Author of

• 16637

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  P1.03 - Poster Session with Presenters Present (ID 455)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: Radiology/Staging/Screening
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 16646

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    P1.03-009 - Venous Thromboembolism (VTE) in Lung Cancer - Associations and Prognostic Role: Results of a Prospective Cohort Study from North India (ID 3758)

    14:30 - 14:30  |  Author(s): M.K. Garg
    • Abstract

    Background:
    Venous thromboembolism (VTE) in cancer remains an under-evaluated and under-diagnosed entity. This prospective study aimed to assess VTE incidence, risk factors for its occurrence and its effect on overall survival (OS) in a cohort of lung cancer (LC) patients at diagnosis and during first-line chemotherapy.
    
    Methods:
    Over a 1-year period (July 2014-June 2015), 301 patients with histology-proven LC were screened for deep venous thrombosis (DVT) with compression ultrasonography and for pulmonary thromboembolism (PTE) with CT pulmonary angiography at diagnosis and after four cycles of chemotherapy. Patient demographics, comorbidities, presenting symptoms of VTE events, treatment details and outcomes were noted. Logistic regression and Cox proportional hazard analyses were done to determine factors associated with VTE occurrence and OS respectively.
    
    Results:
    Most patients had advanced disease (51.2% Stage IV; 31.9% stage IIIB). Overall, 16/301 patients (5.3%) had VTE [DVT alone (n=5), PTE alone (n=2) and DVT with PTE (n=9)] with incidence rate of 90 per 1000 person-years. Median duration from LC diagnosis to VTE event was 96.5 days. All DVT episodes were symptomatic. PTE events were symptomatic in 72.7% and massive (attributable hypotension) in 36.4% for which thrombolysis was done. VTE treatment was associated with minor bleeding in 3 patients but no major bleeding occured. Age, COPD [odds ratio (OR) = 5.2], ECOG PS ≥2 (OR=3.1), and number of extrathoracic metastatic sites (OR=1.9) were independent risk factors for VTE on multivariate logistic regression analysis. No association was observed with histology, EGFR mutation status, other comorbidities or baseline biochemical tests. Chemotherapy regimens, number of chemotherapy cycles and radiological responses were similar amongst patients with and without VTE. Median OS was significantly less in VTE patients [161 (95% CI = 79-243) vs. 311 (95% CI = 270-352) days; p=0.007] with death attributable to VTE in 50%. On multivariate Cox proportional hazard analysis, VTE [hazard ratio (HR) = 2.1 (95% CI = 1.1-3.8)] was independently associated with poor OS as were smoking [HR = 1.7 (95% CI = 1.1-2.7)], ECOG PS ≥ 2 [HR = 1.6 (95% CI = 1.1-2.3)] and serum albumin [continuous variable HR = 0.6 (95% CI = 0.4-0.8)].
    
    Conclusion:
    VTE occurs in approximately 5% of newly diagnosed LC patients, is associated with inherently poor prognostic factors (COPD, ECOG PS≥2, hypoalbuminemia and extent of metastasis) and with worse OS independent of other variables. Since all DVT episodes are symptomatic, compression ultrasonography remains the preferred mode for cost-effective initial evaluation of suspected VTE in developing countries.