Lung Cancer and Pulmonary Thromboembolism
DOI: 10.5455/msm.2015.27.351-353
Published online: 05/10/2015
Published print:10/2015
Received: 10 June 2015; Accepted: 15 September 2015 © 2015 Vesna Cukic, Aida Ustamujic This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
PROFESSIONAL PAPER
Mater Sociomed. 2015 Oct; 27(5): 351-353
LUNG CANCER AND PULMONARY THROMBOEMBOLISM Vesna Cukic, Aida Ustamujic Clinic for pulmonary diseases and TB “Podhrastovi”, Clinical centre of Sarajevo University, Bosnia and Herzegovina Corresponding author: Vesna Cukic, MD, PhD. Bjelave 99, 71000 Sarajevo, Bosnia and Herzegovina. Phone: 00387 61 480-228, E-mail: [email protected]. ABSTRACT Introduction: Malignant diseases including lung cancer are the risk for development of pulmonary thromboembolism (PTE). Objective: To show the number of PTE in patients with lung cancer treated in Clinic for pulmonary diseases and TB “Podhrastovi” in three-year period: from 2012-2014. Material and methods: This is the retrospective study in which we present the number of various types of lung cancer treated in three-year period, number and per cent of PTE in different types of lung carcinoma, number and per cent of PTE of all diagnosed PTE in lung carcinoma according to the type of carcinoma. Results: In three-year period (from 2012 to 2014) 1609 patients with lung cancer were treated in Clinic for pulmonary diseases and TB “ Podhrastovi” Clinical Centre of Sarajevo University. 42 patients: 25 men middle –aged 64.4 years and 17 women middle- aged 66.7 or 2.61% of all patients with lung cancer had diagnosed PTE. That was the 16. 7% of all patients with PTE treated in Clinic “Podhrastovi “in that three-year period. Of all 42 patients with lung cancer and diagnosed PTE 3 patients (7.14%) had planocellular cancer , 4 patients (9.53%) had squamocellular cancer, 9 (21.43%) had adenocarcinoma, 1 (2.38%) had NSCLC , 3 ( 7.14 %) had microcellular cancer, 1 ( 2.38%) had neuroendocrine cancer, 2 (4.76%) had large cell-macrocellular and 19 (45.24%) had histological non-differentiated lung carcinoma. Conclusion: Malignant diseases, including lung cancer, are the risk factor for development of PTE. It is important to consider the including anticoagulant prophylaxis in these patients and so to slow down the course of diseases in these patients. Key words: lung cancer, pulmonary thromboembolism.
1. INTRODUCTION Variable risk and etiologic factors have been demonstrated to play a role in the development of PTE (1-4). Cancer is one of the important risk factors for PTE ; in cancer patients PTE occurs 2-4 times more frequently than in patients without cancer (4, 5).Several mechanisms may contribute to the development of PTE in cancer patients (6) such as immobilization, surgery , down-regulation of anticoagulants, and up-regulation of pro- coagulant proteins (7, 8), endothelial damage caused by chemotherapy or stimulation of endothelial cells to produce procoagulant materials (9), inflammation due to necrosis or release of acute –phase reactants and hemodynamic disorders such as stasis (10). Lung cancer is the most common malignancy coexisting in patients with PTE (11). Mechanisms and risk factors for lung cancer patients for developing PTE are unclear (3). It is believed that use of specific chemotherapeutic drugs in combination with novel target drugs such as antiangiogenic agents and elevated pre- chemotherapy platelet counts can cause PTE (3). Also tissue factor (TF) the initiator of the clotting cascade may be over expressed in lung carcinoma cells (3) Active TF-
bearing micro particles which may originate from tumor cells have been found in the circulation of cancer patients and may provide a link between cancer and thrombosis (3). Some authors emphasized those risk factors for development of PTE in lung cancer patients: adenocarcinoma, metastatic disease, pneumectomy, chemotherapy especially anti-VEGF target drugs, high serum hemoglobin (1-3).
Mater Sociomed. 2015 Oct; 27(5): 351-353 • PROFESSIONAL PAPER
351
2. OBJECTIVE To show the number of PTE in patients with lung cancer treated in Clinic for pulmonary diseases and TB “Podhrastovi” in three-year period: from 2012-2014 year according to the histological type of lung cancer. 3. MATERIAL AND METHODS This is the retrospective study in which we present the number of various types of lung cancer treated in three-year period, number and per cent of PTE in different types of lung carcinoma, number and per cent of PTE of all diagnosed PTE in lung cancer according to the histological type of carcinoma.
