scholarly journals Khorana Score: Νew Predictor of Early Mortality in Patients With Lung Adenocarcinoma

2018 ◽  
Vol 24 (8) ◽  
pp. 1347-1351 ◽  
Author(s):  
Ioannis Vathiotis ◽  
Evangelos P. Dimakakos ◽  
Paraskevi Boura ◽  
Angeliki Ntineri ◽  
Andiani Charpidou ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Adjuvant Chemotherapy ◽  
Lung Adenocarcinoma ◽  
Treatment Period ◽  
Predictive Value ◽  
First Line ◽  
Thromboembolic Risk ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
Significant Difference

Venous thromboembolism (VTE) is a typical complication in patients with lung cancer. Khorana score is an established tool for thromboembolic risk stratification of ambulatory patients with cancer undergoing outpatient chemotherapy. The aim of this study was to evaluate the predictive value of the Khorana score for VTE and death in patients with lung adenocarcinoma during first-line or adjuvant chemotherapy. Medical records of 130 patients with lung adenocarcinoma receiving first-line or adjuvant chemotherapy were retrospectively studied during the time period June 2013 to May 2015. Venous thromboembolism occurred in 13 (10.0%) patients. Thromboembolic events were significantly correlated with reduced survival during treatment period (hazard ratio [HR]: 3.24; 95% confidence interval [CI]: 1.11-9.49; P = .032). The VTE rates did not present statistically significant difference between different Khorana score groups ( P = .96). In univariate analysis, the risk of death during treatment period (median: 16 weeks) was 3.75 times higher in high-risk versus intermediate-risk patients (HR: 3.75, 95% CI: 1.36-10.36; P = .001) and had 2.25 times higher per point increase in the Khorana score (HR: 2.25, 95% CI: 1.36-3.73; P = .002); the above results were also reproduced in multivariate analysis. Khorana score represents a valuable tool for identifying patients with cancer in low thromboembolic risk but does not preserve its predictive value for higher risk individuals. Khorana score is an independent risk factor for death in patients with lung adenocarcinoma receiving first-line or adjuvant chemotherapy.

Treatment with dabigatran or warfarin in patients with venous thromboembolism and cancer

2015 ◽  
Vol 114 (07) ◽  
pp. 150-157 ◽  
Author(s):  
Samuel Z. Goldhaber ◽  
Clive Kearon ◽  
Ajay K. Kakkar ◽  
Sebastian Schellong ◽  
Henry Eriksson ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Treatment Period ◽  
Low Molecular Weight ◽  
Efficacy And Safety ◽  
Patients With Cancer ◽  
Efficacy Outcome ◽  
Significant Difference ◽  
Recurrent Vte ◽  
Active Cancer ◽  
Similar Incidence

SummaryThe efficacy and safety of dabigatran for treatment of venous thromboembolism (VTE) were demonstrated in two trials. It is unclear if the results pertain to patients with cancer and VTE. Data from two randomised trials comparing dabigatran and warfarin for acute VTE were pooled. Primary efficacy outcome was symptomatic recurrent VTE and related death from randomisation to the end of the treatment period. Safety outcomes were major, major and clinically relevant non-major, and any bleeding during the oral-only treatment period. Patients with active cancer (=within 5 years) at baseline or diagnosed during the study were analysed. Compared with 4,772 patients without cancer, recurrent VTE occurred more frequently in 335 patients with cancer at any time (hazard ratio [HR] 3.3; 95 % confidence interval [CI], 2.1–5.3) and more often in 114 with cancer diagnosed during the study compared to 221 with cancer at baseline (HR 2.6; 95 % CI, 1.1–6.2). There was no significant difference in efficacy between dabigatran and warfarin for cancer at baseline (HR 0.75; 95 % CI, 0.20–2.8) or diagnosed during the study (HR 0.63; 95 % CI, 0.20–2.0). Major bleeding (HR 4.1; 95 % CI, 2.2–7.5) and any bleeding (HR 1.5; 95 % CI, 1.2–2.0) were more frequent in patients with cancer than without, but with similar incidence in cancer with dabigatran or warfarin. In conclusion, in cancer patients, dabigatran provided similar clinical benefit as warfarin. VTE recurrence or bleeding were similar in patients on dabigatran or warfarin. The efficacy of dabigatran has not been assessed in comparison with low-molecular-weight heparin.

