Prognostic Value of Treatment Setting in Patients With Cancer Having Pulmonary Embolism: Comparison With the Pulmonary Embolism Severity Index

Background: Active cancer is a poor prognostic factor for survival after pulmonary embolism (PE). This retrospective cohort study was performed to investigate how accurately the pulmonary embolism severity index (PESI) predicts 30-day mortality in patients with active cancer. Whether the treatment setting (palliative vs curative) could predict mortality in these patients was also investigated. Methods: All consecutive patients with active cancer and PE who visited the emergency department of Asan Medical Center in January 2007 to June 2014 were identified. The covariates for predicting 30-day mortality were PESI classification, treatment setting (curative vs palliative), brain natriuretic peptide 150 ng/L, troponin I 0.10 ng/mL, right ventricular dysfunction, deep vein thrombosis, and anticoagulants used. Cox proportional hazards regression analysis was used to assess the association between treatment setting and 30-day mortality. Results: The PESI classification and 30-day mortality did not associate significantly. Area under the receiver-operating curve of the PESI was 0.565 (95% confidence interval [CI]: 0.453-0.677). Palliative treatment setting associated with an increased risk of 30-day mortality, regardless of the PESI classification (adjusted hazard ratio: 3.72, 95% CI: 1.49-9.26). Treatment setting predicted mortality 30 days, 3 months, and 6 months after PE presentation better than PESI. Conclusion: The PESI did not accurately predict mortality in patients with active cancer. Treatment setting was the most important determinant of clinical outcome in these patients. When stratifying patients with active cancer and PE, palliative treatment setting should be considered as it is predictive of high mortality.