Lung Cancer and Pulmonary Thromboembolism carcinoma, number and per cent of PTE of all diagnosed PTE in lung cancer according to the histological type of carcinoma.
4. RESULTS Of 1609 lung cancer patients there were 17.4% planocellular In three-year period (from 2012 to 2014) 1609 patients carcinoma , 15.35% squamocellular carcinoma , 25.05% adeno4. RESULTS with lung cancer were treated in Clinic for pulmonary diseases carcinoma ,5.34% NSCLC (non-small cellular lung carcinoma), In three-year period (from 2012. to 2014.year) 1609 patients with lung cancer were and TB “ Podhrastovi” Clinical centre of Sarajevo University 13.80% microcellular carcinoma, 0.44% mesothelioma, 1.86% treated in Clinic for pulmonary diseases and TB “ Podhrastovi” Clinical centre of . 42 patients: 25 men middle –aged 64.4 years and 17 women neuroendocrine carcinoma, 0.93% large cell-macrocellular Sarajevo University . 42 patients: 25 men middle –aged 64.4 years and 17 women middle- aged 66.7 or 2.61% had diagnosed PTE. That was the carcinoma , 0.12% anaplastic carcinoma, 0.50% pleomorfic middle- aged 66.7 or 2.61% had diagnosed PTE. That was the 16. 7% of all patients 16. 7% of all patients with PTE treated in Clinic “Podhrastovi carcinoma, 0.44% mediastinal carcinoma, 0.50% characinoid , with PTE treated in Clinic “Podhrastovi “in that three-year period. “in that three-year period. PTE developed in all patients within 17.65% non-differentiated histological type of lung carcinoma PTE developed in all patients within one year of the diagnosis of lung cancer. Of all 42 one year of the diagnosis of lung cancer. Of all 42 patients with and , 0.62% pulmonary lymphangitis carcinomatosa because or patients with lungand cancer and2PTE 2 patients were IIB, 5 5patients werewere in IIIA, lung cancer PTE patients were ininIIB, patients in 15 earlier breast carcinoma. patients in IIIB and 20 patients were in IV stage of lung cancer when PTE was diagnosed. IIIA, 15 patients in IIIB and 20 patients were in IV stage of lung Number and per cent of patients with PTE in all patients with different type of lung cancer All patientswhen with lung cancer PTE received chemotherapy according the protocol cancer PTE wasand diagnosed. All patients with lungtocancer for thatPTE type ofreceived lung cancer and no one of them had been previously surgically treated. 19 20 and chemotherapy according to the protocol for 18 that type of lung cancer and no one of them had been previously Results are shown on Figures 1, 2, 3, 4. 16 surgically treated. 13.33 14 Figure 1. Number of patients... 12 Results are shown on Figures 1, 2, 3, 4. number 450
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Number of patients with different type of lung cancer treated in Clinic "Podhrastivi" in three-year period (2012.-2014.)
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Figure 3. Number and per cent of patients with PTE in all patients with different
3 patients with planocellular carcinoma or 1.07% allof 3 patients with planocellulare carcinoma or 1.07% of all patients with thatoftype
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patients with, 4that type cancer hadcarcinoma PTE , 4orpatients with cancer had PTE patients withofsquamocellular 1.62% had PTE, 9
squamocellular carcinoma or 1.62% had1 PTE, 9 patients patients with adenocarcinoma or 2.23% had PTE, patient with NSCLC with (non-small
adenocarcinoma had PTE, 1 patient with NSCLC cellular lung carcinoma) oror2.23% 1.16% had PTE, 3 patients with microcellular carcinoma or
