Clinical Features And Risk Factors Of Pulmonary Adenocarcinoma Complicated With Pulmonary Embolism

Objective(s):Pulmonary embolism is one of the most dangerous complications in lung cancer patients.The purpose of this study is to provide reference for clinical diagnosis and treatment by analyzing the clinical characteristics and related risk factors of patients with pulmonary adenocarcinoma complicated with pulmonaryembolism Method:By retrospective analysis,clinical data of patients with pulmonary adenocarcinoma admitted to the Second Affiliated Hospital of Kunming Medical University from January 2016 to July 2022 were collected and divided into two groups according to the exclusion criteria.Group 1 was the group of pulmonary adenocarcinoma complicated with pulmonary embolism: a total of 50 patients with pulmonary adenocarcinoma were enrolled and diagnosed with pulmonary embolism after clinical evaluation and 256 rows of CTPA.The two groups were adenocarcinoma exclusive pulmonary embolism group(lung adenocarcinoma group):78 patients with lung adenocarcinoma were enrolled,and 256 rows of CTPA exclusive pulmonary embolism were used as control group after clinical evaluation.SPSS 26.0software was used for data analysis and comparison between the two groups of patients.Results:1.General information: lung adenocarcinoma combined with pulmonary embolism group: 31 male patients(62%),19 female patients(38%),the average age is64.30±10.07 years.Lung adenocarcinoma xenophobic pulmonary embolism group(lung adenocarcinoma group): 36 males(46%),42 females(54%),the average age was 61.22±11.13 years.Statistical analysis showed that there were no significant differences in gender,age and smoking history between the two groups(P>0.05).2.Stage : The proportion of stage Ⅲ/Ⅳ in the group with pulmonary embolism was higher than that in the group with pulmonary adenocarcinoma(P < 0.05).3.Symptoms: The incidence of hemoptysis(20% vs 6%)in the pulmonary adenocarcinoma group was higher than that in the pulmonary adenocarcinoma group(P < 0.05),and the incidence of chest pain(12% vs 32%)and asymptomatic(6% vs21%)was lower than that in the pulmonary adenocarcinoma group(P < 0.05).There were no statistical differences in dyspnea,cough,fever and triad between the two groups(P > 0.05).4.Combined with underlying diseases and complications: the rates of COPD(18%vs 4%),diabetes(22% vs 9%)and pleural effusion(76% vs 45%)in the pulmonary adenocarcinoma group were higher than those in the pulmonary adenocarcinoma group(P < 0.05).There was no statistical difference in the combination of hypertension and coronary heart disease between the two groups(P >0.05).5.Laboratory indexes: The WBC,NEUT,LDH,IL-6,PT,INR,D-dimer and CEA of the pulmonary adenocarcinoma group were higher than those of the pulmonary adenocarcinoma group(P < 0.05),and the ALB was lower than that of the pulmonary adenocarcinoma group(P < 0.05).There were no statistical differences between 2 groups in other laboratory indicators(RBC,PLT,HGB,LYMPH,ALT,AST,APTT,FIB,TT and AT)(P > 0.05).6.Embolization location,risk stratification and time to diagnosis: In the group of patients with pulmonary adenocarcinoma complicated with pulmonary embolism,30 patients(60%)had stage pulmonary embolism.In the group of patients with pulmonary adenocarcinoma complicated with pulmonary embolism,25(50%)were in the low-risk group,24(48%)were in the medium-low risk group,1(2%)was in the medium-high risk group,and 0(0%)were in the high-risk group.36 patients(72%)were diagnosed with pulmonary adenocarcinoma and pulmonary embolism,5 patients(10%)were diagnosed with pulmonary embolism 0-3 months after the diagnosis of pulmonary adenocarcinoma,1 patient(2%)was diagnosed with pulmonary embolism3-6 months after the diagnosis of pulmonary adenocarcinoma,and 1 patient(2%)was diagnosed with pulmonary embolism 6-12 months after the diagnosis of pulmonary adenocarcinoma.Pulmonary embolism was found more than 12 months after diagnosis of lung adenocarcinoma in 7 patients(14%).7.Treatment: The proportion of surgical treatment(14% vs 3%)in the pulmonary adenocarcinoma group with pulmonary embolism was higher than that in the pulmonary adenocarcinoma group(P < 0.05),and there was no statistical difference between chemotherapy(12% vs 3%)and targeted therapy(8% vs 3%)(P >0.05).A total of 40 patients(80%)with lung adenocarcinoma complicated with pulmonary embolism received anticoagulation with low molecular weight heparin,while 10 patients(20%)did not receive treatment.All patients were discharged after stable condition.8.Logistic regression analysis of the risk factors of pulmonary adenocarcinoma complicated with pulmonary embolism results: COPD,diabetes mellitus,ALB,LDH,IL-6,INR,D-dimer,CEA and surgical treatment were substituted to indicate D-dimer≥ 1.205ug/ml(OR=6.11,95%CI: 2.073-18.029,P=0.001),CEA ≥ 9.53ng/ml(OR=5.94,95%CI: 1.896-18.623,P=0.002),and surgery(OR=13.79,95%CI:1.781-107.887,P=0.012)was an independent risk factor for pulmonary adenocarcinoma complicated with pulmonary embolism.9.ROC receiver operating curve shows: The critical values of ALB,LDH,IL-6,INR,D-dimer and CEA were 40.4g/L,199.500U/L,13.515ng/L,0.995,1.380ug/ml and 9.205ng/ml.The areas under the curve are 0.657,0.643,0.714,0.681,0.755and0.730,and the sensitivity and specificity were(92.0%,33.3%),(60.0%,66.7%),(64.0%,71.8%),(74.0%,53.8%),(72.0%,67.9%)(78.0%,66.7%).Conclusion:1.D-dimer≥1.205ug/ml,CEA≥9.53ng/ml,surgery is an independent risk factor for pulmonary adenocarcinoma complicated with pulmonary embolism.2.The possibility of pulmonary embolism should be considered when hemoptysis and pleural effusion occur in patients with pulmonary adenocarcinoma,and WBC,NEUT,LDH,IL-6,PT,INR,D-dimer,CEA increase and ALB decrease in laboratory indicators.3.Advanced(stage Ⅲ/Ⅳ)lung adenocarcinoma is more likely to be complicated by pulmonary embolism.