Analysis Of Risk Factors And Prognosis Of Lung Cancer Patients With Venous Thromboembolism

Objective:To explore the risk factors for diagnosis of venous thromboembolism(VTE)in patients with lung cancer.To analyze the impact of VTE on the survival of lung cancer patients.Methods:This study retrospectively collected the data of lung cancer patients who were hospitalized in the cancer center of the First Hospital of Jilin University from March 2017 to September 2021 and met the enrollment criteria.The patients were divided into VTE group and non-VTE group according to the occurrence of VTE events.The differences of clinical characteristics and laboratory indicators between the two groups of patients undergoing venous ultrasonography and/or computed tomography pulmonary angiography were compared.The risk factors for diagnosis of VTE in lung cancer patients were analyzed by multivariate Logistic regression analysis.The enrolled patients were regularly followed up to record their anti-tumor treatments,occurrence and treatments of VTE and overall survival.The impact of VTE events on the overall survival of lung cancer patients was analyzed by univariate and multivariate COX regression analysis.Results:1.A total of 768 lung cancer patients who met the inclusion criteria were included in this study and 130 patients developed VTE,with a cumulative incidence of 16.9%.Among them,113 cases(86.9%)had lower limb deep venous thrombosis,10 cases(7.7%)had upper limb deep venous thrombosis,3 cases(2.3%)had pulmonary embolism and 4 cases(3.1%)had mixed thrombosis at different sites.2.Most VTE events occurred within 180 days of diagnosis of lung cancer.The cumulative incidence of VTE within 30 days,90 days and 180 days after diagnosis of tumor was 11.1%,13.7%,and 15.8%,respectively.3.Multivariate Logistic regression analysis showed that female(OR=2.126,95%CI:1.182-3.824,P=0.012),NSCLC(OR=3.815,95%CI:1.697-8.577,P=0.001),stage IV(OR=1.994,95%CI:1.109-3.584,P=0.021),elevated D-dimer(OR=2.859,95%CI:1.1147.334,P=0.029),elevated FDP(OR=5.747,95%CI:3.128-10.558,P<0.001)and MII≥1520(OR=1.971,95%CI:1.082-3.591,P=0.027)were independent risk factors for diagnosis of VTE in patients with lung cancer.4.The median OS of patients in the VTE group was 22.5 months(95%CI:15.1-29.9 months),while the median OS of patients in the non-VTE group was 27.9 months(95%CI:25.3-30.4 months),with a statistically difference(P=0.047).5.Multivariate COX regression analysis showed that VTE was an independent risk factor for shorter OS in lung cancer patients after adjusting for tumor type,tumor stage,surgery and radiotherapy(HR=1.365,95%CI:1.065-1.751,P=0.014).6.The stratified analysis results showed that there was no statistically impact of anti coagulation therapy on OS of lung cancer patients in both NSCLC patients(P=0.064)and SCLC patients(P=0.553)with VTE.Conclusions:1.Patients with lung cancer have a higher risk of VTE,with most VTE events occurring within 6 months after diagnosis of tumor.2.Female,NSCLC,stage IV,elevated D-dimer,elevated FDP and MII≥1520 were independent risk factors for diagnosis of VTE in patients with lung cancer.3.After adjusting for tumor type,tumor stage,surgery and radiotherapy,VTE was an independent risk factor for shorter OS in lung cancer patients.