Incidence and risk factors of VTE in lung cancer: a meta-analysis

Lung cancer has maintained a high prevalence and mortality. Besides, venous thromboembolism (VTE) is the third most common disease of cardiovascular disease. Lung cancer with VTE usually influenced the overall survival in the follow-up. In the development of lung cancer, vigilance against and early diagnosis of VTE is of significance. We searched the databases of PubMed, Web of Science, Embase and Cochrane for related research up to 30 November 2023 and extracted information of incidence, odds ratio (OR), hazard ratio (HR) and their 95% confidence intervals (CIs), for evaluating the incidence of VTE and its risk factors. A total of 54 articles and 873,292 records were included in our study. The pooled incidences of VTE and PE were 6% and 3%, respectively. Subgroup analysis revealed that the tumour, node and metastasis (TNM) stage (HR= 5.43, 95% CI: 2.42, 12.22), metastasis (HR= 2.67, 95% CI: 1.35, 5.29) and chemotherapy (HR= 2.27, 95% CI: 1.11, 4.65) had major influence on VTE occurrence. Lung cancer complicated with VTE is unignorable, and its occurrence varies widely by tumour staging, tissue type and treatment. The results may aid in clinical decision-making about lung cancer in higher risk with VTE and weather receiving anticoagulant prophylaxis. The pooled incidences of VTE and PE were 6% and 3% in lung cancer. LUAD, NSCLC and tumour stage III-IV have significant relevant with VTE in lung cancer.

肺癌始终保持较高的患病率与病死率。此外，静脉血栓栓塞症（venous thromboembolism, VTE）是第三大常见心血管疾病。合并VTE的肺癌患者通常会影响其随访期间的总生存期。在肺癌诊疗过程中，对VTE保持警惕并实施早期诊断具有重要临床意义。本研究检索了PubMed、Web of Science、Embase及Cochrane数据库截至2023年11月30日的相关研究，提取了发病率、比值比（odds ratio, OR）、风险比（hazard ratio, HR）及其95%置信区间（confidence intervals, CI）等相关信息，以评估肺癌患者中VTE的发病率及其危险因素。本研究最终纳入54篇文献，共计873292条研究记录。经合并分析，肺癌患者中VTE与肺栓塞（pulmonary embolism, PE）的总体发生率分别为6%和3%。亚组分析结果显示，肿瘤-淋巴结-转移（TNM）分期（HR=5.43，95%CI：2.42~12.22）、远处转移（HR=2.67，95%CI：1.35~5.29）以及化疗（HR=2.27，95%CI：1.11~4.65）对VTE的发生具有显著影响。肺癌合并VTE的临床情况不容忽视，其发生率随肿瘤分期、组织学类型及治疗方案的不同存在显著异质性。本研究结果可为临床针对高VTE风险肺癌患者制定诊疗决策，以及判断是否需接受抗凝预防治疗提供参考依据。经合并分析，肺癌患者中VTE与PE的总体发生率分别为6%和3%；肺腺癌（LUAD）、非小细胞肺癌（NSCLC）以及III~IV期肿瘤与肺癌患者VTE的发生存在显著相关性。