| Since the first mention of Trousseau syndrome in 1865,cancer-associated thrombosis(CAT)has been gradually recognized.Venous thromboembolism(VTE)has been widely considered as a common complication of malignant tumors and an important cause of death in cancer patients.VTE mainly includes the clinical manifestations of pulmonary thromboembolism(PTE)and deep vein thrombosis(DVT)in the lower extremities,upper extremities,pelvis or other parts.The latest epidemiological data shows that lung cancer has become the most common malignant tumor among male and female cancer patients worldwide,and it is also one of the malignant tumors with high incidence of VTE.The probability of lung cancer associated with VTE is between 3% and 13.9%,which is influenced by many factors.It is the most likely time for VTE to occur during the first few months of lung cancer diagnosis or distant metastasis.The risk of death in patients with lung cancer associated with VTE was increased by approximately 50% compared with patients without VTE,and the one-year survival rate was significantly shorter than that of patients without VTE lung cancer.At present,the most common pathological type in lung cancer is lung adenocarcinoma,and the incidence rate shows a clear upward trend.Therefore,for the high incidence of lung adenocarcinoma,identifying and screening high-risk groups associated with VTE,early prevention and treatment is particularly important.Objective: To study the risk factors and clinical features of pulmonary adenocarcinoma with VTE,to improve the understanding of lung adenocarcinoma with VTE,and to reduce the mortality.Methods: The clinical data of 2,930 patients with lung adenocarcinoma admittedto the First Affiliated Hospital of Nanjing Medical University from January 2012 to December 2016 were retrospectively analyzed,and 96 cases were found to have VTE.Patients with VTE were included in the VTE group.Patients without VTE were included in the non-VTE group.The risk factors and clinical characteristics of VTE in lung adenocarcinoma were analyzed.Results: Among the 2930 cases of lung adenocarcinoma,96 cases/2930 cases(3.3%)were associated with VTE.In the VTE group,there were 57 males and 39 females,with an average age of 60.8±10.1 years.In the non-VTE group,there were1477 males and 1357 females,the average age was 61 ± 10.5 years old.The difference between the two groups showed that smoking,central venous catheterization,chronic pulmonary diseases,stage of lung adenocarcinoma and pathological differentiation were statistically significant(P<0.05).Multiple factor analysis suggested that the chronic pulmonary disease and III~IV stage of lung adenocarcinoma were high risk factors for lung adenocarcinoma associated with VTE(OR=2.698,2.327)(P<0.05).Of the 96 patients,45 occurred in PTE(46.9%)and 51 in DVT(53.1%).Among 45 patients with PTE,19 cases(42.2%)were accompanied by DVT and PTE,of which 29 cases(64.4%)showed dyspnea,and 8cases(17.8%)had no obvious clinical symptoms.Of the 70 patients with DVT,66(94.3%)showed swelling or pain on the affected side.Deep venous thrombosis of the upper limb mainly(33 cases)consists of subclavian vein and internal jugular vein.Deep venous thrombosis of lower limbs was found in 37 cases.Among them,20/37(54.1%)cases were left lower extremity,10/37(27.0%)cases were right lower extremity,7/37(18.9%)cases were double lower limbs.Of 96 patients with lung adenocarcinoma associated with VTE,7(7.3%)occurred before lung cancer diagnosis,and 55(57.3%)occurred in the first half of March after lung cancer was diagnosed.Among them,71 cases had lung cancer accompanied by VTE,and the cumulative incidence of VTE at 3,6,9,12 months was 52.1%,63.4%,74.6% and 80.3%respectively.The cumulative incidence of VTE in surgery,chemotherapy,surgery +chemotherapy and target group were 75%,75%,83.3%,83.3%;59.1%,72.7%,81.8%,90.9%;50%,66.7%,83.3%,83.3%;60%,60%,66.7%,83.3%.There was nosignificant difference between the four groups.Up to follow-up time,52 cases of/96(54.1%)died,and the median survival time of lung adenocarcinoma associated with VTE was May.Among them,29 cases of /45(64.4%)died of PTE,and 23 cases of /51(45.1%)died of DVT alone.The median survival time for patients with PTE alone was 2 months and 8 months for patients with DVT alone.Conclusion: There was a significant correlation between III~IV stage of lung adenocarcinoma,chronic pulmonary disease and lung adenocarcinoma with VTE.DVT was the most common first symptom of VTE.Most patients had limb pain or swelling.However,PTE patients showed diversity,and there may be missed diagnosis.Deep vein thrombosis of the upper extremity was commonly seen in the subclavian vein and internal jugular vein,and deep venous thrombosis of lower extremities was more common in the lower extremities.VTE can be the precursor of lung cancer,but lung adenocarcinoma was most likely to occur within the first 3 months after diagnosis and treatment.Lung adenocarcinoma associated with PTE had higher mortality and worse prognosis than patients with DVT. |
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