Page 79 - GTM-2-3

Global Translational Medicine Thromboembolism risk in non-small-cell lung cancer

a higher rate in the exon 21 group. EGFR mutations were the time of diagnosis, with a platelet count exceeding
identified in 40 – 50% of Asian patients and 10%–15% of 330,000, correlating with major thromboembolic events.
Caucasian patients . Consistent with the literature, our On the contrary, Demirci et al. did not find a significant
[30]
[41]
study reported an EGFR mutation rate of 33.5%. correlation between vascular events and thrombocytosis in
[42]
Furthermore, a meta-analysis of various studies their study of lung cancer patients. Pedersen and Milman
confirmed that ALK rearrangements are associated with a analyzed platelet count data from a large primary lung cancer
higher risk of VTE in NSCLC patients, irrespective of the population (1178 patients) and observed a high prevalence
treatment effects . In contrast, Lee et al. did not find a of high platelet counts (32%) among these patients. They
[31]
correlation between ALK or EGFR mutations and VTE risk found that the rate of thromboembolism in patients with
in Asian patients with NSCLC. However, they did identify normal platelet counts was statistically similar to the rate
a correlation between molecular mutations and clinically in patients with thrombocytosis. Consequently, these
diagnosed, although not computed, thorax pulmonary authors suggested that thrombocytosis in cancer patients
angiography-confirmed PE . Dou F et al. reported a should not be considered a predisposing risk factor for
[32]
[43]
correlation between the increased risk of VTE in NSCLC thromboembolism . In addition, various experts have
patients and the presence of ALK gene mutations . found that D-dimer levels can predict DVT in cancer
[13]
[43]
Several previous studies on VTE rates of NSCLC with patients . Shiina et al. discovered a high frequency of
[44]
ALK rearrangements either did not report any VTE cases vascular invasion in the high D-dimer group . In our
or reported them in less than 5% of the patients [33,34] . Our study, we investigated the relationship between laboratory
study did not find a correlation between the presence of parameters and VTE and found that only a high D-dimer
ALK gene mutations and VTE, which may be attributed level was identified as a predisposing factor for VTE.
to the difficulty in determining actual VTE rates due to We acknowledge several limitations in our study. First, it
underreporting . is a retrospective and single-center study, which may affect
[35]
In cancer patients, several factors contribute to an the generalizability. Second, patients with PE, which was
increased risk of thrombosis, such as gender, age, venous detected using computed tomography angiography (CTA)
catheter use, prolonged bed rest, chemotherapy with or or ventilation-perfusion scintigraphy, were excluded from
without adjuvant hormone therapy, surgical interventions, this study. However, most distal peripheral subsegmental
infections, and radiotherapy. VTE rates among cancer embolisms may not be detectable by CTA alone. To obtain
patients vary according to clinical factors, with tumor more accurate PE rates, simultaneous review of CTA and
histopathological type and stage being the most significant ventilation-perfusion scans should be performed in future
determinants. prospective studies that larger prospective cohorts are
Alexander et al. conducted a study that revealed a needed for further research.
higher risk of thromboembolism in patients diagnosed 5. Conclusion
with LA compared to squamous cell carcinoma . In our
[36]
study, all patients had adenocarcinoma, and the risk of Our study revealed a VTE prevalence of 19.4% in mutation-
VTE was consistent with the literature, at 15.7%. positive advanced-stage LA patients who did not receive
prophylactic anticoagulant therapy. It was concluded that
Studies have demonstrated an increased risk of VTE in EGFR exon 21 mutation is an independent risk factor for
[5]
older patients with lung cancer or other cancers . Chew VTE in LA.
et al. found that patients under the age of 45 had a higher
risk of developing VTE within 1 year after an NSCLC Based on our findings, health-care providers should
diagnosis . Interestingly, Chew et al. also reported a remain vigilant about VTE development in patients with
[37]
higher risk of VTE in elderly patients . The association EGFR exon 21 mutation-positive LA. This highlights
[37]
between age and the occurrence of VTE in lung cancer the importance of screening, prophylaxis, and regular
remains a topic of debate, and further, research is needed follow-up to detect and manage underlying VTE in this
to clarify this relationship. patient population.

Laboratory parameters such as low hemoglobin level, Acknowledgments
leukocytosis, elevated platelet count, and increased C-reactive
protein levels have been associated with an increased None.
risk of cancer-related thrombosis in lung cancer [29,38,39] .
Kadlec et al. observed that lung cancer patients with Funding
[40]
thromboembolic events had elevated platelet counts at None.

Volume 2 Issue 3 (2023) 6 https://doi.org/10.36922/gtm.1027