Figure 1. Number of patients with different type of lung cancer treated in Clinic. Legend. 1=planocellulare small cellular lung carcinoma), 5=microcellular carcinoma , 6=mesothelioma,carcinoma, 7=neuroendocrine patients with microcellular carcinoma or 1.35% had PTE , 1 carcinoma,8= large cell-macrocellular carcinoma , 9=anaplastic carcinoma , 10=pleomorfic 2=squamocellular carcinoma, 3=adenocarcinoma, 4=NSCLCcarcinoma,patients with large cell-macrocellular carcinoma or 13. 33% had PTE , 19 patients patient with neuroendocrine carcinoma or 3.33% had PTE, (non-small cellular lung carcinoma), 5=microcellular carcinoma with non-differentiated histological type of lung carcinoma or 6,69% of all patients 23 patients with large cell-macrocellular carcinoma or 13. 33% , 6=mesothelioma, 7=neuroendocrine carcinoma,8= large with that type of cancer had PTE . had PTE , 19 patients with non-differentiated histological type cell-macrocellular carcinoma , 9=anaplastic carcinoma Figure 4. Number and percent... , 10=pleomorfi c carcinoma, 11=mediastinal carcinoma,histological typeofoflung 11=mediastinal carcinoma, 12=characinoid, 13=non-differentiated lung carcinoma, carcinoma or 6,69% of all patients with that type of 12=characinoid, 13=non-differentiated histological type of lung 14=lymphangitis carcinomatosa cancer had PTE . carcinoma, 14=lymphangitis carcinomatosa
(non-small carcinoma) or 1.16%orhad PTE, 3 2 Legend. 1=planocellulare carcinoma, 2=squamocellular carcinoma, 3=adenocarcinoma, 4=NSCLC (non 1.35% had PTE , cellular 1 patient lung with neuroendocrine carcinoma 3.33% had PTE,
Number and per cent of all 42 diagnosed PTE according to the type of lung Of 1609 lung cancer patients there were 280 planocellulare carcinoma, 247 cancer Of 1609 lung cancer patients there were 280 planocellular squamocellular carcinoma , 403 adenocarcinoma , 86 NSCLC (non-small cellular lung carcinoma, 247 squamocellular carcinoma , 403 adenocarci50 45.24 carcinoma), 222 microcellular carcinoma , 7 mesothelioma, 3045 neuroendocrine noma , 86 NSCLC (non-small cellular lung carcinoma), 222 carcinoma , 15 large cell-macrocellular carcinoma , 2 anaplastic carcinoma, 8 40 microcellular carcinoma , 7 mesothelioma, 30 neuroendocrine 35 pleomorfic carcinoma, 7 mediastinal carcinoma, 8 characinoid , 284 noncarcinoma , 15 large cell-macrocellular carcinoma , 2 anaplastic 30 differentiated histological type of lung carcinoma , 10 pulmonary lymphangitis carcinoma, 8 pleomorfic carcinoma, 7 mediastinal carcinoma, 25 21.43 19 carcinomatosa because or earlier breast carcinoma. 20 8 characinoid , 284 non-differentiated histological type of lung
carcinoma lymphangitis carcinomatosa because Figure 2. Type, 10 of pulmonary lung... or earlier breast carcinoma.
15 10
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Figure 4. Number and per cent of all 42 diagnosed PTE
Of all 42 patients lung cancer and diagnosed PTE according to with the type of lung
3 patients (7.14%) had
planocellular carcinoma , 4 patients (9.53%) had squamocellular carcinoma, 9 (21.43%)
Of all 42 patients with lung cancer and diagnosed PTE 3 patients (7.14%) had planocellular carcinoma , 4 patients (9.53%) ( 2.38%) had neuroendocrine carcinoma, 2 (4,76%) had large cell-macrocellular had squamocellular carcinoma, 9 (21.43%) had adenocarcicarcinoma and 19 (45,24%) had non-differentiated lung carcinoma. noma, 1 (2.38%) had NSCLC , 3 ( 7,14 %) had microcellular carcinoma, 1 ( 2.38%) had neuroendocrine carcinoma, 2 (4,76%) 5.DISCUSSION hadoften large cell-macrocellular andoccurs 19 (45,24%) hadovarian, PTE occur in malignant diseases carcinoma . Especially PTE in patients with non-diff erentiated lung carcinoma. brain and pancreatic carcionoma when adjusted for prevalence of these tumors (11). A had adenocarcinoma, 1 (2.38%) had NSCLC , 3 ( 7,14 %) had microcellular carcinoma, 1
case controlled study ( 13) recently showed that patients with hematologic malignances
5. DISCUSSION
had the highest risk for PTE ,folowed by patients with lung and gastrointestinal cancers. Figure 2. Type of lung carcinoma treated in Clinic Podhrastovi in PTEin oft en occur in malignant diseases . Especially PTE PTE Advances tomography (CT) enhanced the detection of unsuspected Of three-year 1609 lung period cancerexpressed patients asthere wereof all17.4% carcinoma , computed 15.35% per cent patientsplanocellulare with lung occurs in patients with ovarian, brain and pancreatic carcicarcinoma carcinoma , 25.05% adenocarcinoma ,5.34% NSCLC(14-16).Despite these facts, the clinical features and prognosis of patients with lung squamocellular (non-small allcellular
