The prognostic impact of additional intrathoracic findings in patients with cancer-related pulmonary embolism

• Autores: P. Jiménez Fonseca, Alberto Carmona Bayonas, Carme Font Puig, Juana M.ª Plasencia Martinez, David Calvo Temprano, Remedios Otero Candelera, Carmen Beato Zambrano, Mercedes Biosca Gomez de Tejada, Marcelo Sánchez, Mariana Benegas, D. Varona Porres, L. Faez, Maite Antonio, Irma de la Haba Vacas, Olga Madridano Cobo, M. P. Solis, Avi Ramchandani Vaswani, Eduardo Castañón, P. J. Marchena Yglesias, M. Martín, Francisco Ayala de la Peña, Vicente Vicente García
• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 20, Nº. 2 (February 2018), 2018, págs. 230-242
• Idioma: inglés
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• Resumen

  • Aim To assess the prevalence and prognostic significance of additional intrathoracic findings (AIFs) in patients with cancer and pulmonary embolism (PE). AIFs were considered alterations other than the characteristic ones intrinsic to PE or changes in cardiovascular morphology.

    Methods Subjects have been taken from a Spanish national multidisciplinary and multicenter study of PE and cancer who were treated between 2004 and 2015. The endpoint was the appearance of serious complications or death within 15 days.

    Results The registry contains 1024 eligible patients; 41% diagnosed by computed tomography pulmonary angiography versus 59% by non-angiographic CT. Serious complications occurred within 15 days in 18.9%, [95% confidence interval (CI), 16.6–21.4%] and 9.5% (95% CI 7.9–11.5%) died. At least one AIF was seen in 72.6%. The most common AIFs were as follows: pulmonary nodules (30.9%), pleural effusion (30.2%), tumor progression (28.3%), atelectasis (19.0%), pulmonary infarct (15.2%), emphysema (13.4%), pulmonary lymphangitic carcinomatosis (4.5%), and pneumonia (6.1%). Patients with AIF exhibited a higher complication rate at 15 days: 21.9% versus 13.0%, odds ratio (OR) 1.8 (95% CI 1.2–2.8), P = 0.03, and 15-day mortality: 15.0% versus 7.3%, OR 1.9 (95% CI 1.1–3.2), P = 0.020. Patients with pneumonia, pneumothorax, pulmonary edema, pulmonary nodules, tumor progression, pulmonary fibrosis, and pleural effusion showed an excess of adverse events.

    Conclusions Additional intrathoracic findings are highly prevalent and significantly impact prognosis in patients with PE and cancer, making them germane to the classification of this population.