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      Prognostic Significance of Incidental Deep Vein Thrombosis in Patients with Cancer Presenting with Incidental Pulmonary Embolism

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          Abstract

          In symptomatic acute pulmonary embolism (PE), the presence of deep vein thrombosis (DVT) is a risk factor for 30- and 90-day mortality. In patients with cancer and incidental PE, the prognostic effect of concomitant incidental DVT is unknown. In this retrospective study, we examined the effect of incidental DVT on all-cause mortality in such patients. Adjusted Cox multivariate regression analysis was used for relevant covariates. From January 2010 to March 2018, we included 200 patients (mean age, 65.3 ± 12.4 years) who were followed up for 12.5 months (interquartile range 7.4–19.4 months). Of these patients, 62% had metastases, 31% had concomitant incidental DVT, and 40.1% ( n = 81) died during follow-up. All-cause mortality did not increase in patients with DVT (hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.43–2.75, p = 0.855). On multivariate analysis, weight (adjusted HR 0.96, 95% CI 0.92–0.99, p = 0.032), and metastasis (adjusted HR 10.26, 95% CI 2.35–44.9, p = 0.002) were predictors of all-cause mortality. In conclusion, low weight and presence of metastases were associated with all-cause mortality, while presence of concomitant DVT was unrelated to poorer survival.

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          Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)

          S Z Goldhaber, L Visani, M. De Rosa (1999)
          Pulmonary embolism (PE) remains poorly understood. Rates of clinical outcomes such as death and recurrence vary widely among trials. We therefore established the International Cooperative Pulmonary Embolism Registry (ICOPER), with the aim of identifying factors associated with death. 2454 consecutive eligible patients with acute PE were registered from 52 hospitals in seven countries in Europe and North America. The primary outcome measure was all-cause mortality at 3 months. The prognostic effect of baseline factors on survival was assessed with multivariate analyses. 2110 (86.0%) patients had PE proven by necropsy, high-probability lung scan, pulmonary angiography, or venous ultrasonography plus high clinical suspicion; ICOPER accepted without independent review diagnoses and interpretation of imaging provided by participating centres; 3-month follow-up was completed in 98.0% of patients. The overall crude mortality rate at 3 months was 17.4% (426 of 2454 deaths, including 52 patients lost to follow-up): 179 of 397 (45.1%) deaths were ascribed to PE and 70 of 397 (17.6%) to cancer, and no information on the cause of death was available for 29 patients. After exclusion of 61 patients in whom PE was first discovered at necropsy, the mortality rate at 3 months was 15.3% (365 of 2393 deaths). On multiple-regression modelling, age over 70 years (hazard ratio 1.6 [95% CI 1.1-2.3]), cancer (2.3 [1.5-3.5]), congestive heart failure (2.4 [1.5-3.7]), chronic obstructive pulmonary disease (1.8 [1.2-2.7]), systolic arterial hypotension (2.9 [1.7-5.0]), tachypnoea (2.0 [1.2-3.2]), and right-ventricular hypokinesis on echocardiography (2.0 [1.3-2.9]) were identified as significant prognostic factors. PE remains an important clinical problem with a high mortality rate. Data from ICOPER provide rates and highlight adverse prognostic categories that will help in planning of future trials of high-risk PE patients.
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            Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry.

            Silvy Laporte, Fernando Uresandi, R. Mendez-Otero … (2008)
            Clinical predictors for fatal pulmonary embolism (PE) in patients with venous thromboembolism have never been studied. Using data from the international prospective Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry about patients with objectively confirmed symptomatic acute venous thromboembolism, we determined independent predictive factors for fatal PE. Between March 2001 and July 2006, 15 520 consecutive patients (mean age+/-SD, 66.3+/-16.9 years; 49.7% men) with acute venous thromboembolism were included. Symptomatic deep-vein thrombosis without symptomatic PE was observed in 58.0% (n=9008) of patients, symptomatic nonmassive PE in 40.4% (n=6264), and symptomatic massive PE in 1.6% (n=248). At 3 months, the cumulative rates of overall mortality and fatal PE were 8.65% and 1.68%, respectively. On multivariable analysis, patients with symptomatic nonmassive PE at presentation exhibited a 5.42-fold higher risk of fatal PE compared with patients with deep-vein thrombosis without symptomatic PE (P 75 years, and cancer. PE remains a potentially fatal disease. The clinical predictors identified in the present study should be included in any clinical risk stratification scheme to optimally adapt the treatment of PE to the risk of the fatal outcome.
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              Cancer and venous thromboembolism.

