Early venous thromboembolic events are associated with worse prognosis in patients with lung cancer

• Early venous thromboembolic events (VTE) account for approximately half of VTE in patients with lung cancer.
• Early VTE are associated with worse mortality independent of lung cancer stage and other, well-recognized risk factors.
• Early VTE should be considered as a separate risk factor in addition to stage for the purpose of clinical trial participation.
• Patients with early VTE need to be identified for participation in clinical trials to determine optimal thromboprophylaxis strategies.

ObjectivesVenous thromboembolic events (VTE) are a leading cause of death in cancer patients. We hypothesized that early VTE (EVTE, within 3 months of diagnosis) in patients with lung cancer (LC) are associated with worse overall survival (OS).Materials and methodsWe identified 727 patients with LC between 1998 and 2011. Late VTE (LVTE) were defined as VTE occurring after 3 months from LC diagnosis. Advance disease (AD) was defined as patients with Stage IV non-small cell lung cancer (NSCLC) or extensive stage small cell lung cancer (SCLC), and non-advanced disease (non-AD) was defined as ≤Stage III NSCLC or limited stage SCLC.ResultsOut of 727 patients included in our review, 617 patients had NSCLC (85%), 94 (13%) SCLC, and 16 (2%) low grade neuroendocrine tumors. Ninety five patients (13%) experienced VTE, 44 (6%) experienced an EVTE and 49 (7%) had a LVTE. Patients with an EVTE had worse OS when compared to all other patients (medians 4 vs. 17 months, p < 0.0001). EVTE were associated with worse OS in patients with non-AD (medians 12 vs. 42 months, p = 0.01) and AD (medians 4 vs. 6 months, p = 0.02). When considering patients with NSCLC only, in a multivariate model that included age, stage, performance status >2, administration of chemotherapy and Charlson comorbidity index, EVTE were an independent predictor of increased mortality (HR 2.4; 95% CI 1.6–3.3).ConclusionsEVTE are associated with worse OS, irrespective of stage of the disease. Our findings underscore the need for an efficient preventive strategy for VTE among patients with lung cancer.