cancer and PTE have rarely been reported (6). In some studies that dealt with these issue lung carcinoma), 13.80% microcellular carcinoma, 0.44% mesothelioma, 1.86% PROFESSIONAL PAPERwas • Mater Sociomed. Oct; 27(5): 351-353 (1-3, 6, 9) adenocarcionoma the most common2015 histological type and most patients 352 neuroendocrine carcinoma, 0.93% large cell-macrocellular carcinoma , 0.12% had advancedcarcinoma, stage disease (IIIB/IV). In our study the most common histological type of anaplastic carcinoma, 0.50% pleomorfic carcinoma, 0.44% mediastinal
Lung Cancer and Pulmonary Thromboembolism
onoma when adjusted for prevalence of these tumors (11). A case controlled study ( 13) recently showed that patients with hematologic malignances had the highest risk for PTE ,followed by patients with lung and gastrointestinal cancers. Advances in computed tomography (CT) enhanced the detection of unsuspected PTE (14, 15, 16).Despite all these facts, the clinical features and prognosis of patients with lung cancer and PTE have rarely been reported (6). In some studies that dealt with these issue (1, 2, 3, 6, 9) adenocarcinoma was the most common histological type and most patients had advanced stage disease (IIIB/IV). In our study the most common histological type of lung cancer with PTE was non –differentiated histological type of lung cancer- 19 patients or 45, 24%. It was may be because these patients came to hospital with so advanced disease that they could not be subjected to bronchoscopy because of bad clinical condition and other comorbidities such as cardiologic diseases, advanced stage of COPD, heart failure or respiratory insufficiency etc. but the diagnosis was established by radiological methods such as computed tomography(CT) or MRI ; or material obtained by bronchoscopy was full of necrosis so it was impossible for pathologist to give accurate type of malignant cells . Most of our patients were in advanced stage of diseases (IIIB or IV stage) such as was in the other studies (1- 3). In one study (2) authors show that incidence of PTE in patients with lung cancer is 40-100 cases in 1000 patients vs. 1-2 cases in general population. In our study 2.61% of patients with lung cancer had diagnosed PTE which presents about 26 cases of PTE in 1000 patients with lung cancer. We supposed that number would be greater if we had done CT in patients with unsuspected PTE. Their bad clinical condition we ascribed to their basic illness and its progression. In few studies (1-3) authors found that PTE develops within 12 months of the diagnosis of lung cancer that we confirmed in our study. Patients with lung cancer and PTE present 16. 7% of all patients with PTE treated in Clinic “Podhrastovi “in studied three-year period (2012.2014.). In one study (1) median survival from the diagnosis of PTE in patients with lung cancer was 3, 5 months but authors did not find the difference with a group of patients with lung cancer without PTE. In both groups the most common cause of death was lung cancer progression (76, 9%-80, 3%) or chemotherapy –related septic shock (16, 7,% - 19, 2%) (1). In our study we did not compare median survival between patients with lung cancer with and without PTE.
and so to slow down the course of diseases in these patients.
6. CONCLUSION Malignant diseases, including lung cancer, are the great risk factor for development of PTE. PTE is one of the various complications of lung cancer that may suggest being the factor which accelerate the bad course of that illness. It is important to consider the including anticoagulant prophylaxis in these patients
15.
Mater Sociomed. 2015 Oct; 27(5): 351-353 • PROFESSIONAL PAPER
CONFLICT OF INTEREST: NONE DECLARED.