              Paolo Prandoni, Anna Falanga, Andrea Piccioli (2005)
              Venous thromboembolism occurs commonly in patients with cancer. The pathogenetic mechanisms of thrombosis involve a complex interaction between tumour cells, the haemostatic system, and characteristics of the patient. Among risk factors for thromboembolism are long-term immobilisation, especially in hospital, surgery, and chemotherapy with or without adjuvant hormone therapy. Although prophylaxis and treatment of thromboembolism in patients with cancer draw on the agents that are commonly used in those without cancer, there are many special features of patients with cancer that make use of these drugs more challenging. Low-molecular-weight heparins are the cornerstone of prophylaxis and treatment of venous thromboembolism in patients with cancer. These drugs have the potential to increase survival, at least in patients with more favourable outlook. About 10% of patients with idiopathic venous thromboembolism have an underlying malignant disorder that can be detected by extensive diagnostic investigation. However, the issue of whether screening for occult malignant disease ultimately improves prognosis and survival remains to be resolved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cancers (Basel)
                Journal ID (iso-abbrev): Cancers (Basel)
                Journal ID (publisher-id): cancers
                Title: Cancers
                Publisher: MDPI
                ISSN (Electronic): 2072-6694
                Publication date (Electronic): 13 August 2020
                Publication date Collection: August 2020
                Volume: 12
                Issue: 8
                Electronic Location Identifier: 2267
                Affiliations
                [1 ]Respiratory Department, Medical Surgical Unit of Respiratory Diseases, Hospital Virgen del Rocio, CIBERES, 41013 Sevilla, Spain; maria.barca.sspa@ 123456juntadeandalucia.es (M.B.-H.); rocio.ortega.rivera.sspa@ 123456juntadeandalucia.es (R.O.-R.); sergio.lopez.ruz.sspa@ 123456juntadeandalucia.es (S.L.-R.); teresa.elias.sspa@ 123456juntadeandalucia.es (T.E.-H.); isabel.asensio.cruz.sspa@ 123456juntadeandalucia.es (M.I.A.-C.); samira.marin.sspa@ 123456juntadeandalucia.es (S.M.-R.); rotero@ 123456separ.es (R.O.-C.)
                [2 ]Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
                [3 ]Emergency Unit, Hospital Virgen del Rocio, 41013 Sevilla, Spain; jignacio.toral.sspa@ 123456juntadeandalucia.es (J.T.); emilio.montero.sspa@ 123456juntadeandalucia.es (E.M.)
                [4 ]Institute of Biomedicine of Seville (IBIS), Hospital Virgen del Rocio/CSIC/Universidad de Sevilla, 410013 Sevilla, Spain; veronica.sanchez.lopez.sspa@ 123456juntadeandalucia.es (V.S.); elena.arellano.orden.sspa@ 123456juntadeandalucia.es (E.A.)
                [5 ]Pharmacy, Respiratory Department, Medical Surgical Unit of Respiratory Diseases; Hospital Virgen del Rocio, 410013 Sevilla, Spain; josem.sanchez.diaz.sspa@ 123456juntadeandalucia.es
                [6 ]Department of Preventive Medicine and Public Health, Universidad de Málaga, 29010 Malaga, Spain; macarenareal@ 123456uma.es
                Author notes
                [* ]Correspondence: luisj.jara.sspa@ 123456juntadeandalucia.es ; Tel.: +34-6-67-95-64-80; Fax: +34-9-55-01-21-90
                Article
                Publisher ID: cancers-12-02267
                DOI: 10.3390/cancers12082267
                PMC ID: 7463961
                PubMed ID: 32823554
                SO-VID: e8f2c856-105c-4d03-998e-f799978001c5
                Copyright © © 2020 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 29 June 2020
                Date accepted : 11 August 2020
                Categories
                Subject: Article

                Keywords: neoplasm,incidental,pulmonary embolism,venous thromboembolism,mortality,prognosis
                Data availability:
                Keywords: neoplasm, incidental, pulmonary embolism, venous thromboembolism, mortality, prognosis

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