cancer, the 1-year risk of VTE was highest in the first 6 months and varied markedly by cancer stage and cancer treatment. In stage IIIA, VTE risk was highest with chemotherapy (3.9%) and chemoradiation (4.1%). 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引用次数: 0
摘要
静脉血栓栓塞症（VTE）是开始接受癌症治疗的非小细胞肺癌（NSCLC）患者常见的并发症。我们根据接受癌症治疗的情况，研究了 IIIA、IIIB 至 C 期和 IV 期 NSCLC 患者发生 VTE 的风险和时间。我们对丹麦肺癌登记处（2010-2021 年）中记录的患者进行了全国范围的登记队列研究，在患者进入登记处一年后对其进行随访，以评估 VTE 的发生率。研究采用Aalen-Johansen估算器计算化疗、放疗、化放疗、免疫治疗和靶向治疗开始后的VTE风险。在3475名IIIA期、4047名IIIB至C期和18082名IV期癌症患者中，VTE的1年风险在最初6个月最高，并因癌症分期和癌症治疗方法的不同而有明显差异。在 IIIA 期，化疗（3.9%）和化放疗（4.1%）的 VTE 风险最高。在 IIIB 至 C 期，化疗（5.2%）、免疫疗法（9.4%）和靶向疗法（6.0%）的风险增加。IV期NSCLC患者接受靶向治疗（12.5%）和免疫治疗（12.2%）的风险较高。肺栓塞的风险始终高于深静脉血栓。VTE风险因癌症治疗方法和癌症分期的不同而有很大差异。在开始治疗的最初 6 个月中，观察到的风险最高。这些观点强调，在管理 NSCLC 患者的 VTE 并发症时，需要进行有针对性的风险评估并提高警惕。还需要进一步研究，以优化不可切除和转移性 NSCLC 患者的个体血栓预防策略。
Risk of Venous Thromboembolism in Patients With Stage III and IV Non–Small-Cell Lung Cancer: Nationwide Descriptive Cohort Study
Background
Venous thromboembolism (VTE) is a common complication in patients starting cancer therapies for non–small-cell lung cancer (NSCLC). We examined the risk and timing of VTE in patients with stage IIIA, IIIB to C, and stage IV NSCLC according to received cancer treatments.
Materials and Methods
A nationwide registry-based cohort study of patients recorded in the Danish Lung Cancer Registry (2010-2021) followed for 1 year after entry into the registry to assess the incidence of VTE. The Aalen–Johansen estimator was used to calculate the risk of VTE after treatment commencement with chemotherapy, radiotherapy, chemoradiation, immunotherapy, and targeted therapy.
Results
Among the 3475 patients with stage IIIA, 4047 with stage IIIB to C, and 18,082 patients with stage IV cancer, the 1-year risk of VTE was highest in the first 6 months and varied markedly by cancer stage and cancer treatment. In stage IIIA, VTE risk was highest with chemotherapy (3.9%) and chemoradiation (4.1%). In stage IIIB to C, risks increased with chemotherapy (5.2%), immunotherapy (9.4%), and targeted therapy (6.0%). Stage IV NSCLC showed high risk with targeted therapy (12.5%) and immunotherapy (12.2%). The risk was consistently higher for pulmonary embolism than deep vein thrombosis.
Conclusion
VTE risks vary substantially according to cancer treatments and cancer stages. The highest risk was observed in the initial 6 months of therapy initiation. These insights emphasize the need for tailored risk assessment and vigilance in managing VTE complications in patients with NSCLC. Further research is needed to optimize individual thromboprophylaxis strategies for patients with unresectable and metastatic NSCLC.
期刊介绍：
Clinical Lung Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of lung cancer. Clinical Lung Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of lung cancer. The main emphasis is on recent scientific developments in all areas related to lung cancer. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.
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