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Jung-Woo L, Seung-Ick C, Chi -Young J, Won- Il C, Kyung-Nyeo J and al. Clinical course of pulmonary embolism in lung cancer patients. Respiration. 2009; 78: 42-48. Tesslaar- Margot ET, Osanto S. Risk of venous thromboembolism in lung cancer. Current Opinion in Pulmonary Medicine. 2007; 13(5): 362-367. Wang J, Zhou W, Xu L, Yang M, Fan W, Pu X, Yang Y. Risk factors and prognosis of lung cancer combined with pulmonary embolism. Zhngguo Fei Ai Za Zhi 2011 Oct: 14 (10): 780-784. Heit JA, Silverstain MD, Mohr DN, Peterson TM, O Fallon WM, Melton LJ. Risk factors for deep vein thrombosis and pulmonary embolism; a population based case-control study. Arc Intern Med. 2000; 160: 809-815. Rosendaal FR. Risk factors for venous thrombosis: prevalence, risk and interactions. Semin Hematol. 1997; 34: 171-187. Bloom JW, Osanto S, Rosendaal FR. The risk of a venous thrombotic event in lung cancer patients. Higher risk for adenocarcinoma than squamous cell carcinoma . J Thromb Haemost. 2004; 2: 1760-1765. FalangaA, Rickles FR. Patophysiology of the thrombophilic state in the cancer patient. Semin Throm Hemost. 1999; 25: 173-182. Gale AJ, Gordon SG. Update on tumor cell procoagulant factors. Acta Haematol. 2001; 106: 25-32. Donati MB, Falanga A. Patogenetic mechanisms of thrombosis in malignancy. Acta Haematol. 2001; 106: 18-24. Tesselear ME, Osanto S. Risk of venous thromboembolism in lung cancer. Curr Opin Pulm Med. 2007; 13: 362-367. Sorensen HT, Mellem Kjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Engl J Med. 2000; 343: 1846-1850. Levitan N, Dowlati A, Reimck SC,Tahslidar HI,Sivinski LD, et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using medicare claims data. Medicine. 1999; 78: 285-291. Blom JW, Doggn CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005; 293: 715-722. O Conell CL, Boswel WD, Duddalwar V, CatoA, Mark LS. et al. Unsuspected pulmonary emboli in cancer patients: clinical correlates and relevance. J Clin Oncol. 2006; 24: 4928-4932. Gladissh GW, Choe DH, Marom EM, Sablof BS, Broemeling LD, Munden RF. Incidental pulmonary emboli in oncology patients : prevalence, CT evaluation and natural history. Radiology. 2006:240: 246-255. Sebastian AJ, Paddon AJ. Clinically unsuspected pulmonary embolism –important secondary findings in oncology CT. Clin Radiol .2006; 61: 81-85
353
DOI: 10.5455/msm.2015.27.351-353
Published online: 05/10/2015
Published print:10/2015
Received: 10 June 2015; Accepted: 15 September 2015 © 2015 Vesna Cukic, Aida Ustamujic This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
PROFESSIONAL PAPER
Mater Sociomed. 2015 Oct; 27(5): 351-353
LUNG CANCER AND PULMONARY THROMBOEMBOLISM Vesna Cukic, Aida Ustamujic Clinic for pulmonary diseases and TB “Podhrastovi”, Clinical centre of Sarajevo University, Bosnia and Herzegovina Corresponding author: Vesna Cukic, MD, PhD. Bjelave 99, 71000 Sarajevo, Bosnia and Herzegovina. Phone: 00387 61 480-228, E-mail: [email protected]. ABSTRACT Introduction: Malignant diseases including lung cancer are the risk for development of pulmonary thromboembolism (PTE). Objective: To show the number of PTE in patients with lung cancer treated in Clinic for pulmonary diseases and TB “Podhrastovi” in three-year period: from 2012-2014. Material and methods: This is the retrospective study in which we present the number of various types of lung cancer treated in three-year period, number and per cent of PTE in different types of lung carcinoma, number and per cent of PTE of all diagnosed PTE in lung carcinoma according to the type of carcinoma. Results: In three-year period (from 2012 to 2014) 1609 patients with lung cancer were treated in Clinic for pulmonary diseases and TB “ Podhrastovi” Clinical Centre of Sarajevo University. 42 patients: 25 men middle –aged 64.4 years and 17 women middle- aged 66.7 or 2.61% of all patients with lung cancer had diagnosed PTE. That was the 16. 7% of all patients with PTE treated in Clinic “Podhrastovi “in that three-year period. Of all 42 patients with lung cancer and diagnosed PTE 3 patients (7.14%) had planocellular cancer , 4 patients (9.53%) had squamocellular cancer, 9 (21.43%) had adenocarcinoma, 1 (2.38%) had NSCLC , 3 ( 7.14 %) had microcellular cancer, 1 ( 2.38%) had neuroendocrine cancer, 2 (4.76%) had large cell-macrocellular and 19 (45.24%) had histological non-differentiated lung carcinoma. Conclusion: Malignant diseases, including lung cancer, are the risk factor for development of PTE. It is important to consider the including anticoagulant prophylaxis in these patients and so to slow down the course of diseases in these patients. Key words: lung cancer, pulmonary thromboembolism.
