Abstract

Background: Pulmonary embolism is a frequent condition in cancer patients that may complicate the management and worsen the prognosis of these patients. Mortality, recurrence and bleeding in cancer patients with PE, treated with anticoagulant, are still poorly defined.

Aims: To evaluate mortality rate, recurrence and bleeding in a population of cancer and non cancer patients with PE.

Methods: A series of 200 consecutive (January 2012-December 2014) patients with diagnosis of PE were followed for one year at the Pulmonary Unit of the University Hospital of Pisa, Italy. Mean age was 67.9±15.0 year, 99 (49.5%) were males, 122 (61%) patients had concomitant deep venous thrombosis of lower limbs, 60 (30%) patients had recent cancer diagnosis. PE was diagnosed by CT angiography. All patients were treated with anticoagulant therapy from diagnosis to the end of follow-up.

Results: Overall mortality rate was 11.7% in cancer and 1.4% in non cancer patients (p=0.001). No statistically significant difference in recurrence and bleeding between cancer (15.0% and 3.3% respectively) and non cancer (7.8% and 4.3% respectively) was found (p=0.121, p=0.748). In multivariate analysis, the presence of cancer resulted associated to mortality (OR, 9.3; 95% CI, 1.8-48.1; p= 0.008) and male sex to recurrence (OR, 5.5; 95% CI, 1.7-18.1; p=0.005). No factor associated to bleeding was identified.

Conclusion: As expected, mortality is higher in cancer patients with pulmonary embolism and is closely related to cancer itself. Under anticoagulation cancer patients seem to show similar risk of recurrence and bleeding as non cancer patients.