Risk assessment in lung cancer-associated pulmonary embolism (LCA-PE)

<bold>Background:</bold> CA-PE remains a major health problem, due to its impact on prognosis. Little is known about risk assessment in LCA-PE. <bold>Aims:</bold> to assess the performance of validated prognostic tools for PE in lung cancer (LC) patients. <bold>Methods:</bold> consecutive LC outpatients attending our Pulmonary Unit in Pisa from 2019 to 2021 were retrospectively studied; PE was diagnosed by computed tomography pulmonary angiography (CTPA). Among LCA-PE patients, clinical course and death were recorded; comorbidities, histotype and Khorana risk score (KRS) were collected. Based on current guidelines, troponin/NT-proBNP alteration, right ventricle to left ventricle diameter ratio (RV/LV) and main pulmonary artery diameter (øPA) on CTPA, shock index (SI), PE severity indices (PESI, sPESI) were considered for risk assessment. Student’s t test, Mann-Whitney test, ANOVA, and Kaplan-Meier survival analysis were used as appropriate. <bold>Results:</bold> among 512 patients, 40 cases of PE were detected (incidence 7.81%); after PE diagnosis, 8 patients died within 1 month, 22 patients died within 6 months. Unlike PESI, sPESI and øPA, troponin/NT-proBNP and SI were significantly different between survivors and non-survivors (p<0.05). Unexpectedly, patients with RV/LV>1 had a longer survival at 1 month (p=0.04). Patients’ survival significantly decreased from KRS=1 to KRS=2 and, even more, to KRS=3 (p<0.001), regardless histotype. <bold>Conclusions:</bold> comparing to previous studies, a higher incidence of LCA-PE was detected. Some PE-prognostic factors performed sub-optimally; prognosis seemed to be influenced more by the natural history of the tumor than by PE severity. KRS may be considered a prognostic tool in LCA-PE, regardless histotype. Further studies are needed.