Association of Venous Thromboembolism and Early Mortality in Patients with Newly Diagnosed Metastatic Non-Small Cell Lung Cancer.
Association of Venous Thromboembolism and Early Mortality in Patients with Newly Diagnosed Metastatic Non-Small Cell Lung Cancer.
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新诊断的转移性非小细胞肺癌患者的静脉血栓栓塞与早期死亡率的关系
DOI：
10.2147/cmar.s301088
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发表时间：
2021
影响因子：
3.3
通讯作者：
Zhang Y
中科院分区：
文献类型：
--
作者：
Su Y;Huo M;Hua L;Zhang Y;Yi J;Zhang S;Li J;Zhang Y
目的探讨中国新诊断转移性非小细胞肺癌(NSCLC)患者进入精准治疗时代后静脉血栓栓塞症(VTE)与早期死亡率(6个月内)的关系。前瞻性观察了706名新诊断为转移性非小细胞肺癌的连续受试者。临床和生存数据被记录在六个月的随访期内。通过单因素和多因素分析评价VTE发生的预测因素及其与早期死亡率的关系。在6个月的随访期内，12.2%(86/706)的入选患者发生了VTE事件。在VTE的多因素分析中，年龄大于70岁(vs<；70：次分布危险比，1.678；95%可信区间(CI)，1.073-2.600；P=0.022)，东部合作肿瘤组表现状态≥2(vs 0/1：SHR，1.946；95%CI，1.277-2.970；P=0.002)，有ALK重排(vs未重排：SHR，2.377；95%CI，1.186-4.760；P=0.015)与静脉血栓栓塞症的发生显著相关。6个月内死亡116例(16.4%)，发生静脉血栓栓塞者(与未发生静脉血栓栓塞者：校正后HR：1.863；95%CI：1.178~2.947，P=0.008)与早期死亡率显著相关。进一步分析发现，98名早期死亡患者(13.9%)携带EGFR/ALK野生型基因，其早期死亡风险是携带EGFR突变/ALK重排患者的5.935倍。最后，亚组分析显示，静脉血栓栓塞症的发生是预测携带EGFR/ALK野生型基因患者早期死亡率的重要因素(调整后的HR：1.682；95%CI：1.023-2.768，P=0.041)。在靶向治疗时代，具有EGFR突变/ALK重排的患者早期死亡的风险显著降低；然而，VTE的发生仍然是转移性NSCLC患者早期死亡的重要预测因素，特别是在携带EGFR/ALK野生型基因的患者中。
To explore the relationship between venous thromboembolism (VTE) and early mortality (within six months) in Chinese patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC) after entering the era of precision treatment. A cohort of 706 consecutive subjects with newly diagnosed metastatic NSCLC were prospectively observed. Clinical and survival data were recorded over a six-month follow-up period. The predictive factors for the occurrence of VTE and the relationship with early mortality were evaluated through univariate and multivariate analyses. During the six-month follow-up period, VTE events occurred in 12.2% (86/706) of the enrolled patients. In the multivariate analyses for VTE, an age older than 70 years (vs < 70: sub-distribution hazard radio [SHR], 1.678; 95% confidence interval (CI), 1.073–2.600; P=0.022), an Eastern Cooperative Oncology Group performance status ≥2 (vs 0/1: SHR, 1.946; 95% CI, 1.277–2.970; P=0.002), and having an ALK rearrangement (vs non-rearrangement: SHR, 2.377; 95% CI, 1.186–4.760; P=0.015) were significantly associated with the occurrence of VTE. Within six months, 116 subjects (16.4%) died, and the occurrence of VTE (vs no VTE: adjusted HR: 1.863; 95% CI: 1.178–2.947, P=0.008) was remarkably associated with early mortality. Further analysis showed 98 patients (13.9%) with early mortality had EGFR/ALK wild-type genes, with a risk of early mortality 5.935-fold higher than that of patients with an EGFR mutation/ALK rearrangement. Finally, subgroup analyses showed that VTE occurrence was a significant factor for predicting early mortality in patients with EGFR/ALK wild-type genes (adjusted HR: 1.682; 95% CI: 1.023–2.768, P=0.041). Patients with an EGFR mutation/ALK rearrangement had a significantly decreased risk of early mortality in the era of targeted therapy; however, VTE occurrence remained an important predictor for early mortality in metastatic NSCLC patients, especially in patients with EGFR/ALK wild-type genes.