Pulmonary Embolism in Patients with Lung Cancer: Incidence and Performance of Prognostic Markers

The incidence of cancer-associated thromboembolism has been extensively investigated, but mostly in heterogeneous cancer populations. Prognostic risk assessment is crucial in pulmonary embolism, but the accuracy of the commonly used tools remains uncertain in patients with cancer.

We retrospectively included outpatients with consecutive lung cancer attending the Pulmonary Unit in Pisa from July 2019 to June 2021. The study population was the subgroup of patients who developed at least one episode of pulmonary embolism. For all patients, clinical data within 72 h of pulmonary embolism diagnosis, Khorana Risk Score, and overall survival time were collected.

A total of 512 patients with lung cancer attended the clinic; 40 patients developed pulmonary embolism (cumulative incidence of 7.81%). Eight patients (20%) died within a month, and twenty-two patients (55%) died within 6 months. Troponin, N-terminal pro-brain-type natriuretic peptide and shock index were significantly different between survivors and non-survivors (p < 0.05). Pulmonary artery diameter and the right to left ventricle index were not significantly different between survivors and non-survivors. Patients' survival significantly decreased with the increase in Khorana Risk Score.

Compared to previous studies, a higher incidence of pulmonary embolism in lung cancer was detected by our study. The prognosis of patients with lung cancer with pulmonary embolism seemed to be influenced more by the natural history of cancer than by the severity of pulmonary embolism. Khorana Risk Score might be considered as a prognostic tool in patients with lung cancer and may be used in the prognostic work-up for lung cancer-associated thromboembolism after a prospective validation.