Hemoptysis recurrence after arterial embolization in lung cancer: a 5-year retrospective cohort study

Hemoptysis is a life-threatening complication in patients with lung malignancy. Although arterial embolization provides reliable immediate hemostasis, recurrence rates in the oncologic setting substantially exceed those observed in benign disease. Whether routine baseline clinical and tumor characteristics can identify patients at higher risk of post-embolization rebleeding remains unclear.

We conducted a 5-year single-center retrospective cohort study of 126 consecutive patients with histologically confirmed lung cancer treated with arterial embolization for hemoptysis (January 2021-December 2025). The hemoptysis-free interval was estimated using the Kaplan-Meier method and compared across subgroups using the log-rank test. Associations between prespecified covariates and recurrence were assessed using multivariable Cox proportional hazards regression. Embolic materials included metallic microcoils, polyvinyl alcohol particles (300-700 μm), gelatin sponge, and combinations thereof. Five covariates were examined: tumor diameter, cancer stage, histological subtype, age, and sex.

Technical success was achieved in 124 of 126 procedures (98.4%), and clinical success (no hemoptysis recurrence within 30 days) in 121 of 124 technically successful procedures (97.6%). Over a median follow-up of 31.3 months (interquartile range: 14.6-47.8 months), hemoptysis recurrence occurred in 32 patients (25.4%), with a median time to recurrence of 13.9 months. Recurrence proportions across embolic agent groups were considered descriptive only because allocation was not protocolized (log-rank P = 0.45). On multivariable Cox analysis, none of the five prespecified covariates showed a statistically detectable association with recurrence: tumor diameter [hazard ratio (HR): 1.00; 95% confidence interval (CI): 0.98-1.01; P = 0.783], cancer stage (HR: 1.21; 95% CI: 0.75-1.94; P = 0.432), squamous cell vs. other histology (HR: 0.80; 95% CI: 0.36-1.77; P = 0.585), age (HR: 0.98; 95% CI: 0.94-1.02; P = 0.299), and male sex (HR: 1.12; 95% CI: 0.53-2.36; P = 0.761). The events-per-variable ratio was approximately 6.4. Major complications occurred in 2.4% of patients (3/126), with no clinically adjudicated procedure-related mortality or permanent neurological sequelae.

In this exploratory single-center cohort, arterial embolization achieved high technical success with an acceptable short-term safety profile. The evaluated baseline clinical and tumor characteristics were not statistically associated with hemoptysis recurrence; however, the limited event count and absence of key angiographic and oncologic treatment variables preclude definitive conclusions regarding their predictive value.

Standard tumor burden descriptors alone appeared insufficient for post-embolization recurrence risk stratification in this exploratory cohort. Future models should prioritize angiographic vascular anatomy, collateral supply, prior thoracic radiotherapy, and concurrent systemic anticancer therapy.