Thrombosis and haemostasis · 2025
Risk Factors and Outcomes of Subsegmental versus More Central Pulmonary Embolism in Patients with Lung Cancer.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Yang Delun, Deng Jiajun, Huang Shenghao, He Hua, Dai Chenyang, Zhao Deping, Chen Chang
Аннотация
BACKGROUND: The clinical significance of lung cancer-associated subsegmental pulmonary embolism (PE) remains unclear.
METHODS: This study retrospectively included 902 patients with lung cancer-associated PE (160 subsegmental PE, 742 more central PE). Cox proportional hazards regression was used to assess the risk of all-cause death. Fine-Gray tests and competing risk models were applied to evaluate the risks (hazard ratio [HR] [95% confidence interval]) of venous thromboembolism (VTE) recurrence and major bleeding. All-cause death was treated as a competing event for both VTE recurrence and major bleeding.
RESULTS: Compared with the more central PE group, the subsegmental PE group showed no significant differences in the adjusted risks of VTE recurrence (HR 0.99 [0.62-1.57], p = 0.95) and all-cause death (HR 0.83 [0.52-1.34], p = 0.45), and this finding was consistent across subgroups. Compared with patients with subsegmental PE without anticoagulation, those with anticoagulation had a lower adjusted risk of VTE recurrence (HR 0.16 [0.05-0.53], p = 0.003). The adjusted risks of major bleeding (HR 0.30 [0.05-1.70], p = 0.18) and all-cause death (HR 0.43 [0.13-1.42], p = 0.17) did not reach statistical significance. Independent predictors of VTE recurrence included symptomatic deep vein thrombosis (HR 2.71 [1.63-4.52], p < 0.001), tumor-node-metastasis stage (HR 2.07 [1.19-3.60], p = 0.010), EGFR mutations (HR 0.62 [0.39-0.98], p = 0.041), and anticoagulation (HR 0.32 [0.20-0.52], p < 0.001).
CONCLUSION: The risk of recurrent VTE is not miniscule in patients with lung cancer-associated subsegmental PE.
METHODS: This study retrospectively included 902 patients with lung cancer-associated PE (160 subsegmental PE, 742 more central PE). Cox proportional hazards regression was used to assess the risk of all-cause death. Fine-Gray tests and competing risk models were applied to evaluate the risks (hazard ratio [HR] [95% confidence interval]) of venous thromboembolism (VTE) recurrence and major bleeding. All-cause death was treated as a competing event for both VTE recurrence and major bleeding.
RESULTS: Compared with the more central PE group, the subsegmental PE group showed no significant differences in the adjusted risks of VTE recurrence (HR 0.99 [0.62-1.57], p = 0.95) and all-cause death (HR 0.83 [0.52-1.34], p = 0.45), and this finding was consistent across subgroups. Compared with patients with subsegmental PE without anticoagulation, those with anticoagulation had a lower adjusted risk of VTE recurrence (HR 0.16 [0.05-0.53], p = 0.003). The adjusted risks of major bleeding (HR 0.30 [0.05-1.70], p = 0.18) and all-cause death (HR 0.43 [0.13-1.42], p = 0.17) did not reach statistical significance. Independent predictors of VTE recurrence included symptomatic deep vein thrombosis (HR 2.71 [1.63-4.52], p < 0.001), tumor-node-metastasis stage (HR 2.07 [1.19-3.60], p = 0.010), EGFR mutations (HR 0.62 [0.39-0.98], p = 0.041), and anticoagulation (HR 0.32 [0.20-0.52], p < 0.001).
CONCLUSION: The risk of recurrent VTE is not miniscule in patients with lung cancer-associated subsegmental PE.