Early venous thromboembolic events are associated with worse prognosis in patients with lung cancer

Taxiarchis Kourelis, Ewa M. Wysokinska, Yi Wang, Ping Yang, Aaron Mansfield, Alfonso J. Tafur

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objectives: Venous thromboembolic events (VTE) are a leading cause of death in cancer patients. We hypothesized that early VTE (EVTE, within 3 months of diagnosis) in patients with lung cancer (LC) are associated with worse overall survival (OS). Materials and methods: We identified 727 patients with LC between 1998 and 2011. Late VTE (LVTE) were defined as VTE occurring after 3 months from LC diagnosis. Advance disease (AD) was defined as patients with Stage IV non-small cell lung cancer (NSCLC) or extensive stage small cell lung cancer (SCLC), and non-advanced disease (non-AD) was defined as ≤Stage III NSCLC or limited stage SCLC. Results: Out of 727 patients included in our review, 617 patients had NSCLC (85%), 94 (13%) SCLC, and 16 (2%) low grade neuroendocrine tumors. Ninety five patients (13%) experienced VTE, 44 (6%) experienced an EVTE and 49 (7%) had a LVTE. Patients with an EVTE had worse OS when compared to all other patients (medians 4 vs. 17 months, p<. 0.0001). EVTE were associated with worse OS in patients with non-AD (medians 12 vs. 42 months, p=. 0.01) and AD (medians 4 vs. 6 months, p=. 0.02). When considering patients with NSCLC only, in a multivariate model that included age, stage, performance status >2, administration of chemotherapy and Charlson comorbidity index, EVTE were an independent predictor of increased mortality (HR 2.4; 95% CI 1.6-3.3). Conclusions: EVTE are associated with worse OS, irrespective of stage of the disease. Our findings underscore the need for an efficient preventive strategy for VTE among patients with lung cancer.

Original languageEnglish (US)
Pages (from-to)358-362
Number of pages5
JournalLung Cancer
Volume86
Issue number3
DOIs
StatePublished - Dec 1 2014

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Lung Neoplasms
Non-Small Cell Lung Carcinoma
Small Cell Lung Carcinoma
Survival
Neuroendocrine Tumors
Comorbidity
Cause of Death
Drug Therapy
Mortality

Keywords

  • Incidence
  • Lung neoplasms
  • Prognosis
  • Survival
  • Thrombosis
  • Venous thromboembolism

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Early venous thromboembolic events are associated with worse prognosis in patients with lung cancer. / Kourelis, Taxiarchis; Wysokinska, Ewa M.; Wang, Yi; Yang, Ping; Mansfield, Aaron; Tafur, Alfonso J.

In: Lung Cancer, Vol. 86, No. 3, 01.12.2014, p. 358-362.

Research output: Contribution to journalArticle

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abstract = "Objectives: Venous thromboembolic events (VTE) are a leading cause of death in cancer patients. We hypothesized that early VTE (EVTE, within 3 months of diagnosis) in patients with lung cancer (LC) are associated with worse overall survival (OS). Materials and methods: We identified 727 patients with LC between 1998 and 2011. Late VTE (LVTE) were defined as VTE occurring after 3 months from LC diagnosis. Advance disease (AD) was defined as patients with Stage IV non-small cell lung cancer (NSCLC) or extensive stage small cell lung cancer (SCLC), and non-advanced disease (non-AD) was defined as ≤Stage III NSCLC or limited stage SCLC. Results: Out of 727 patients included in our review, 617 patients had NSCLC (85{\%}), 94 (13{\%}) SCLC, and 16 (2{\%}) low grade neuroendocrine tumors. Ninety five patients (13{\%}) experienced VTE, 44 (6{\%}) experienced an EVTE and 49 (7{\%}) had a LVTE. Patients with an EVTE had worse OS when compared to all other patients (medians 4 vs. 17 months, p<. 0.0001). EVTE were associated with worse OS in patients with non-AD (medians 12 vs. 42 months, p=. 0.01) and AD (medians 4 vs. 6 months, p=. 0.02). When considering patients with NSCLC only, in a multivariate model that included age, stage, performance status >2, administration of chemotherapy and Charlson comorbidity index, EVTE were an independent predictor of increased mortality (HR 2.4; 95{\%} CI 1.6-3.3). Conclusions: EVTE are associated with worse OS, irrespective of stage of the disease. Our findings underscore the need for an efficient preventive strategy for VTE among patients with lung cancer.",
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AU - Mansfield, Aaron

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AB - Objectives: Venous thromboembolic events (VTE) are a leading cause of death in cancer patients. We hypothesized that early VTE (EVTE, within 3 months of diagnosis) in patients with lung cancer (LC) are associated with worse overall survival (OS). Materials and methods: We identified 727 patients with LC between 1998 and 2011. Late VTE (LVTE) were defined as VTE occurring after 3 months from LC diagnosis. Advance disease (AD) was defined as patients with Stage IV non-small cell lung cancer (NSCLC) or extensive stage small cell lung cancer (SCLC), and non-advanced disease (non-AD) was defined as ≤Stage III NSCLC or limited stage SCLC. Results: Out of 727 patients included in our review, 617 patients had NSCLC (85%), 94 (13%) SCLC, and 16 (2%) low grade neuroendocrine tumors. Ninety five patients (13%) experienced VTE, 44 (6%) experienced an EVTE and 49 (7%) had a LVTE. Patients with an EVTE had worse OS when compared to all other patients (medians 4 vs. 17 months, p<. 0.0001). EVTE were associated with worse OS in patients with non-AD (medians 12 vs. 42 months, p=. 0.01) and AD (medians 4 vs. 6 months, p=. 0.02). When considering patients with NSCLC only, in a multivariate model that included age, stage, performance status >2, administration of chemotherapy and Charlson comorbidity index, EVTE were an independent predictor of increased mortality (HR 2.4; 95% CI 1.6-3.3). Conclusions: EVTE are associated with worse OS, irrespective of stage of the disease. Our findings underscore the need for an efficient preventive strategy for VTE among patients with lung cancer.

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