Prevalence and Associations of VTE in Patients With Newly Diagnosed Lung Cancer

• Published in: Chest Vol. 146; no. 3; pp. 650 - 658
• Main Authors: Zhang, Yuhui, MD, PhD, Yang, Yuanhua, MD, PhD, Chen, Wenhui, MD, Guo, Lijuan, MD, PhD, Liang, Lirong, MD, PhD, Zhai, Zhenguo, MD, PhD, Wang, Chen, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2014
• Subjects: Adenocarcinoma - complications; Adenocarcinoma - diagnosis; Aged; Biomarkers - blood; Blood Cell Count; Carcinoembryonic Antigen - blood; Female; Humans; Logistic Models; Lung Neoplasms - complications; Lung Neoplasms - diagnosis; Male; Middle Aged; Prevalence; Pulmonary Embolism - epidemiology; Pulmonary Embolism - mortality; Pulmonary/Respiratory; Retrospective Studies; Risk Factors; Survival Rate; Venous Thromboembolism - epidemiology; Venous Thromboembolism - mortality; non-small cell lung cancer; SCLC; carcinoembryonic antigen; NSCLC; PE; ROC; small cell lung cancer; pulmonary embolism; receiver operating characteristic; CEA
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.13-2379

BACKGROUND The risk of VTE before anticancer therapy in patients with lung cancer is not well defined. METHODS A total of 673 hospitalized patients with newly diagnosed lung cancer were examined for VTE within 1 week after admission at five hospitals between January 2009 and January 2011. Additionally, VTE diagnoses within the last 3 months were reviewed. All VTE events were confirmed with imaging studies. Blood cell count and serum carcinoembryonic antigen (CEA) levels were measured before initial treatment. RESULTS VTE events occurred in 89 of the 673 patients (13.2%) enrolled in this study. Forty-two patients (6.2%) developed lower extremity DVT alone, 33 patients (4.9%) developed pulmonary embolism (PE) alone, and 14 patients (2.1%) developed both DVT and PE. By multivariate logistic regression analysis, distant metastasis (OR, 2.2; 95% CI, 1.2-3.9) and leukocytosis (OR, 2.8; 95% CI, 1.5-5.4) were significantly associated with DVT, adenocarcinoma (OR, 2.1; 95% CI, 1.1-4.4) and anemia (OR, 4.6; 95% CI, 1.4-14.5) were significantly associated with PE, and an elevated CEA level in tertiles was linearly associated with PE ( P for trend = .06). The area under the receiver operating characteristic curve for the prognostic or diagnostic CEA values was 0.68 (95% CI, 0.59-0.76; P < .001). CONCLUSIONS The prevalence of VTE was high in patients with newly diagnosed lung cancer. In patients with lung cancer, the factors associated with DVT might be different from those associated with PE. An elevated CEA level might facilitate the identification of patients at a higher risk of developing PE.