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Publications

Journal Article Epublish

PubMed: 42835926 DOI: 10.3389/fonc.2026.1886848

Subclinical pulmonary embolism in first-line/induction therapy of lung cancer - a remaining clinically relevant adverse event.

Front Oncol 16:1886848

Authors: Kristin Mersmann, Martin Metzenmacher, Gregor Zaun, Marcel Wiesweg, Filiz Oezkan, Jane Winantea, Christian Taube, Dirk Theegarten, Martin Schuler, Lale Umutlu, Servet Bölükbas, Fabian Doerr, Daniel Messiha, Marcel Opitz, Wilfried Ee Eberhardt, Johannes Wienker

Affiliations

  • Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany. National Center for Tumor Diseases (NCT), NCT West, Essen, Germany.
  • Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany.
  • National Center for Tumor Diseases (NCT), NCT West, Essen, Germany.
  • Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany.
  • Department of Pulmonology, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany.
  • Department of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany.
  • Institute of Diagnostic and Interventional Radiology and Neuroradiology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
  • Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, Essen, Germany.
  • Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre, University of Duisburg-Essen, Essen, Germany.

Abstract

INTRODUCTION

Pulmonary embolism (PE) at initial diagnosis and during first-line systemic treatment is clinically relevant in patients with lung cancer. However, real-world incidence of subclinical PE is not well established.

METHODS

Retrospective single-center analysis of patients at least 18 years old with non-small-cell lung cancer (NSCLC) or small-cell lung cancer (SCLC) who received first-line/induction systemic therapy. All patients underwent contrast-enhanced computed tomography (CT) of the thorax with bolus tracking for PE detection. Treatment response was assessed by restaging at weeks 6 and 12 after treatment initiation.

RESULTS

A total of 373 patients treated between 2019 and 2022 were included (261 NSCLC, 112 SCLC; 179 women and 194 men; median age 66 years [range, 22 to 86]; median smoking history 40 Pack Years [range, 0-150]). There was a predominance of locally advanced and metastatic disease (IB-IIB, n = 22; IIIA-C, n = 123; IVA-B, n = 228). Adenocarcinoma was the predominant histology among NSCLC cases (LUAD, n = 146), followed by squamous cell carcinoma and other NSCLC subtypes combined (n = 115); 112 patients had SCLC.PE was detected in 61/373 patients, of whom 58 (95%) had subclinical PE. In NSCLC, body-mass-index (BMI) was independently associated with occurrence of PE (OR = 1.111, p = 0.005), while central tumor localization (OR 5.637, p = 0.028) and vascular infiltration (OR 7.683, p = 0.010) were significantly associated with PE in SCLC. All patients with PE received anticoagulants according to national and international guidelines and no PE-related deaths occurred.

CONCLUSION

This single-center analysis demonstrates a high incidence of subclinical PE in newly diagnosed lung cancer patients and identifies clinical risk factors associated with PE development.

MeSH

Cells, Lung, Embolism, Incidence, Neoplasms, Carcinoma, Non-Small-Cell Lung, Drug Therapy, Drug-Related Side Effects And Adverse Reactions, Lung Neoplasms, Pulmonary Embolism, Therapeutics, Chemotherapy