Cancer Histology and Natural History of Patients with Lung Cancer and Venous Thromboembolism

Ruiz-Artacho, Pedro; Lecumberri, Ramón; Trujillo-Santos, Javier; Font, Carme; López-Núñez, Juan J; Peris, María Luisa; Díaz Pedroche, Carmen; Lobo, José Luis; López Jiménez, Luciano; López Reyes, Raquel; Jara Palomares, Luis; Pedrajas, José María; Mahé, Isabelle; Monreal, Manuel; The Riete Investigators,; Bosevski, Marijan; Zdraveska, Marija

doi:10.3390/cancers14174127

Cancer Histology and Natural History of Patients with Lung Cancer and Venous Thromboembolism

Journal

Cancers

Date Issued

2022-08-26

Author(s)

Ruiz-Artacho, Pedro

Lecumberri, Ramón

Trujillo-Santos, Javier

Font, Carme

López-Núñez, Juan J

Peris, María Luisa

Díaz Pedroche, Carmen

Lobo, José Luis

López Jiménez, Luciano

López Reyes, Raquel

Jara Palomares, Luis

Pedrajas, José María

Mahé, Isabelle

Monreal, Manuel

The Riete Investigators,

DOI

10.3390/cancers14174127

Abstract

Background: In patients with lung cancer and venous thromboembolism (VTE), the influence of cancer histology on outcome has not been consistently evaluated. Methods: We used the RIETE registry (Registro Informatizado Enfermedad TromboEmbólica) to compare the clinical characteristics and outcomes during anticoagulation in patients with lung cancer and VTE, according to the histology of lung cancer. Results: As of April 2022, there were 482 patients with lung cancer and VTE: adenocarcinoma 293 (61%), squamous 98 (20%), small-cell 44 (9.1%), other 47 (9.8%). The index VTE was diagnosed later in patients with squamous cancer than in those with adenocarcinoma (median, 5 vs. 2 months). In 50% of patients with adenocarcinoma, the VTE appeared within the first 90 days since cancer diagnosis. During anticoagulation (median 106 days, IQR: 45-214), 14 patients developed VTE recurrences, 15 suffered major bleeding, and 218 died: fatal pulmonary embolism 10, fatal bleeding 2. The rate of VTE recurrences was higher than the rate of major bleeding in patients with adenocarcinoma (11 vs. 6 events), and lower in those with other cancer types (3 vs. 9 events). On multivariable analysis, patients with adenocarcinoma had a non-significantly higher risk for VTE recurrences (hazard ratio [HR]: 3.79; 95%CI: 0.76-18.8), a lower risk of major bleeding (HR: 0.29; 95%CI: 0.09-0.95), and a similar risk of mortality (HR: 1.02; 95%CI: 0.76-1.36) than patients with other types of lung cancer. Conclusions: In patients with lung adenocarcinoma, the rate of VTE recurrences outweighed the rate of major bleeding. In patients with other lung cancers, it was the opposite.

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