CASE PRESENTATION:A 40-year-old woman presented with a 3-week history of progressive exertional dyspnea. She had previously been active, but her symptoms progressed to the point where she was short of breath with walking. Her oxygen level was 90% at rest and decreased to 70% to 80% after exertion. The patient denied fever, cough, sputum production, edema, syncope, or other clinically remarkable symptoms. No significant weight loss was noted recently. Two and a half years ago, the patient was diagnosed with stage IV poorly differentiated lung adenocarcinoma (cT2N3M1c) with a 70% PD-L1 expression level, along with metastases to the pelvis, liver, brain, and bone. The patient received sequential ROS1-targeted therapy (crizotinib, entrectinib, repotrectinib) plus local therapies for metastatic lesions. A tumor assessment 2 months prior showed stable disease. She had no history of smoking, substance misuse, or alcohol consumption. No family history of genetic diseases was reported.

Acute pulmonary thromboembolism (PTE) is the third leading cause of cardiovascular mortality with increased incidence. Comorbidities are prevalent among PTE patients, yet their characteristics and impacts have not been thoroughly investigated. Thus, this retrospective study aims to explore the comorbidity characteristics and impact in patients with acute PTE, so as to provide a reference for comorbidity management and risk assessment in acute PTE patients. A retrospective study was conducted on 243 patients with acute PTE in Beijing Hospital between January 2009 and December 2015. Univariate and multivariate Logistic regression analysis were performed to analyze the associations between comorbidity, and risk factors, mortality and adverse events risk. The mean age of the 243 acute PTE patients was 67.18 ± 12.96 years, with 123 (50.6

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is the third most common cardiovascular disease. Unprovoked VTE can be the initial presentation of occult cancer. Up to 10% of patients with unprovoked VTE are diagnosed with cancer within a year. Cancer screening in patients with unprovoked VTE is beneficial for early cancer diagnosis and treatment, which may theoretically reduce cancer-related morbidity and mortality. The epidemiology of occult cancer in patients with unprovoked VTE, screening strategies originated from evidence-based medicine, risk factors of cancer and different models of risk assessment are reviewed in this article.

Objective:To increase the understanding of neuroleptic malignant syndrome, rhabdomyolysis and acute renal injury in advanced-aged patients with Parkinson's disease after abdominal surgery.Methods:We report a case of malignant syndrome, rhabdomyolysis and acute renal injury in an 85-year-old patient with Parkinson's disease after abdominal surgery in our department.The diagnosis and successful treatment experience were summarized, and a literature review was conducted.Results:The body temperature was as high as 40.5℃ in this patient, accompanied by stiffness, sustained involuntary shaking, increased muscle tone, serum creatine kinase at 104 615 U/L, tachycardia, low blood pressure, accelerated breathing rate, disturbance of consciousness, excessive sweating and other clinical manifestations, which met the diagnostic criteria for neuroleptic malignant syndrome.The patient had complications including concurrent rhabdomyolysis, acute renal injury and shock.The emergency was resolved after an early diagnosis and proactive treatment.Conclusions:If patients with Parkinson's disease have a high fever with rigidity or sudden aggravation within a short period of time after medication, the possibility of neuroleptic malignant syndrome should be considered and the causes should be screened.

目的 探讨肺血栓栓塞症患者合并下肢深静脉血栓(DVT)临床特征.方法 对2009年1月至2018年5月北京医院收治的343例急性肺血栓栓塞症(PTE)患者的临床资料进行回顾性分析,根据合并下肢DVT情况分为近端DVT组、单纯下肢远端DVT (IDDVT)组和无DVT组.比较各组临床特征及预后情况.结果 343例PTE患者平均(68.2±13.0)岁,男165例(48.1％).158例(46.1％)合并DVT,其中下肢近端DVT 91例(57.6％),IDDVT 67例(42.4％).伴下肢DVT相关症状者137例(39.9％)中,检出DVT 79例(57.7％).近端DVT组伴DVT相关症状的比例显著高于另两组(P=0.002和P＜0.001).近端DVT和IDDVT组白细胞及D-二聚体水平显著高于非DVT组(均P＜0.05).近端DVT组溶栓、置入下腔静脉滤器的比例均显著高于非DVT组(均P＜0.05),近端DVT组及IDDVT组低危PTE的比例显著低于无DVT组(P=0.042和P=0.013).三组住院病死率差异无统计学意义(均P＞0.05).多因素Logistic回归分析显示,目前吸烟(OR=2.96,95％CI 1.44～6.09,P=0.003)、DVT病史(OR=2.27,95％CI 1.09～4.70,P=0.028)、DVT症状(OR=3.26,95％CI 1.86～ 5.69,P＜0.001)、D-二聚体＞500 ng/mL (OR=4.47,95％CI 2.25 ～ 8.86,P＜0.001)是PTE患者合并近端DVT的独立危险因素.DVT病史(OR=7.27,95％CI 2.87～18.43,P＜0.001)、脑血管病(OR=2.49,95％CI 1.07～5.76,P=0.033)、D-二聚体＞500 ng/mL (OR=2.50,95％CI 1.30～4.82,P=0.006)是PTE患者合并IDDVT的独立危险因素.结论 急性PTE患者伴发下肢DVT的比例接近50％,其中超过一半为下肢近端DVT.依据临床症状诊断DVT的可靠性较低,DVT病史和D-二聚体＞500 pg/mL是PTE患者合并下肢近端和远端DVT的独立危险因素.

