PUBLICAÇÕES científicas

The prognostic impact of additional intrathoracic findings in patients with cancer-related pulmonary embolism

Jiménez-Fonseca P (1), Carmona-Bayonas A (2), Font C (3), Plasencia-Martínez J (4), Calvo-Temprano D (5), Otero R (6), Beato C (7), Biosca M (8), Sánchez M (9), Benegas M (9), Varona D (10), Faez L (11), Antonio M (12), de la Haba I (13), Madridano O (14), Solis MP (11), Ramchandani A (15), Castañón E (16), Marchena PJ (17), Martín M (14), de la Peña FA (2), Vicente V (2); EPIPHANY study investigators and the Asociación de Investigación de la Enfermedad Tromboembólica de la Región de Murcia. (1) Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Spain. palucaji@hotmail.com.
(2) Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain.
(3) Medical Oncology Department, Hospital Universitari Clinic, Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain.
(4) Radiology Department, Hospital Universitario Morales Meseguer, Murcia, Spain.
(5) Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
(6) Pneumology Department, Hospital Universitario Virgen del Rocío, CIBER de Enfermedades Respiratorias, Seville, Spain.
(7) Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Seville, Spain.
(8) Medical Oncology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
(9) Radiology Department, Hospital Universitari Clínic, Barcelona, Spain.
(10) Radiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
(11) Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011, Oviedo, Spain.
(12) Medical Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.
(13) Internal Medicine Department, Hospital Duran i Reynals, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.
(14) Internal Medicine Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.
(15) Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain.
(16) Medical Oncology Department, Clínica Universidad de Navarra, Pamplona,  Spain.
(17) Internal Medicine Department, Parc Sanitari Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.

Revisão:Clinical & Translational Oncology

Data: 10/Jul/2017

Oncologia Médica

AIM:

To assess the prevalence and prognostic significance of additional intrathoracic findings (AIFs) in patients with cancer and pulmonary embolism (PE). AIFs were considered alterations other than the characteristic ones intrinsic to PE or changes in cardiovascular morphology.

METHODS:

Subjects have been taken from a Spanish national multidisciplinary and multicenter study of PE and cancer who were treated between 2004 and 2015. The endpoint was the appearance of serious complications or death within 15 days.

RESULTS:

The registry contains 1024 eligible patients; 41% diagnosed by computed tomography pulmonary angiography versus 59% by non-angiographic CT. Serious complications occurred within 15 days in 18.9%, [95% confidence interval (CI), 16.6-21.4%] and 9.5% (95% CI 7.9-11.5%) died. At least one AIF was seen in 72.6%.

The most common AIFs were as follows: pulmonary nodules (30.9%), pleural effusion (30.2%), tumor progression (28.3%), atelectasis (19.0%), pulmonary infarct (15.2%), emphysema (13.4%), pulmonary lymphangitic carcinomatosis (4.5%), and pneumonia (6.1%). Patients with AIF exhibited a higher complication rate at 15 days: 21.9% versus 13.0%, odds ratio (OR) 1.8 (95% CI 1.2-2.8), P = 0.03, and 15-day mortality: 15.0% versus 7.3%, OR 1.9 (95% CI 1.1-3.2), P = 0.020.

Patients with pneumonia, pneumothorax, pulmonary edema, pulmonary nodules, tumor progression, pulmonary fibrosis, and pleural effusion showed an excess of adverse events.

CONCLUSIONS:

Additional intrathoracic findings are highly prevalent and significantly impact prognosis in patients with PE and cancer, making them germane to the classification of this population.

CITAÇÃO DO ARTIGO  Clin Transl Oncol. 2017 Jul 10. doi: 10.1007/s12094-017-1713-3

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