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

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Abstract

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.

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Acknowledgments

All the authors would like to thank Priscilla Chase Duran for editing the manuscript.

Author information

Author notes

  1. P. Jiménez-Fonseca and A. Carmona-Bayonas contributed equally to the work.

Authors and Affiliations

  1. Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Spain

    P. Jiménez-Fonseca, L. Faez & M. P. Solis

  2. Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain

    A. Carmona-Bayonas, F. Ayala de la Peña & V. Vicente

  3. Medical Oncology Department, Hospital Universitari Clinic, Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain

    C. Font

  4. Radiology Department, Hospital Universitario Morales Meseguer, Murcia, Spain

    J. Plasencia-Martínez

  5. Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain

    D. Calvo-Temprano

  6. Pneumology Department, Hospital Universitario Virgen del Rocío, CIBER de Enfermedades Respiratorias, Seville, Spain

    R. Otero

  7. Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Seville, Spain

    C. Beato

  8. Medical Oncology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain

    M. Biosca

  9. Radiology Department, Hospital Universitari Clínic, Barcelona, Spain

    M. Sánchez & M. Benegas

  10. Radiology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain

    D. Varona

  11. Medical Oncology Department, Hospital Duran i Reynals, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain

    M. Antonio

  12. Internal Medicine Department, Hospital Duran i Reynals, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain

    I. de la Haba

  13. Internal Medicine Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain

    O. Madridano & M. Martín

  14. Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain

    A. Ramchandani

  15. Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain

    E. Castañón

  16. Internal Medicine Department, Parc Sanitari Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain

    P. J. Marchena

Authors
  1. P. Jiménez-Fonseca
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  2. A. Carmona-Bayonas
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  3. C. Font
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  4. J. Plasencia-Martínez
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  5. D. Calvo-Temprano
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  6. R. Otero
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  7. C. Beato
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  8. M. Biosca
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  9. M. Sánchez
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  10. M. Benegas
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  12. L. Faez
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  13. M. Antonio
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  15. O. Madridano
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  16. M. P. Solis
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  17. A. Ramchandani
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  18. E. Castañón
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  19. P. J. Marchena
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  20. M. Martín
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  21. F. Ayala de la Peña
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  22. V. Vicente
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Consortia

On behalf of the EPIPHANY study investigators and the Asociación de Investigación de la Enfermedad Tromboembólica de la Región de Murcia

Corresponding author

Correspondence to P. Jiménez-Fonseca.

Ethics declarations

Conflict of interest

None to declare. This is an academic study.

Funding source

This project was funded in part by a restricted educational grant from Leo Pharma Spain and by support from the Asociación de Investigación de la Enfermedad Tromboembólica de la Región de Murcia.

Ethical statement

The study has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments. This study is an observational trial without intervention.

Informed consent

Signed informed consent was obtained from all patients.

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Jiménez-Fonseca, P., Carmona-Bayonas, A., Font, C. et al. The prognostic impact of additional intrathoracic findings in patients with cancer-related pulmonary embolism. Clin Transl Oncol 20, 230–242 (2018). https://doi.org/10.1007/s12094-017-1713-3

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  • DOI: https://doi.org/10.1007/s12094-017-1713-3

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