Conditional catheter-related thrombosis free probability and risk-adapted choices of catheter for lung cancer

Current predictive tools assess catheter-related thrombosis (CRT) in patients with lung cancer in a static manner at a single time point of catheterization. The subsequent hazard changes over time are unknown. The conditional catheter-related thrombosis-free probability (CCFP) can provide dynamic information on continual CRT-free expectations. This study aimed to assess the CCFP and hazard rates based on risk categories and various venous access devices (VADs).

This retrospective study reviewed 939 patients with lung cancer with peripherally inserted central venous catheters (PICCs) or central venous catheters (CVCs) identified at the National Clinical Research Center for Cancer between January 1, 2015 and December 31, 2018. The incidence of CRT has also been reported. Patients were stratified into low- and high-risk groups according to multivariate Cox regression analyses. CCFP is defined as the CRT-free probability given that patients have no CRT for a definite time.

A total of 507 patients with PICCs and 432 patients with CVCs were included in this study. The 3-month CCFP increased from 74.2% at catheter insertion to 93.6% at 3 months. The hazards of CRT in the first month were highest (16.4%) and slightly thereafter. The high-risk group initially had a higher (21.4%) but significantly decreased CRT hazard after 2 months (8.3%), whereas the low-risk group maintained a comparable lower risk hazard of less than 5% after 1 month. In the overall cohort, patients with CVCs had lower CRT probability than those with PICCs (HR, 1.76; 95% CI: 1.28-2.41; p < 0.01). Further analysis demonstrated that compared with PICCs, CVCs provided a CRT-free benefit in low-risk patients (p = 0.02) but not in high-risk patients (p = 0.06).

CCFP increased, and the hazards of CRT decreased over time in a risk-dependent manner in patients with lung cancer. These valuable dynamic data may help optimize risk-adjusted choices of VADs and risk-adjusted prophylactic anticoagulation strategies for patients.