Incidence, risk factors and prognostic impact of venous thromboembolism in patients with advanced non-small cell lung cancer receiving systemic therapy: a single-center retrospective analysis.
- 1Department of Oncology Hematology, Xijing 986 Hospital, Air Force Medical University, Xi'an, Shaanxi, 710054, China.
- 2Department of Oncology Hematology, Xijing 986 Hospital, Air Force Medical University, Xi'an, Shaanxi, 710054, China. [email protected].
Abstract
Background
To evaluate the incidence, timing, risk factors, and prognostic impact of venous thromboembolism (VTE) in patients with advanced non-small cell lung cancer (NSCLC) receiving systemic therapy.Methods
This single-center retrospective cohort study included 164 consecutive patients with pathologically confirmed stage IIIB-IV NSCLC who initiated systemic therapy between January 2021 and December 2025. VTE events were identified during follow-up and objectively confirmed by imaging. The cumulative incidence of VTE was estimated using a competing-risk approach, with death before VTE treated as a competing event. Risk factors for incident VTE were evaluated using cause-specific Cox regression. The prognostic impact of VTE was assessed using time-dependent Cox regression.Results
During follow-up, 29 patients developed VTE, corresponding to a crude proportion of 17.68%. The median time to first VTE was 104 days, and 24 of 29 events (82.76%) occurred within 6 months. When death before VTE was treated as a competing event, the cumulative incidence of VTE was 8.00% at 3 months, 15.04% at 6 months, and 17.97% at 12 months. In multivariable cause-specific Cox analysis, higher baseline D-dimer was independently associated with incident VTE (HR 2.714, 95% CI 1.970-3.741, P < 0.001). In a sensitivity model, anti-angiogenic therapy was associated with higher VTE risk (HR 2.810, 95% CI 1.320-5.984, P = 0.007). In time-dependent Cox analysis, VTE was independently associated with worse OS (HR 4.464, 95% CI 2.162-9.216, P < 0.001), but not PFS (HR 1.622, 95% CI 0.811-3.245, P = 0.172).Conclusions
VTE was a relatively common and early complication in patients with advanced NSCLC receiving systemic therapy. Baseline D-dimer was the most consistent factor associated with incident VTE, and VTE was independently associated with worse OS when analyzed as a time-dependent event. These findings support early risk assessment and vigilant clinical surveillance for thrombosis in advanced NSCLC.
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BibTeX
@article{lu2026incidence,
title = {{Incidence, risk factors and prognostic impact of venous thromboembolism in patients with advanced non-small cell lung cancer receiving systemic therapy: a single-center retrospective analysis.}},
author = {Wanling Lu and Hongguo Guo and Song Qiao and Shangzhen Yang and Cai Cheng},
journal = {BMC pulmonary medicine},
year = {2026},
month = aug,
doi = {10.1186/s12890-026-04498-3},
url = {https://europepmc.org/article/MED/42958169},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Incidence, risk factors and prognostic impact of venous thromboembolism in patients with advanced non-small cell lung cancer receiving systemic therapy: a single-center retrospective analysis.
AU - Wanling Lu
AU - Hongguo Guo
AU - Song Qiao
AU - Shangzhen Yang
AU - Cai Cheng
PY - 2026
DA - 2026/08/03
JO - BMC pulmonary medicine
DO - 10.1186/s12890-026-04498-3
UR - https://europepmc.org/article/MED/42958169
AB - Background To evaluate the incidence, timing, risk factors, and prognostic impact of venous thromboembolism (VTE) in patients with advanced non-small cell lung cancer (NSCLC) receiving systemic therapy.Methods This single-center retrospective cohort study included 164 consecutive patients with pathologically confirmed stage IIIB-IV NSCLC who initiated systemic therapy between January 2021 and December 2025. VTE events were identified during follow-up and objectively confirmed by imaging. The cumulative incidence of VTE was estimated using a competing-risk approach, with death before VTE treated as a competing event. Risk factors for incident VTE were evaluated using cause-specific Cox regression. The prognostic impact of VTE was assessed using time-dependent Cox regression.Results During follow-up, 29 patients developed VTE, corresponding to a crude proportion of 17.68%. The median time to first VTE was 104 days, and 24 of 29 events (82.76%) occurred within 6 months. When death before VTE was treated as a competing event, the cumulative incidence of VTE was 8.00% at 3 months, 15.04% at 6 months, and 17.97% at 12 months. In multivariable cause-specific Cox analysis, higher baseline D-dimer was independently associated with incident VTE (HR 2.714, 95% CI 1.970-3.741, P < 0.001). In a sensitivity model, anti-angiogenic therapy was associated with higher VTE risk (HR 2.810, 95% CI 1.320-5.984, P = 0.007). In time-dependent Cox analysis, VTE was independently associated with worse OS (HR 4.464, 95% CI 2.162-9.216, P < 0.001), but not PFS (HR 1.622, 95% CI 0.811-3.245, P = 0.172).Conclusions VTE was a relatively common and early complication in patients with advanced NSCLC receiving systemic therapy. Baseline D-dimer was the most consistent factor associated with incident VTE, and VTE was independently associated with worse OS when analyzed as a time-dependent event. These findings support early risk assessment and vigilant clinical surveillance for thrombosis in advanced NSCLC.
SN - 1471-2466
ER -