Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.002117
Jornal Vascular Brasileiro
Original Article

Prevalência de tromboembolismo pulmonar incidental em pacientes oncológicos: análise retrospectiva em grande centro

Prevalence of incidental pulmonary thromboembolism in cancer patients: retrospective analysis at a large center

Renata Mota Carneiro, Bonno van Bellen, Pablo Rydz Pinheiro Santana, Antônio Carlos Portugal Gomes

Downloads: 1
Views: 1210

Resumo

Resumo Contexto: Devido à maior aplicação de exames de imagem rotineiros, especialmente nos pacientes com neoplasia para controle da doença, vem aumentando o diagnóstico de tromboembolismo pulmonar (TEP) incidental, importante fator de morbimortalidade associado. Objetivo: Identificar os casos de TEP incidental em pacientes oncológicos submetidos a tomografia computadorizada (TC) de tórax, correlacionando aspectos clínicos e fatores de risco associados. Métodos: Estudo retrospectivo de todos os episódios de TEP ocorridos de janeiro de 2013 a junho de 2016, com seleção dos pacientes oncológicos e divisão deles em dois grupos: com suspeita clínica e sem suspeita clínica (incidentais) de embolia pulmonar. Resultados: Foram avaliados 468 pacientes com TEP no período citado. Destes, 23,1% eram oncológicos, entre os quais 44,4% apresentaram achado incidental de embolia pulmonar na TC de tórax. Não houve diferença estatística entre os grupos para sexo, idade e tabagismo. Quanto à procedência, 58,3% dos pacientes sem suspeita clínica eram de origem ambulatorial e 41,7% com suspeita de TEP vinham do pronto-socorro (p < 0,001). As neoplasias mais prevalentes foram de pulmão (17,6%), intestino (15,7%) e mama (13,0%). Aqueles com achado incidental apresentaram significativamente mais metástases, sem diferença entre os grupos para realização de quimioterapia, radioterapia ou cirurgia recente. Quanto aos sintomas apresentados, 41,9% daqueles sem suspeita clínica tinham queixas sugestivas de TEP quando realizaram o exame. Conclusão: TEP incidental é frequente em pacientes oncológicos, especialmente naqueles provenientes de seguimento ambulatorial e em estágios avançados da doença. Sintomas sugestivos de TEP estavam presentes em pacientes sem suspeita clínica ao realizarem a TC de tórax.

Palavras-chave

tromboembolismo pulmonar; câncer; incidental.

Abstract

Background: Increased use of routine imaging exams has led to higher rates of incidental diagnosis of pulmonary thromboembolism (PTE), especially for management of disease in cancer patients, among whom it is an important factor in associated morbidity and mortality. Objective: To identify cases of incidental PTE in cancer patients examined with computed tomography (CT) of the thorax, correlating clinical features and associated risk factors. Methods: This is a retrospective study of all episodes of PTE diagnosed between January 2013 and June 2016, selecting cases involving cancer patients and dividing them into two subsets: those with clinical suspicion and those without clinical suspicion of pulmonary embolism (incidental cases). Results: At total of 468 patients had PTE during the period investigated and 23.1% of them were cancer patients, 44.4% of whom exhibited pulmonary embolism as an incidental finding of a chest CT. There was no statistical difference between the two subsets in terms of sex, age, or smoking. In terms of patients’ admission status, 58.3% of the patients without clinical suspicion were outpatients and 41.7% of those with suspicion of PTE were admitted via the emergency room (p < 0.001). The most common cancer sites were lung (17.6%), intestine (15.7%), and breast (13.0%). Patients whose PTE were diagnosed incidentally exhibited a significantly greater rate of metastases, while there were no differences between the groups in terms of chemotherapy, radiotherapy, or recent surgery. Analysis of symptoms revealed that 41.9% of patients without clinical suspicion had complaints suggestive of PTE when they underwent the CT examination. Conclusions: Incidental PTE is common among cancer patients, especially those in outpatients follow-up and in advanced stages of the disease. Patients without clinical suspicion also had symptoms suggestive of PTE when they presented for chest CT.

