A comparative analysis of pulmonary thromboembolism in patients with malignancy and the general population: diagnosis, clinical presentation and prognosis

Introduction and Aim: Pulmonary thromboembolism (PTE) is a common and potentially fatal complication in patients with malignancy. The diagnosis, treatment, and prognosis PTE in patients with malignancy (Mi-PTE) differ from those in the general population. This study aimed to investigate the impact of malignancy on the clinical presentation and prognosis of patients with PTE. Materials and Methods: Between 2020 and 2023, three groups of 80 patients each (PTE, Mi-PTE, and control) with a preliminary diagnosis of PTE were retrospectively evaluated at our center. Symptoms, risk factors, laboratory data, PTE localization, and clinical scores (Wells' score, modified Geneva score, and Khorana score for patients with malignancy) were recorded from the patients' files. Prognostic and mortality scores (PESI, Bova, Pompe-C, 30-day mortality, and modified Glasgow Prognostic Score) and mortality times were also recorded. Results: The most common malignancies were lung and brain tumors. 15% of the patients with malignancy were in the early stage, 35% in the locally advanced stage, and 50% in the metastatic stage. 54 patients (67,5%) were receiving active chemotherapy. The presenting symptoms of the patients were similar in both groups. Although the locations of the embolisms in the pulmonary artery were similar, the incidence of pulmonary trunk location was higher in the Mi-PTE group (p=0,05). The neutrophil/lymphocyte ratio (p=0,006), monocyte/lymphocyte ratio (p=0,01) and platelet/lymphocyte ratio (p=0,015) were higher in the Mi-PTE group. The mean PESI score was higher in the Mi-PTE group (p<0,01) and right ventricular dysfunction was less frequently detected in echocardiography (p=0,031). The mean Troponin-I and BNP levels were also similar in both groups. Although the three-month (p<0,01) and one-year mortality (p<0,01) rates were higher in the Mi-PTE group, the 30-day mortality rates were similar between the two groups. Conclusion: Our findings suggest that the presence of malignancy in PTE patients increases inflammatory indices, but does not significantly affect the clinical course and severity of embolism compared to the general population. The increased long-term mortality observed in patients with Mi-PTE may be attributed to other cancer-related motality causes other than PTE. Existing PTE risk prediction and severity assessment scores may be inadequate for patients with Mi-PTE. A new scoring system which includes malignancy-specific factors is needed in patients with malignancy.