Incidence and Predictors of Venous Thromboembolism and Mortality in Saudi Lung Cancer Patients: A Retrospective Two-center Cohort Study

Abstract

BACKGROUND: Venous thromboembolism (VTE) frequently occurs among individuals with cancer, and lung cancer (LC) is among the malignancies associated with the highest rate of VTE development. PURPOSE: The study’s objective was to ascertain the incidence rates of VTE and evaluate predictors of both VTE occurrence and mortality in LC patients. METHODS: This two-center retrospective study involved 497 Saudi Arabian patients diagnosed with LC aged ≥ 18 years. In this study, we calculated VTE incidence and mortality rates. We conducted Cox regression analyses (both univariate and multivariate) to explore the relationship between patient characteristics, VTE, and mortality using a 95% confidence interval (CI) and hazard ratios (HRs). RESULTS: Among 497 LC patients, 98 developed VTE, resulting in a prevalence rate of 9.8 per 100 person-years (PYs) with a 95% CI of 8.0–11.8. Furthermore, 280 patients passed away, resulting in a mortality rate of 26.5 per 100 PY with a 95% CI of 23.9–29.3. Low albumin levels, diagnosis of nonsmall cell LC (NSCLC), and high Eastern Cooperative Oncology Group (ECOG) performance status were all independent risk factors for VTE. Patients with VTE had notably higher mortality risk (HR: 3.10; 95% CI, 2.53–3.91; P < 0.001) than non-VTE patients. The Kaplan–Meier analyses showed that the predicted median time of VTE occurrence was significantly higher in small cell LC (SCLC) (33.7 months) (P = 0.002 by the log-rank test) compared to NSCLC (28.7 months) patients. Furthermore, the estimated median time of survival for NSCLC patients (23.8 months) was significantly lower than in SCLC (29.7 months) (P < 0.001 by the log-rank test). CONCLUSION: The study findings indicated that the VTE occurrence in LC patients was 9.8 per 100 PY, with a corresponding mortality rate of 26.5 per 100 PY. Reduced levels of albumin, ECOG performance status, and NSCLC emerged as significant risk factors of VTE. Patients who experienced VTE had a 3.10-fold higher mortality risk than non-VTE LC patients.