Clinical Outcomes of Incidental Venous Thromboembolism in Cancer and Noncancer Patients: The SWIss Venous ThromboEmbolism Registry (SWIVTER)

2020 ◽  
Author(s):  
David Spirk ◽  
Tim Sebastian ◽  
Stefano Barco ◽  
Martin Banyai ◽  
Jürg H. Beer ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Mortality Rate ◽  
Recurrence Rate ◽  
Anticoagulation Therapy ◽  
Early Mortality ◽  
Recurrence Rates ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Baseline Characteristics

Abstract Objective In patients with cancer-associated venous thromboembolism (VTE), the risk of recurrence is similar after incidental and symptomatic events. It is unknown whether the same applies to incidental VTE not associated with cancer. Methods and Results We compared baseline characteristics, anticoagulation therapy, all-cause mortality, and VTE recurrence rates at 90 days between patients with incidental (n = 131; 52% without cancer) and symptomatic (n = 1,931) VTE included in the SWIss Venous ThromboEmbolism Registry (SWIVTER). After incidental VTE, 114 (87%) patients received anticoagulation therapy for at least 3 months. The mortality rate was 9.2% after incidental and 8.4% after symptomatic VTE for hazard ratio (HR) 1.10 (95% confidence interval [CI] 0.49–2.50). After adjustment for competing risk of death, recurrence rate was 3.1 versus 2.8%, respectively, for sub-HR 1.07 (95% CI 0.39–2.93). These results were consistent among cancer (mortality: 15.9% vs. 12.6%; HR 1.32, 95% CI 0.67–2.59; recurrence: 4.8% vs. 4.7%; HR 1.02, 95% CI 0.30–3.42) and noncancer patients (mortality: 2.9% vs. 2.1%; HR 1.37, 95% CI 0.33–5.73; recurrence: 1.5% vs. 2.3%; HR 0.63, 95% CI 0.09–4.58). Patients with incidental VTE who received anticoagulation therapy for at least 3 months had lower mortality (4% vs. 41%) and recurrence rate (1% vs. 18%) compared with those who did not. Conclusion In SWIVTER, more than half of incidental VTE events occurred in noncancer patients who often received anticoagulation therapy. Among noncancer patients, early mortality and recurrence rates were similar after incidental versus symptomatic VTE. Our findings suggest that anticoagulation therapy for incidental VTE may be beneficial regardless of the presence of cancer.

Recurrent thrombosis followed by Lazarus response in ROS1 rearranged NSCLC treated with crizotinib: a case report

2020 ◽  
Vol 106 (6) ◽  
pp. NP41-NP45
Author(s):  
Teresa Beninato ◽  
Giuseppe Lo Russo ◽  
Marina Chiara Garassino ◽  
Filippo De Braud ◽  
Marco Platania
Keyword(s):  
Venous Thromboembolism ◽  
Genetic Alterations ◽  
Small Cell Lung ◽  
Recurrent Thrombosis ◽  
Right Heart ◽  
Thromboembolic Risk ◽  
Patients With Cancer ◽  
Recurrent Venous Thromboembolism ◽  
Progressive Respiratory Failure ◽  
Alk Positive

Introduction: Patients with cancer have higher risk of thrombosis compared to the general population and particularly lung adenocarcinoma is considered at high risk for venous thromboembolism. Some targetable oncogenic drivers are supposed to further increase this risk. Case description: A 35-year-old man who had developed a recurrent venous thromboembolism and pulmonary embolism (PE) was diagnosed with ROS1 rearranged non-small cell lung cancer (NSCLC). While molecular examinations were ongoing, he developed progressive respiratory failure. For PE and thrombosis worsening with detection of right heart thrombus, he underwent therapy with unfractionated heparin. Despite initial good radiologic results, only with the start of crizotinib did the patient’s clinical condition significantly improve to configure a Lazarus response. Conclusions: Cancer diagnosis should always be considered in patients with unprovoked thrombosis and, if NSCLC is diagnosed, genetic alterations should be always sought after. A possible relation between venous thromboembolism and oncogenic drivers, particularly for ALK translocations, has been hypothesized. Similarly to ALK-positive NSCLC, ROS1 rearranged disease has been associated with an increased thromboembolic risk. Further studies are needed to better evaluate this relation and to evaluate the potential benefit of a prophylactic anticoagulating treatment in this subset of patients.