Keywords

pulmonary thromboembolism; cancer; incidental.

References

1. White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(23, Suppl 1):4-8. PMid:12814979.

2. Anderson FA Jr, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and casefatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT study. Arch Intern Med. 1991;151(5):933-8. PMid:2025141. http://dx.doi.org/10.1001/archinte.1991.00400050081016.

3. Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998;158(6):585-93. PMid:9521222. http://dx.doi.org/10.1001/archinte.158.6.585.

4. Yoo HH, Mendes FG, Alem CE, Fabro AT, Corrente JE, Queluz TT. Clinicopathological findings in pulmonary thromboembolism: a 24-year autopsy study. J Bras Pneumol. 2004;30(5):426-32.

5. Menna-Barreto S, Cerski MR, Gazzana MB, Stefani SD, Rossi R. Tromboembolia pulmonar em necropsias no Hospital de Clínicas de Porto Alegre, 1985-1995. J Bras Pneumol. 1997;23(3):131-6.

6. Amary J, Coli DF Jr, Pereira M, Bailone S. Embolismo pulmonar - levantamento em 13500 necrópsias. Arq Hosp Santa Casa S Paulo. 1974;20:143-7.

7. Maffei FH, Faleiros AT, Venezian CA, Franco MF. Contribuição ao estudo da incidência e anatomia patológica do tromboembolismo pulmonar em autópsias. Rev Assoc Med Bras. 1980;26:7-9.

8. Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Arch Intern Med. 2003;163(14):1711-7. PMid:12885687. http://dx.doi.org/10.1001/archinte.163.14.1711.

9. Gillum RF. Pulmonary embolism and thrombophlebitis in the United States, 1970-1985. Am Heart J. 1987;114(5):1262-4. PMid:3673898. http://dx.doi.org/10.1016/0002-8703(87)90212-2.

10. Darze ES, Casqueiro JB, Ciuffo LA, Santos JM, Magalhães IR, Latado AL. Mortalidade por embolia pulmonar no Brasil entre 1989 e 2010: disparidades regionais e por gênero. Arq Bras Cardiol [revista eletrônica]. 2016 Jan [citado 2017 Abr 4];106(1):4-12. http://dx.doi.org/10.5935/abc.20160001.

11. Karwinski B, Svendsen E. Comparison of clinical and postmortem diagnosis of pulmonary embolism. J Clin Pathol. 1989;42(2):135-39. PMid:2921354. http://dx.doi.org/10.1136/jcp.42.2.135.

12. Giuntini C, Ricco G, Marini C, Melillo E, Palla A. Pulmonary embolism: epidemiology. Chest. 1995;107(1):3-9. http://dx.doi.org/10.1378/chest.107.1_Supplement.3S.

13. Alem CE, Fabro AT, Corrente JE, Queluz TT. Clinicopathological findings in pulmonary thromboembolism: a 24-year autopsy study. J Bras Pneumol. 2004;30(5):426-32.

14. Reibscheid SM. Tromboembolia pulmonar: incidência, etiopatogenia e fisiopatologia. In: Maffei FH, Yoshida WB, Moura R. et al. Doenças vasculares periféricas. vol. 2. Rio de Janeiro: Guanabara Koogan S/A; 2016. p. 1862.

15. Faiz AS, Khan I, Beckman MG, et al. Characteristics and risk factors of cancer associated venous thromboembolism. Thromb Res. 2015;136(3):535-41. PMid:26168693. http://dx.doi.org/10.1016/j.thromres.2015.06.036.

16. Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood. 2013;122(10):1712-23. PMid:23908465. http://dx.doi.org/10.1182/blood-2013-04-460121.

17. Meis E, Levy RA. Câncer e trombose: uma revisão da literatura. Ver Bras Cancerol. 2007;53(2):183-93.

18. Exter PL den, Kroft LJM, Hulle T van der, Klok FA, Jimenez D, Huisman MV. Embolic burden of incidental pulmonary embolism diagnosed on routinely performed contrast-enhanced computed tomography imaging in cancer patients. J Thromb Haemost. 2013;11(8):1620-2. PMid:23782874. http://dx.doi.org/10.1111/jth.12325.