1. INTRODUCTION Variable risk and etiologic factors have been demonstrated to play a role in the development of PTE (1-4). Cancer is one of the important risk factors for PTE ; in cancer patients PTE occurs 2-4 times more frequently than in patients without cancer (4, 5).Several mechanisms may contribute to the development of PTE in cancer patients (6) such as immobilization, surgery , down-regulation of anticoagulants, and up-regulation of pro- coagulant proteins (7, 8), endothelial damage caused by chemotherapy or stimulation of endothelial cells to produce procoagulant materials (9), inflammation due to necrosis or release of acute –phase reactants and hemodynamic disorders such as stasis (10). Lung cancer is the most common malignancy coexisting in patients with PTE (11). Mechanisms and risk factors for lung cancer patients for developing PTE are unclear (3). It is believed that use of specific chemotherapeutic drugs in combination with novel target drugs such as antiangiogenic agents and elevated pre- chemotherapy platelet counts can cause PTE (3). Also tissue factor (TF) the initiator of the clotting cascade may be over expressed in lung carcinoma cells (3) Active TF-
bearing micro particles which may originate from tumor cells have been found in the circulation of cancer patients and may provide a link between cancer and thrombosis (3). Some authors emphasized those risk factors for development of PTE in lung cancer patients: adenocarcinoma, metastatic disease, pneumectomy, chemotherapy especially anti-VEGF target drugs, high serum hemoglobin (1-3).
Mater Sociomed. 2015 Oct; 27(5): 351-353 • PROFESSIONAL PAPER
351
2. OBJECTIVE To show the number of PTE in patients with lung cancer treated in Clinic for pulmonary diseases and TB “Podhrastovi” in three-year period: from 2012-2014 year according to the histological type of lung cancer. 3. MATERIAL AND METHODS This is the retrospective study in which we present the number of various types of lung cancer treated in three-year period, number and per cent of PTE in different types of lung carcinoma, number and per cent of PTE of all diagnosed PTE in lung cancer according to the histological type of carcinoma.
Lung Cancer and Pulmonary Thromboembolism carcinoma, number and per cent of PTE of all diagnosed PTE in lung cancer according to the histological type of carcinoma.
4. RESULTS Of 1609 lung cancer patients there were 17.4% planocellular In three-year period (from 2012 to 2014) 1609 patients carcinoma , 15.35% squamocellular carcinoma , 25.05% adeno4. RESULTS with lung cancer were treated in Clinic for pulmonary diseases carcinoma ,5.34% NSCLC (non-small cellular lung carcinoma), In three-year period (from 2012. to 2014.year) 1609 patients with lung cancer were and TB “ Podhrastovi” Clinical centre of Sarajevo University 13.80% microcellular carcinoma, 0.44% mesothelioma, 1.86% treated in Clinic for pulmonary diseases and TB “ Podhrastovi” Clinical centre of . 42 patients: 25 men middle –aged 64.4 years and 17 women neuroendocrine carcinoma, 0.93% large cell-macrocellular Sarajevo University . 42 patients: 25 men middle –aged 64.4 years and 17 women middle- aged 66.7 or 2.61% had diagnosed PTE. That was the carcinoma , 0.12% anaplastic carcinoma, 0.50% pleomorfic middle- aged 66.7 or 2.61% had diagnosed PTE. That was the 16. 7% of all patients 16. 7% of all patients with PTE treated in Clinic “Podhrastovi carcinoma, 0.44% mediastinal carcinoma, 0.50% characinoid , with PTE treated in Clinic “Podhrastovi “in that three-year period. “in that three-year period. PTE developed in all patients within 17.65% non-differentiated histological type of lung carcinoma PTE developed in all patients within one year of the diagnosis of lung cancer. Of all 42 one year of the diagnosis of lung cancer. Of all 42 patients with and , 0.62% pulmonary lymphangitis carcinomatosa because or patients with lungand cancer and2PTE 2 patients were IIB, 5 5patients werewere in IIIA, lung cancer PTE patients were ininIIB, patients in 15 earlier breast carcinoma. patients in IIIB and 20 patients were in IV stage of lung cancer when PTE was diagnosed. IIIA, 15 patients in IIIB and 20 patients were in IV stage of lung Number and per cent of patients with PTE in all patients with different type of lung cancer All patientswhen with lung cancer PTE received chemotherapy according the protocol cancer PTE wasand diagnosed. All patients with lungtocancer for thatPTE type ofreceived lung cancer and no one of them had been previously surgically treated. 