The influence of venous thromboembolism on prognosis of esophageal cancer patients.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 29-29
Author(s):  
En Amada ◽  
Hiroya Takeuchi ◽  
Fumihiko Kato ◽  
Hirofumi Kawakubo ◽  
Kazumasa Fukuda ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Risk Factor ◽  
Venous Thromboembolism ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Disease Free Survival ◽  
Secondary Outcome ◽  
Neck Lymph Node ◽  
Significant Difference ◽  
Neo Adjuvant Chemotherapy

29 Background: Venous thromboembolism (VTE) is sometimes found in esophageal cancer patients who underwent surgical treatment. VTE contains deep vein thrombosis, pulmonary embolism and catheter-related thrombosis. Our previous study revealed that pre-therapeutic plasma fibrinogen level, C-reactive protein level, adenocarcinoma histology and neck lymph node dissection are the risk factors for venous thromboembolism in patients[Surg Today, 2015]. However, the correlation between VTE and prognosis is not clear in esophageal cancer. We hypothesized that VTE may have an impact on prognosis of esophageal cancer patients. Methods: One hundred and seventy-two patients who underwent radical esophagectomy from March 2008 to December 2012 in our hospital were reviewed in this study. The existence of VTE was assessed from the neck to the pelvis with computed tomography at the initial visit and after neo-adjuvant chemotherapy (NAC) and 6thpostoperative day. The patient and tumor characteristics, neo-adjuvant chemotherapy were compared between patients with VTE (VTE group) and those without VTE (non-VTE group). The primary outcome is disease-free survival (DFS) and the secondary outcome is overall survival (OS). Results: Twenty-one VTE events among 172 patients (12%) were observed. Six of which occurred preoperatively and were considered to be associated with NAC, 14 were detected postoperatively and one occurred just after inserting a peripherally inserted central catheter preoperatively. The VTE group and the non-VTE group have homogenous characteristics in patients’ backgrounds and tumor features. We found no significant difference in median DFS and OS between two groups. However, in patients with pathologically N 0 or 1(7thedition of UICC TNM classification, n = 157), the median DFS was significantly shorter in VTE group compared with non-VTE group (41 months versus 64 months, p = 0.04). The recurrence risk increased 50.9% in VTE group in comparison with non VTE group (p = 0.048). By using logistic regression analysis, we found that existence of VTE is an independent risk factor with Odd’s ratio 2.964 (p = 0.026). Conclusions: Our study suggests that VTE may be the risk factor for recurrence in esophageal cancer patients.

The risk of venous thromboembolism after surgery for esophagogastric malignancy and the impact of chemotherapy: a population-based cohort study

2019 ◽  
Vol 33 (6) ◽  
Author(s):  
Alfred Adiamah ◽  
Lu Ban ◽  
Joe West ◽  
David J Humes
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Venous Thromboembolism ◽  
Adjuvant Chemotherapy ◽  
Cumulative Incidence ◽  
Population Based ◽  
Risk Of Death ◽  
Increased Risk ◽  
Esophagogastric Cancer ◽  
The Impact

SUMMARY To define the incidence of postoperative venous thromboembolism (VTE) and effects of chemotherapy in a population undergoing surgery for esophagogastric cancer. This population-based cohort study used linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data from England to identify subjects undergoing esophageal or gastric cancer surgery between 1997 and 2014. Exposures included age, comorbidity, smoking, body mass index, and chemotherapy. Crude rates and adjusted hazard ratios (HRs) were calculated for rate of first postoperative VTE using Cox regression models. The cumulative incidence of VTE at 1 and 6 months was estimated accounting for the competing risk of death from any cause. Of the 2,452 patients identified, 1,012 underwent gastrectomy (41.3%) and 1,440 esophagectomy (58.7%). Risk of VTE was highest in the first month, with absolute VTE rates of 114 per 1,000 person-years (95% CI 59.32–219.10) following gastrectomy and 172.73 per 1,000 person-years (95% CI 111.44–267.74) following esophagectomy. Neoadjuvant and adjuvant chemotherapy was associated with a six-fold increased risk of VTE following gastrectomy, HR 6.19 (95% CI 2.49–15.38). Cumulative incidence estimates of VTE at 6 months following gastrectomy in patients receiving no chemotherapy was 1.90% and esophagectomy 2.21%. However, in those receiving both neoadjuvant and adjuvant chemotherapy, cumulative incidence following gastrectomy was 10.47% and esophagectomy, 3.9%. VTE rates are especially high in the first month following surgery for esophageal and gastric cancer. The cumulative incidence of VTE at 6 months is highest in patients treated with chemotherapy. In this category of patients, targeted VTE prophylaxis may prove beneficial during chemotherapy treatment.

