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

被引：99

作者：

Kraaijpoel, Noemie ^{[1
]}

Bleker, Suzanne M. ^{[1
]}

Meyer, Guy ^{[2
,3
,4
]}

Mahe, Isabelle ^{[4
,5
,6
,7
]}

Munoz, Andres ^{[8
]}

Bertoletti, Laurent ^{[4
,9
,10
,11
]}

Bartels-Rutten, Annemarieke ^{[12
]}

Beyer-Westendorf, Jan ^{[13
]}

Porreca, Ettore ^{[14
]}

Boulon, Carine ^{[15
]}

van Es, Nick ^{[1
]}

Iosub, Diana I. ^{[16
]}

Couturaud, Francis ^{[17
]}

Biosca, Mercedes ^{[18
]}

Lerede, Teresa ^{[19
]}

Lacroix, Philippe ^{[20
]}

Maraveyas, Anthony ^{[21
]}

Aggarwal, Anita ^{[22
]}

Girard, Philippe ^{[23
,24
]}

Buller, Harry R. ^{[1
]}

Di Nisio, Marcello ^{[25
]}

机构：

[1] Univ Amsterdam, Amsterdam UMC, Amsterdam, Netherlands

[2] H op Europeen Georges Pompidou, Paris, France

[3] Univ Paris 05, Paris, France

[4] French Clin Res Infrastruct Network, St Etienne, France

[5] Fac Pharm, Inst Natl Sante & Rech Med, Unite Mixte Rech S1140, Paris, France

[6] Univ Paris Diderot, Paris, France

[7] Hop Louis Mourier, Assistance Publ Hop Paris, Colombes, France

[8] Hosp Gen Univ Gregorio Maranon, Madrid, Spain

[9] CHU St Etienne, Serv Med Vasc & Therapeut, St Etienne, France

[10] Univ St Etienne, Equipe Dysfonct Vasc & H emostase, Inst Natl Sante & Rech Med, Unite Mixte Rech 1059, St Etienne, France

[11] Ctr Hosp Univ St Etienne, Inst Natl Sante & Rech Med, CIC 1408, St Etienne, France

[12] Netherlands Canc Inst, Amsterdam, Netherlands

[13] Univ Klinikum Carl Gustav Carus, Dresden, Germany

[14] Gabriele DAnnunzio Univ, Chieti, Italy

[15] Ctr Hosp Univ Bordeaux, Bordeaux, France

[16] Osped A Manzoni, Lecce, Italy

[17] Hop Cavale Blanche, Ctr Hosp Reg & Univ Brest, Brest, France

[18] Hosp Valle De Hebron, Barcelona, Spain

[19] Azienda Socio Sanit Terr Papa Giovanni XXIII, Bergamo, Italy

[20] Hop Dupuytren, Ctr Hosp Univ Limoges, Limoges, France

[21] Hull & York Med Sch, Castle Hill, York, N Yorkshire, England

[22] George Washington Univ, Sch Med, Veteran Affairs Hosp, Washington, DC USA

[23] Inst Thorax Curie Montsouris, Paris, France

[24] Inst Mutualiste Montsouris, Paris, France

[25] Univ G DAnnunzio, Chieti, Italy

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2019年 / 37卷 / 20期

关键词：

RECURRENT VENOUS THROMBOEMBOLISM; DIAGNOSIS; RISK; METAANALYSIS; ANGIOGRAPHY;

D O I：

10.1200/JCO.18.01977

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

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. (c) 2019 by American Society of Clinical Oncology

引用

页码：1713 / +

页数：12

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