19 20 and chemotherapy according to the protocol for 18 that type of lung cancer and no one of them had been previously Results are shown on Figures 1, 2, 3, 4. 16 surgically treated. 13.33 14 Figure 1. Number of patients... 12 Results are shown on Figures 1, 2, 3, 4. number 450
6.69
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Figure 3. Number and per cent of patients with PTE in all patients with different
3 patients with planocellular carcinoma or 1.07% allof 3 patients with planocellulare carcinoma or 1.07% of all patients with thatoftype
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patients with, 4that type cancer hadcarcinoma PTE , 4orpatients with cancer had PTE patients withofsquamocellular 1.62% had PTE, 9
squamocellular carcinoma or 1.62% had1 PTE, 9 patients patients with adenocarcinoma or 2.23% had PTE, patient with NSCLC with (non-small
adenocarcinoma had PTE, 1 patient with NSCLC cellular lung carcinoma) oror2.23% 1.16% had PTE, 3 patients with microcellular carcinoma or
Figure 1. Number of patients with different type of lung cancer treated in Clinic. Legend. 1=planocellulare small cellular lung carcinoma), 5=microcellular carcinoma , 6=mesothelioma,carcinoma, 7=neuroendocrine patients with microcellular carcinoma or 1.35% had PTE , 1 carcinoma,8= large cell-macrocellular carcinoma , 9=anaplastic carcinoma , 10=pleomorfic 2=squamocellular carcinoma, 3=adenocarcinoma, 4=NSCLCcarcinoma,patients with large cell-macrocellular carcinoma or 13. 33% had PTE , 19 patients patient with neuroendocrine carcinoma or 3.33% had PTE, (non-small cellular lung carcinoma), 5=microcellular carcinoma with non-differentiated histological type of lung carcinoma or 6,69% of all patients 23 patients with large cell-macrocellular carcinoma or 13. 33% , 6=mesothelioma, 7=neuroendocrine carcinoma,8= large with that type of cancer had PTE . had PTE , 19 patients with non-differentiated histological type cell-macrocellular carcinoma , 9=anaplastic carcinoma Figure 4. Number and percent... , 10=pleomorfi c carcinoma, 11=mediastinal carcinoma,histological typeofoflung 11=mediastinal carcinoma, 12=characinoid, 13=non-differentiated lung carcinoma, carcinoma or 6,69% of all patients with that type of 12=characinoid, 13=non-differentiated histological type of lung 14=lymphangitis carcinomatosa cancer had PTE . carcinoma, 14=lymphangitis carcinomatosa
(non-small carcinoma) or 1.16%orhad PTE, 3 2 Legend. 1=planocellulare carcinoma, 2=squamocellular carcinoma, 3=adenocarcinoma, 4=NSCLC (non 1.35% had PTE , cellular 1 patient lung with neuroendocrine carcinoma 3.33% had PTE,
Number and per cent of all 42 diagnosed PTE according to the type of lung Of 1609 lung cancer patients there were 280 planocellulare carcinoma, 247 cancer Of 1609 lung cancer patients there were 280 planocellular squamocellular carcinoma , 403 adenocarcinoma , 86 NSCLC (non-small cellular lung carcinoma, 247 squamocellular carcinoma , 403 adenocarci50 45.24 carcinoma), 222 microcellular carcinoma , 7 mesothelioma, 3045 neuroendocrine noma , 86 NSCLC (non-small cellular lung carcinoma), 222 carcinoma , 15 large cell-macrocellular carcinoma , 2 anaplastic carcinoma, 8 40 microcellular carcinoma , 7 mesothelioma, 30 neuroendocrine 35 pleomorfic carcinoma, 7 mediastinal carcinoma, 8 characinoid , 284 noncarcinoma , 15 large cell-macrocellular carcinoma , 2 anaplastic 30 differentiated histological type of lung carcinoma , 10 pulmonary lymphangitis carcinoma, 8 pleomorfic carcinoma, 7 mediastinal carcinoma, 25 21.43 19 carcinomatosa because or earlier breast carcinoma. 20 8 characinoid , 284 non-differentiated histological type of lung
carcinoma lymphangitis carcinomatosa because Figure 2. Type, 10 of pulmonary lung... or earlier breast carcinoma.
