Prognostic Effect of Incidental Pulmonary Embolism on Long-Term Mortality in Cancer Patients

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  • Nishikawa Tatsuya
    Department of Onco-Cardiology, Osaka International Cancer Institute
  • Fujita Takeshi
    Department of Onco-Cardiology, Osaka International Cancer Institute
  • Morishima Toshitaka
    Cancer Control Center, Osaka International Cancer Institute
  • Okawa Sumiyo
    Cancer Control Center, Osaka International Cancer Institute
  • Hino Terutaka
    Department of Medical Informatics, Osaka International Cancer Institute
  • Yasui Taku
    Department of Onco-Cardiology, Osaka International Cancer Institute
  • Shioyama Wataru
    Department of Onco-Cardiology, Osaka International Cancer Institute
  • Oka Toru
    Department of Onco-Cardiology, Osaka International Cancer Institute
  • Miyashiro Isao
    Cancer Control Center, Osaka International Cancer Institute
  • Fujita Masashi
    Department of Onco-Cardiology, Osaka International Cancer Institute

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<p>Background:The effect of incidental pulmonary embolism (PE) on long-term prognosis in cancer patients is unclear. This study assessed the characteristics of cancer and venous thromboembolism (VTE) and the effect of incidental PE identified by oncologists on long-term survival of patients with cancer.</p><p>Methods and Results:This single-center, retrospective, cohort study used hospital-based cancer registry data from the Osaka International Cancer Institute linked with electronic medical records and administrative data from Japan’s Diagnosis Procedure Combination Per-diem Payment System. Overall, 15,689 cancer patients underwent contrast-enhanced thoracic computed tomography during 2010–2018. After excluding patients with missing data, symptomatic patients, or patients with suspected PE, 174 with incidental PE (PE+ group) and 13,197 with no PE (PE− group) were identified. The total incidence of incidental PE was 1.3%. No deaths from thrombotic events were identified in the PE+ group. Both groups were adjusted for cancer- and VTE-related characteristics using inverse probability weighting. After adjusting for immortal time bias in the PE+ group, Kaplan-Meier analysis revealed that all-cause mortality was higher in the PE+ group (hazard ratio, 2.26; 95% confidence interval, 1.53–3.33). A Cox proportional hazard model revealed that metastatic cancer and a history of curative treatment were significant prognostic factors, whereas central PE and residual proximal deep vein thrombosis were not.</p><p>Conclusions:Incidental PE in cancer patients indicates poorer prognosis. Cancer-related but not thrombosis-related factors determine prognosis.</p>

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  • Circulation Journal

    Circulation Journal 88 (2), 198-204, 2024-01-25

    一般社団法人 日本循環器学会

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