Clinical Research On Cancer Associated Venous Thromboembolism

Objective:The first part of this study aimed to learn the incidence of cancer patients with venous thromboembolism (VTE) of our hospital in last decade, and identify the clinical picture and outcomes of them. The second part of this study aimed to compare the clinical feature and prognosis of different cancer types with VTE.Methods:280cancer patients with venous thromboembolism who hospitalized from January2003to January2013in Beijing hospital were enrolled. The clinical factors including age, gender, clinical picture, pathological type of tumor, clinical stage performance status and therapeutic regimen were recorded. VTE events, clinical characteristic and prognosis were evaluated. Meanwhile, lung cancers, gastrointestinal cancer and urologic neoplasm patients with VTE was evaluated for the clinical presentation and outcomes. The prognosis of different cancer types with VTE were compared.Results:There were18531cancer patients and1402VTE patients hospitalized from January2003to January2013in Beijing hospital. The incidence of cancer with VTE of our hospital was1.51%in the last decade. The proportion of cancer associated thrombosis events in VTE patients was19.97%. Among them,82lung cancers,78gastrointestinal cancer,32urologic neoplasm,27gynecological oncology,27haematological malignancies,12breast cancers and22other cancers patients were involved. There were157men and123female (median age:66.6years). Common comorbidity, bedridden, chemotherapy, operation and use of central venous catheter were most common risk factors for VTE. There were206patients (73.6%) initially presented with advanced cancer, which including187(66.8%) TNM stage Ⅲ-Ⅳ patients. On the pathology types of cancers,139patients (49.6%) were adenocarcinoma. The histodifferentiation of123patients were moderately and/or poorly differentiated. Dyspnea was the most common symptom in PTE patients, while swollen of limb was predominant in DVT patients.There were26PTE patients identified incidentally.24patients who received anticoagulation had bleeding events. Among patients developing VTE after cancer diagnosis, with53.9%,63.2%,68.9%and72.1%of patients experience an thrombotic event within3,6,9and12months, respectively. Among patients developing VTE after chemotherapy, with41.3%,51.6%,61.9%and64.3%of patients experience an thrombotic event within3,6,9and12months, respectively. Among patients developing VTE after cancer surgery, with55.9%,64.9%,68.7%and72.4%of patients experience an thrombotic event within3,6,9and12months, respectively. Up to Jaunary2013,130patients were dead. The cumulative mortality rate within3,6,9and12months after VTE event were46.9%,69.2%,80.8%and83.1%, respectively. The most common causes of death were cancer, PTE and infection. Only41(14.6%) patients were given VTE prophylaxis.In different cancer types with VTE,82lung cancers,78gastrointestinal (GI) cancer,32urologic neoplasm were involved. Non-small cell lung cancer (NSCLC) was the most common type in lung cancer patients with VTE. In gastrointestinal cancer patients, colon/rectal and gastric cancers were predominant, while in urologic neoplasm, bladder and prostate were more common. On the pathology types of cancers, adenocarcinoma was higher and the histodifferentiation were moderately and/or poorly differentiated in lung cancer and GI cancer group. Advanced disease patients with TNM stage Ⅲ-Ⅳ were more in lung cancer group than urologic neoplasm group. There were more patients developed VTE in lung cancer and GI group within6months after tumor diagnosis, chemotherapy or surgery. The diagnosis of VTE was associated with a higher risk of death within1year in those two groups. The median survive time of urologic group was better than lung cancer and GI group.Conclusions:1. Cancer is one of the most common predisposing factors for VTE. The incidence of VTE was high in lung cancers, gastrointestinal cancer, urologic neoplasm, gynecological oncology, haematological malignancies and breast cancers patients.2. Advanced disease, adenocarcinoma, poor histodifferentiation, chemotherapy and surgery are associated with thrombotic events.3. More than50%of cancer associated VTE patients develop thrombotic events within6months. The diagnosis of VTE is associated with a higher risk of death within1year.4. More patients in lung cancer and GI group developed thrombotic events within6months, and the diagnosis of VTE was associated with a higher risk of death within1years. Urologic neoplasm patients had a better prognosis.