15 10
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Figure 4. Number and per cent of all 42 diagnosed PTE
Of all 42 patients lung cancer and diagnosed PTE according to with the type of lung
3 patients (7.14%) had
planocellular carcinoma , 4 patients (9.53%) had squamocellular carcinoma, 9 (21.43%)
Of all 42 patients with lung cancer and diagnosed PTE 3 patients (7.14%) had planocellular carcinoma , 4 patients (9.53%) ( 2.38%) had neuroendocrine carcinoma, 2 (4,76%) had large cell-macrocellular had squamocellular carcinoma, 9 (21.43%) had adenocarcicarcinoma and 19 (45,24%) had non-differentiated lung carcinoma. noma, 1 (2.38%) had NSCLC , 3 ( 7,14 %) had microcellular carcinoma, 1 ( 2.38%) had neuroendocrine carcinoma, 2 (4,76%) 5.DISCUSSION hadoften large cell-macrocellular andoccurs 19 (45,24%) hadovarian, PTE occur in malignant diseases carcinoma . Especially PTE in patients with non-diff erentiated lung carcinoma. brain and pancreatic carcionoma when adjusted for prevalence of these tumors (11). A had adenocarcinoma, 1 (2.38%) had NSCLC , 3 ( 7,14 %) had microcellular carcinoma, 1
case controlled study ( 13) recently showed that patients with hematologic malignances
5. DISCUSSION
had the highest risk for PTE ,folowed by patients with lung and gastrointestinal cancers. Figure 2. Type of lung carcinoma treated in Clinic Podhrastovi in PTEin oft en occur in malignant diseases . Especially PTE PTE Advances tomography (CT) enhanced the detection of unsuspected Of three-year 1609 lung period cancerexpressed patients asthere wereof all17.4% carcinoma , computed 15.35% per cent patientsplanocellulare with lung occurs in patients with ovarian, brain and pancreatic carcicarcinoma carcinoma , 25.05% adenocarcinoma ,5.34% NSCLC(14-16).Despite these facts, the clinical features and prognosis of patients with lung squamocellular (non-small allcellular
cancer and PTE have rarely been reported (6). In some studies that dealt with these issue lung carcinoma), 13.80% microcellular carcinoma, 0.44% mesothelioma, 1.86% PROFESSIONAL PAPERwas • Mater Sociomed. Oct; 27(5): 351-353 (1-3, 6, 9) adenocarcionoma the most common2015 histological type and most patients 352 neuroendocrine carcinoma, 0.93% large cell-macrocellular carcinoma , 0.12% had advancedcarcinoma, stage disease (IIIB/IV). In our study the most common histological type of anaplastic carcinoma, 0.50% pleomorfic carcinoma, 0.44% mediastinal
Lung Cancer and Pulmonary Thromboembolism
onoma when adjusted for prevalence of these tumors (11). A case controlled study ( 13) recently showed that patients with hematologic malignances had the highest risk for PTE ,followed by patients with lung and gastrointestinal cancers. Advances in computed tomography (CT) enhanced the detection of unsuspected PTE (14, 15, 16).Despite all these facts, the clinical features and prognosis of patients with lung cancer and PTE have rarely been reported (6). In some studies that dealt with these issue (1, 2, 3, 6, 9) adenocarcinoma was the most common histological type and most patients had advanced stage disease (IIIB/IV). In our study the most common histological type of lung cancer with PTE was non –differentiated histological type of lung cancer- 19 patients or 45, 24%. It was may be because these patients came to hospital with so advanced disease that they could not be subjected to bronchoscopy because of bad clinical condition and other comorbidities such as cardiologic diseases, advanced stage of COPD, heart failure or respiratory insufficiency etc. but the diagnosis was established by radiological methods such as computed tomography(CT) or MRI ; or material obtained by bronchoscopy was full of necrosis so it was impossible for pathologist to give accurate type of malignant cells . Most of our patients were in advanced stage of diseases (IIIB or IV stage) such as was in the other studies (1- 3). In one study (2) authors show that incidence of PTE in patients with lung cancer is 40-100 cases in 1000 patients vs. 1-2 cases in general population. In our study 2.61% of patients with lung cancer had diagnosed PTE which presents about 26 cases of PTE in 1000 patients with lung cancer. We supposed that number would be greater if we had done CT in patients with unsuspected PTE. Their bad clinical condition we ascribed to their basic illness and its progression. In few studies (1-3) authors found that PTE develops within 12 months of the diagnosis of lung cancer that we confirmed in our study. Patients with lung cancer and PTE present 16. 7% of all patients with PTE treated in Clinic “Podhrastovi “in studied three-year period (2012.2014.). In one study (1) median survival from the diagnosis of PTE in patients with lung cancer was 3, 5 months but authors did not find the difference with a group of patients with lung cancer without PTE. In both groups the most common cause of death was lung cancer progression (76, 9%-80, 3%) or chemotherapy –related septic shock (16, 7,% - 19, 2%) (1). In our study we did not compare median survival between patients with lung cancer with and without PTE.
and so to slow down the course of diseases in these patients.
6. CONCLUSION Malignant diseases, including lung cancer, are the great risk factor for development of PTE. PTE is one of the various complications of lung cancer that may suggest being the factor which accelerate the bad course of that illness. It is important to consider the including anticoagulant prophylaxis in these patients
15.
Mater Sociomed. 2015 Oct; 27(5): 351-353 • PROFESSIONAL PAPER
CONFLICT OF INTEREST: NONE DECLARED.
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