Incidence of venous thromboembolic events and effect on survival in patients with lung cancer

Abstract

18017 Background: Venous thromboemboli (VTE) is a known complication in patients with cancer, however the true incidence and effect on survival in patients with lung cancer is not clear. Methods: We retrospectively reviewed a cohort of 388 patients with lung cancer from 1997 to 2006 seen at the University of Alabama in Birmingham. Results: Median age was 62 and the male (n=227) to female (n=160) ratio was 1.41:1. Small cell lung cancer (SCLC) was the histology in 50 patients (13%) and non small cell lung cancer (NSCLC) in 331 patients (87%). Among NSCLC, the distribution of various subtypes was: 144 (37%) adenocarcinoma, 93 (24%) squamous cell, 7 (2%) large cells and 93 (24%) non-small cell, not otherwise specified(NOS). Metastatic disease was present in 29% (96/337) of NSCLC and extensive disease in 54% (27/50) of SCLC patients. 73% had a performance status of 0/1 and 29% had weight loss ( > 5% body weight). The overall incidence of VTE was 17 % (n=64); 9 patients prior to the diagnosis and 55 patients (86%) during the course of their disease. The incidence of VTE in SCLC was 10% (n=5) and in NSCLC 19% (n=59). VTE events in patients with non-small cell histologies were: 18% in adenocarcinoma, 25% in NSCLC-NOS, and 8% in squamous cell carcinoma. In patients with SCLC the incidence of VTE in limited stage disease (3/23) was similar to extensive stage disease (2/27). In NSCLC, patients with stage 1–3 disease had an incidence rate of 16% (39/241) compared to 21% (20/96) with metastatic disease. The median survival (MS) in SCLC patients with VTE was 21 months and without DVT was 17 months (P = 0.28). The MS in patients with NSCLC with VTE was 15 months and without VTE was 18 months (P = 0.12). Conclusions: There is a high incidence of VTE in patients with both NSCLC and SCLC with a trend to increased incidence in specific histologic subtypes and increased disease burden. Despite the potential anti-neoplastic benefit of anticoagulants there was a minimal difference in overall survival between cohorts, although this study was not designed to evaluate differences in survival. This data supports trials evaluating the role of prophylactic use of anticoagulants as a means to reduce the morbidity/mortality associated with VTE in this high risk population. No significant financial relationships to disclose.