19. Sociedade Brasileira de Cardiologia. Diretriz de embolia pulmonar. Arq Bras Cardiol. 2004;83(suppl 1):1-8.

20. Trujillo-Santos J, Monreal M. Management of unsuspected pulmonary embolism in cancer patients. Expert Rev Hematol. 2013;6(1):83-89. PMid:23373783. http://dx.doi.org/10.1586/ehm.12.72.

21. Fuentes HE, Tafur AJ, Caprini JA. Cancer-associated thrombosis. Dis Mon. 2016;62(5):121-58. PMid:27037224. http://dx.doi.org/10.1016/j.disamonth.2016.03.003.

22. Font C, Carmona-Bayonas A, Fernandez-Martinez A, Mellado B, Tuca A, Gascon P. Tromboembolismo pulmonar (TEP) incidental vs sintomático en pacientes con cáncer [slides]. Salamanca: SEOM; 2013 [citado 2017 Abr 4]. http://www.seom.org/seomcms/ images/stories/recursos/ponencias/2013/viernes/3_1_Incidental_SEOM_2013.pdf.

23. Silva P, Rosales M, Milheiro MJ, Santos LL. Pulmonary embolism in ambulatory oncologic patients. Acta Med Port. 2015;28(4):463-8. PMid:26574981. http://dx.doi.org/10.20344/amp.5872.

24. Exter PL den, Hooijer J, Dekkers OM, Huisman MV. Risk of recurrent venous thromboembolism and mortality in patients with cancer incidentally diagnosed with pulmonary embolism: a comparison with symptomatic patients. J Clin Oncol. 2011;29(17):2405-9. PMid:21555690. http://dx.doi.org/10.1200/JCO.2010.34.0984.

25. Font C, Farrus B, Vidal L, et al. Incidental versus symptomatic venous thrombosis in cancer: a prospective observational study of 340 consecutive patients. Ann Oncol. 2011;22(9):2101-6. PMid:21325446. http://dx.doi.org/10.1093/annonc/mdq720.

26. Ashrani AA, Gullerud RE, Petterson TM, Marks RS, Bailey KR, Heit JA. Risk factors for incident venous thromboembolism in active cancer patients: a population based case–control study. Thromb Res. 2016;139:29-37. PMid:26916293. http://dx.doi.org/10.1016/j.thromres.2016.01.002.

27. Lyman GH, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology Clinical practice guideline update. J Clin Oncol. 2013;31(17):2189-204. PMid:23669224. http://dx.doi.org/10.1200/JCO.2013.49.1118.

28. Petterson TM, Marks RS, Ashrani AA, Bailey KR, Heit JA. Risk of site-specific cancer in incident venous thromboembolism: a population-based study. Thromb Res. 2015;135(3):472-8. PMid:25547213. http://dx.doi.org/10.1016/j.thromres.2014.12.013.

29. Nisio MD, Lee AYY, Carrier M, Liebman HA, Khorana AA. Diagnosis and treatment of incidental venous thromboembolism in cancer patients: guidance from the SSC of the ISTH. J Thromb Haemost. 2015;13(5):880-3. PMid:25714858. http://dx.doi.org/10.1111/jth.12883.

30. D’izarn MH, Prim AC, Planquette B, et al. Risk factors and clinical outcome of unsuspected pulmonary embolism in cancer patients: a case-control study. J Thromb Haemost. 2012;10(10):2032-8. PMid:22845852. http://dx.doi.org/10.1111/j.1538-7836.2012.04868.x.

31. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest Journal. 2012;141(2 Suppl):e419s-e496s. PMid:22315268. http://dx.doi.org/10.1378/chest.11-2301.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5cd323a00e8825e333632f8f jvb Articles

J Vasc Bras

Share this page
Page Sections