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J Clin Oncol. 2019 Jul 10;37(20):1713-1720. doi: 10.1200/JCO.18.01977. Epub 2019 May 22.

Treatment and Long-Term Clinical Outcomes of Incidental Pulmonary Embolism in Patients With Cancer: An International Prospective Cohort Study.

Author information

1
1 Amsterdam UMC/University of Amsterdam, Amsterdam, the Netherlands.
2
2 Hôpital Européen Georges-Pompidou, Paris, France.
3
3 Université Paris Descartes, Paris, France.
4
4 French Clinical Research Infrastructure Network, Saint-Étienne, France.
5
5 Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1140, Faculté de Pharmacie, Paris, France.
6
6 Université Paris Diderot, Paris, France.
7
7 Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Colombes, France.
8
8 Hospital General Universitario Gregorio Marañon, Madrid, Spain.
9
9 Service de Médecine Vasculaire et Thérapeutique, CHU de St-Étienne, Saint-Étienne, France.
10
10 Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Étienne, France.
11
11 Institut National de la Santé et de la Recherche Médicale, CIC-1408, Centre Hospitalier Universitaire Saint-Etienne, Saint-Étienne, France.
12
12 Netherlands Cancer Institute, Amsterdam, the Netherlands.
13
13 Universitätsklinikum Carl Gustav Carus, Dresden, Germany.
14
14 Gabriele D'Annunzio University, Chieti, Italy.
15
15 Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
16
16 Ospedale "A. Manzoni," Lecco, Italy.
17
17 Centre Hospitalier Régionaux et Universitaire de Brest, Hôpital de la Cavale Blanche, Brest, France.
18
18 Hospital Vall d'Hebron, Barcelona, Spain.
19
19 Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.
20
20 Centre Hospitalier Universitaire Limoges, Hôpital Dupuytren, Limoges, France.
21
21 Hull and York Medical School, Castle Hill, United Kingdom.
22
22 George Washington University School of Medicine, Veteran Affairs Hospital, Washington, DC.
23
23 Institut du Thorax Curie-Montsouris, Paris, France.
24
24 Institut Mutualiste Montsouris, Paris, France.
25
25 University G D'Annunzio, Chieti-Pescara, Italy.

Abstract

PURPOSE:

Pulmonary embolism is incidentally diagnosed in up to 5% of patients with cancer on routine imaging scans. The clinical relevance and optimal therapy for incidental pulmonary embolism, particularly distal clots, is unclear. The aim of the current study was to assess current treatment strategies and the long-term clinical outcomes of incidentally detected pulmonary embolism in patients with cancer.

PATIENTS AND METHODS:

We conducted an international, prospective, observational cohort study between October 22, 2012, and December 31, 2017. Unselected adults with active cancer and a recent diagnosis of incidental pulmonary embolism were eligible. Outcomes were recurrent venous thromboembolism, major bleeding, and all-cause mortality during 12 months of follow-up. Outcome events were centrally adjudicated.

RESULTS:

A total of 695 patients were included. Mean age was 66 years and 58% of patients were male. Most frequent cancer types were colorectal (21%) and lung cancer (15%). Anticoagulant therapy was initiated in 675 patients (97%), of whom 600 (89%) were treated with low-molecular-weight heparin. Recurrent venous thromboembolism occurred in 41 patients (12-month cumulative incidence, 6.0%; 95% CI, 4.4% to 8.1%), major bleeding in 39 patients (12-month cumulative incidence, 5.7%; 95% CI, 4.1% to 7.7%), and 283 patients died (12-month cumulative incidence, 43%; 95% CI, 39% to 46%). The 12-month incidence of recurrent venous thromboembolism was 6.4% in those with subsegmental pulmonary embolism compared with 6.0% in those with more proximal pulmonary embolism (subdistribution hazard ratio, 1.1; 95% CI, 0.37 to 2.9; P = .93).

CONCLUSION:

In patients with cancer with incidental pulmonary embolism, risk of recurrent venous thromboembolism is significant despite anticoagulant treatment. Patients with subsegmental pulmonary embolism seemed to have a risk of recurrent venous thromboembolism comparable to that of patients with more proximal clots.

PMID:
31116676
DOI:
10.1200/JCO.18.01977

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