Hypercoagulabilty, venous thromboembolism, and death in patients with cancer

2016 ◽  
Vol 115 (04) ◽  
pp. 817-826 ◽  
Author(s):  
Florian Posch ◽  
Julia Riedl ◽  
Eva-Maria Reitter ◽  
Alexandra Kaider ◽  
Christoph Zielinski ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Independent Risk Factor ◽  
Fold Increase ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
One Year ◽  
After Cancer ◽  
D Dimer

SummaryVenous thromboembolism (VTE) is a frequent complication of malignancy. The aim of this study was to investigate whether multi-state modelling may be a useful quantitative approach to dissect the complex epidemiological relationship between hypercoagulability, VTE, and death in cancer patients. We implemented a three-state/three-transition unidirectional illness-death model of cancer-associated VTE in data of 1,685 cancer patients included in a prospective cohort study, the Vienna Cancer and Thrombosis Study (CATS). During the two-year follow-up period, 145 (8.6%) patients developed VTE, 79 (54.5%) died after developing VTE, and 647 (38.4%) died without developing VTE, respectively. VTE events during follow-up were associated with a three-fold increase in the risk of death (Transition Hazard ratio (HR)=2.98, 95% confidence interval [CI]: 2.36-3.77, p< 0.001). This observation was independent of cancer stage. VTE events that occurred later during follow-up exerted a stronger impact on the risk of death than VTE events that occurred at earlier time points (HR for VTE occurrence one year after baseline vs at baseline=2.30, 95% CI: 1.28-4.15, p=0.005). Elevated baseline D-dimer levels emerged as a VTE-independent risk factor for mortality (HR=1.07, 95% CI: 1.05-1.08, p< 0.001), and also predicted mortality risk in patients who developed VTE. A higher Khorana Score predicted both the risk for VTE and death, but did not predict mortality after cancer-associated VTE. In conclusion, multi-state modeling represents a very potent approach to time-to-VTE cohort data in the cancer population, and should be used for both observational and interventional studies on cancer-associated VTE.

scholarly journals Clinical Course of Cancer Patients with COVID-19: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Naomi Alpert ◽  
Joseph L Rapp ◽  
Bridget Marcellino ◽  
Wil Lieberman-Cribbin ◽  
Raja Flores ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Cancer Treatments ◽  
Patients With Cancer ◽  
Significant Difference

Abstract Background Complications in cancer patients with COVID-19 have not been examined. This analysis aimed to compare characteristics of COVID-19 patients with and without cancer, and assess whether cancer is associated with COVID-19 morbidity or mortality. Methods COVID-19 positive patients with an inpatient or emergency encounter at the Mount Sinai Health System between March 1, 2020 and May 27, 2020 were included, and compared across cancer status on demographics and clinical characteristics. Multivariable logistic regressions were used to model the associations of cancer with sepsis, venous thromboembolism, acute kidney injury, intensive care unit admission, and all-cause mortality. Results There were 5,556 COVID-19 positive patients included; 421 (7.6%) with cancer (325 solid, 96 non-solid). Those with cancer were statistically significantly older, more likely to be non-Hispanic Black and to be admitted to the hospital during their encounter, and had more comorbidities than non-cancer COVID-19 patients. Cancer patients were statistically significantly more likely to develop sepsis (adjusted odds ratio [ORadj]=1.31, 95% confidence interval [CI]=1.06-1.61) and venous thromboembolism (ORadj=1.77, 95% CI = 1.01-3.09); there was no statistically significant difference in acute kidney injury (ORadj=1.10, 95% CI = 0.87-1.39), intensive care unit admissions (ORadj=1.04, 95% CI = 0.80-1.34), or mortality (ORadj=1.02, 95% CI = 0.81-1.29). Conclusions COVID-19 patients with cancer may have a higher risk for adverse outcomes. Although there was no statistically significant difference in mortality, COVID-19 patients with cancer have significantly higher risk of thromboembolism and sepsis. Further research is warranted into the potential effects of cancer treatments on inflammatory and immune responses to COVID-19, and on the efficacy of anticoagulant therapy in these patients.

scholarly journals Subtype Classification of Lung Adenocarcinoma Predicts Benefit From Adjuvant Chemotherapy in Patients Undergoing Complete Resection

