Incidence and impact of incidental pulmonary embolism in solid cancer patients.

Abstract

e23272 Background: Incidental pulmonary embolism (IPE) refers to asymptomatic pulmonary embolism (PE) detected during routine imaging in cancer patients. The reported prevalence of IPE in cancer patients is estimated at 3.36%. This study evaluates the risk factors, characteristics, treatment patterns, and outcomes of IPE in solid cancer patients. Methods: A retrospective chart review was conducted on solid cancer patients diagnosed with PE at our institution (July 2014–December 2023). Among 335 solid cancer patients, 118 IPE cases were identified, excluding symptomatic PE. Data collected included demographics, cancer characteristics, treatments, and outcomes, including 30-day and 90-day mortality. Associations between factors (e.g., cancer status, concurrent DVT, treatments) and mortality were analyzed using Fisher’s exact test. Results: The median age was 69 years (range: 38–90), with 50.8% male and 72% White patients. Active cancer was present in 88.1%, and metastatic disease in 74.6%. Common cancers are gastrointestinal (40.7%), genitourinary (18.6%), and lung cancers (13.6%). At diagnosis, 50% were on chemotherapy, 13.6% on immunotherapy, 18.6% on targeted therapy, 9.3% on radiation, and 5.1% on hormonal therapy. Concurrent DVT was present in 33.9%, 2.5% had recent surgery, and 3.4% had a prior DVT. The 30-day and 90-day mortality rates were 8% and 21%, with an overall mortality rate of 62.7%. Metastatic disease was significantly associated with higher 90-day mortality (p = 0.03) but not 30-day mortality (p = 0.11). Active cancer increased 90-day mortality (p = 0.03) but not 30-day mortality (p = 0.59). Neither chemotherapy status nor concurrent DVT significantly impacted mortality at either time point. Conclusions: There was high prevalence of active cancer, metastatic disease, gastrointestinal cancers, concurrent DVT and ongoing chemotherapy at the time of IPE. Ninety day and overall mortality rates were 21% and 62.7%. Metastatic disease and active cancer were significantly associated with higher 90-day mortality. Close monitoring and pro-active management are essential for these patients. Characteristics and mortality in solid cancer patients with IPE. Patient Group Total, N (%) 335 (100%) 30-day mortality, N (%) P-value 90-day mortality, N (%) P-value Solid cancer and PE 335 ( 100%) N/A N/A N/A N/A Solid cancer with IPE 118 (35.0%) 9 (8.0%) N/A 25 (21%) N/A Concurrent DVT 40 (33.9%) 6 (15%) p=0.06 11 (27.5%) p=0.24 Metastatic Disease 88 (74.6%) 9 (10.2%) p=0.10 23 (26.1%) p=0.03 Active Cancer 104 (88.1%) 9 (8.7%) p=0.50 25 (24%) p=0.03 Chemotherapy 59 (50.0%) 4 (6.8%) p=1.00 12 (20.3%) p=1.00 Immunotherapy 16 (13.6%) N/A N/A N/A N/A Targeted therapy 22(18.6%) N/A N/A N/A N/A Hormonal therapy 6 ( 5.1%) N/A N/A N/A N/A N/A- Not applicable.