2015 ◽  
Vol 33 (30) ◽  
pp. 3439-3446 ◽  
Author(s):  
Ming-Sound Tsao ◽  
Sophie Marguet ◽  
Gwénaël Le Teuff ◽  
Sylvie Lantuejoul ◽  
Frances A. Shepherd ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Lung Adenocarcinoma ◽  
Predictive Value ◽  
International Association ◽  
Disease Free Survival ◽  
Pooled Analysis ◽  
European Respiratory Society ◽  
Cox Models ◽  
Significance Level ◽  
Histologic Pattern

Purpose The classification for invasive lung adenocarcinoma by the International Association for the Study of Lung Cancer, American Thoracic Society, European Respiratory Society, and WHO is based on the predominant histologic pattern—lepidic (LEP), papillary (PAP), acinar (ACN), micropapillary (MIP), or solid (SOL)—present in the tumor. This classification has not been tested in multi-institutional cohorts or clinical trials or tested for its predictive value regarding survival from adjuvant chemotherapy (ACT). Patients and Methods Of 1,766 patients in the IALT, JBR.10, CALGB 9633 (Alliance), and ANITA ACT trials included in the LACE-Bio study, 725 had adenocarcinoma. Histologies were reclassified according to the new classification and then collapsed into three groups (LEP, ACN/PAP, and MIP/SOL). Primary end point was overall survival (OS); secondary end points were disease-free survival (DFS) and specific DFS (SDFS). Hazard ratios (HRs) and 95% CIs were estimated through multivariable Cox models stratified by trial. Prognostic value was estimated in the observation arm and predictive value by a treatment effect interaction with histologic subgroups. Significance level was set at .01 for pooled analysis. Results A total of 575 patients were included in this analysis. OS was not prognostically different between histologic subgroups, but univariable DFS and SDFS were worse for MIP/SOL compared with LEP or ACN/PAP subgroup (P < .01); this remained marginally significant after adjustment. MIP/SOL patients (but not ACN/PAP) derived DFS and SDFS but not OS benefit from ACT (OS: HR, 0.71; 95% CI, 0.51 to 0.99; interaction P = .18; DFS: HR, 0.60; 95% CI, 0.44 to 0.82; interaction P = < .01; and SDFS: HR, 0.59; 95% CI, 0.42 to 0.81; interaction P = .01). Conclusion The new lung adenocarcinoma classification based on predominant histologic pattern was not predictive for ACT benefit for OS, but it seems predictive for disease-specific outcomes.

Failure of the Ottawa Score to Predict the Risk of Recurrent Venous Thromboembolism in Cancer Patients: The Prospective PREDICARE Cohort Study

2021 ◽  
Author(s):  
Philippe Girard ◽  
Silvy LAPORTE ◽  
Céline Chapelle ◽  
Nicolas Falvo ◽  
Lionel Falchero ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Cancer Patients ◽  
Risk Groups ◽  
Therapeutic Implications ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
C Statistic ◽  
Recurrent Venous Thromboembolism ◽  
Recurrent Vte

Introduction: Recurrent venous thromboembolism (VTE) despite curative anticoagulation is frequent in patients with cancer. Identifying patients with a high risk of recurrence could have therapeutic implications. A prospective study was designed to validate the Ottawa risk score of recurrent VTE in cancer patients. Methods: In a prospective multicenter observational cohort, adult cancer patients with a recent diagnosis of symptomatic or incidental lower limb deep vein thrombosis or pulmonary embolism were treated with tinzaparin for 6 months. The primary endpoint was the recurrence of symptomatic or asymptomatic VTE within the first 6 months of treatment. All clinical events were centrally reviewed and adjudicated. Time-to-event outcomes were estimated by the Kalbfleisch and Prentice method to take into account the competing risk of death. A C-statistic value >0.70 was needed to validate the Ottawa score. Results: A total of 409 patients were included and analyzed on an intention-to-treat basis. Median age was 68 years, 60.4% of patients had PE, VTE was symptomatic in 271 patients (66.3%). The main primary sites were lung (31.3%), digestive tract (18.3%) and breast (13.9%) cancers. The Ottawa score was high (≥1) in 58% of patients. The 6-month cumulative incidence of recurrent VTE was 7.3% (95% confidence interval [CI]: 4.9-11.1) overall, and 5.0% (95%CI: 2.3-10.8) vs 9.1% (95%CI: 6.1-13.6) in the Ottawa low vs high risk groups, respectively. The C-statistic value was 0.60 (95%CI: 0.55-0.65). Conclusion: In this prospective cohort of patients with cancer receiving tinzaparin for VTE, the Ottawa score failed to accurately predict recurrent VTE.

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