Objective To investigate clinical features and prognosis of patients with cancerrelated isolated distal deep vein thrombosis(IDDVT).Methods Data of 64 patients with malignant tumor complicated with IDDVT at our hospital from January 2003 to January 2013 were retrospectively analyzed for the clinical features and prognosis.Results Among the 64 patients,32 male and 32 female cases were involved,aged 37 to 87 years,average(66.0 ± 12.6) years.There were 42 cases aged 65 years and older and 22 cases aged under 65 years.The IDDVT involved veins of lower extremity in 64 patients,unilaterally (47/64)or bilaterally (17/64).The intermuscular veins were involved by IDDVT in 46 cases(71.9％).Posterior tibial veins were involved in 17 cases(26.6％),peroneal veins were involved in 14 cases(21.9％),anterior tibial veins were involved in 2 cases (3.1 ％).Common symptoms were swollen lower extremity and pain (53.1％).Bleeding occurred in 2 (3.6 ％) of the 55 patients(55/64,85.9 ％) who underwent anticoagulant therapy,and no major bleeding occurred.The cumulative incidence of IDDVT at 3,6,and 12 months after tumor diagnosis was 64.0％ (41/64 cases),75.0 ％ (48/64 cases) and 85.9 ％ (55/64 cases),respectively.The cumulative incidences of IDDVT at 3 and 6 months were higher after diagnosis of lung cancer than after diagnosis of digestive tract tumors(P =0.005 and 0.035).By the end of follow-up(a median follow-up of 13.0 months),30 patients(46.9 ％)died.The mortality rate was lower in the non-elderly group than in the elderly group (22.7％ vs.59.5％,x2 =7.850,P=0.005).The mortality rate was lower in patients with stage Ⅰ-Ⅲa than in patients with stage Ⅲb-Ⅳ(24.0％ vs.68.8％,x2=11.246,P=0.001).The mortality rate was lower in patients with gynecologic tumors(10.0％) than in patients with lung cancer(55.6％),digestive tract tumors (40.0％) and hematologic tumors (71.4％) (P =0.041,0.037 and 0.035,respectively).TNM Ⅲ b-Ⅳ (OR =8.42,95 ％ CI:1.93-30.00,P =0.004) and age ≥ 65 years (OR =6.28,95％CI:1.50-27.76,P=0.012)were independent risk factors for death.Conclusions Cancerassociated IDDVT most commonly involves the intermuscular veins.The incidence of hemorrhage after anticoagulant therapy is low.For patients without anticoagulation contraindications,active anticoagulant therapy should be recommended.The advanced cancer and old age are independent risk factors for cancer-related IDDVT death.

Objective To explore the incidence,clinical characteristic and outcome of malignancy surgical patients with venous thromboembolism (VTE).Methods The clinical data of sixty-eight malignancy surgical cases who suffered from VTE during the postoperative 90 days and hospitalized from January 2003 to April 2013 at Beijing Hospital were reviewed.Results There were 10 967 cases of malignancy surgeries during the observed ten years and 68 cases suffered from VTE during the postoperative 90 days (incidence was 0.62 ％),including gynecological malignancy,lung cancer,urinary system malignancy,digestive tract malignancy,breast cancer and hematological malignancy.Gynecological malignancy and lung cancer had the highest VTE incidence (1.03％ and 0.95％ respectively),there was significant difference with the other types (all P ＜0.05).Among 68 patients,31 cases of male and 37 cases of female were involved,with an average age of (63.94±10.50) years old,average postoperative time of (33 ± 30) days,average anesthesia duration of (172.75± 104.71) minutes,including 29 cases (42.65％) with cardiovascular diseases,34 cases (50.00％) immobilized more than three days after operation,40 cases (58.82 ％) with middle and low differentiation carcinoma in pathology,and 51 cases (75.00％) with Caprini score equal or greater than five.There were 36 cases in elderly group (≥65 years old)and 32 cases in non-elderly group (＜65 years old).Compared with non-elderly group,the body mass index was lower (t =-2.052,P =0.044),Caprini score (t =2.613,P =0.011),D-dimer (Z =-1.976,P =0.048),and incidence of late-onset VTE (occurring in postoperative 5-12 weeks)(x2=8.438,P =0.004) were higher in elderly group.All the three cases of fetal pulmonary thromboembolism were late-onset VTE patients in elderly group without any prophylactic measures.Conclusions The incidence of VTE in malignancy surgery patients during the postoperative 90 days is 0.62％.Gynecological malignancy and lung cancer are the most common types.The observation time for the VTE events should be extended to 12 weeks after surgery in elderly patients,as fetal pulmonary thromboembolism may occur during postoperative 5-12 weeks.

目的 分析伴有咯血的肺血栓栓塞(PTE)患者临床特征和住院期间预后.方法 纳入2010年1月至2015年1月北京医院住院的急性PTE患者220例,采集患者的基线特征、临床表现、实验室检查、影像学表现、治疗情况和住院转归(含病死率和出血发生率);按是否伴有咯血分为咯血组和无咯血组,比较两组患者临床特征和预后的差异.结果 220例患者中,16例(7.3％)伴有咯血,204例(92.7％)不伴咯血.咯血组年龄显著小于无咯血组[(59.7±16.6)岁对(67.2±13.6)岁,P=0.037],男性更多见(75.0％对44.6％,P=0.034).与无咯血患者相比,咯血组患者发热和胸痛发生率较高(分别为31.3％对11.3％,P=0.037;50.0％对26.0％,P=0.039).咯血组平均确诊时间为(8.91±6.09)d.咯血组患者放置下腔静脉滤器(IVCF)的比例更高(18.8％对3.4％,P=0.028).两组患者的危险程度和住院病死率差异无统计学意义.结论 PTE引起的咯血缺乏特异性,常导致误诊或诊断延误,尽早明确诊断,有助于正确的治疗,减少不当措施带来的不良后果.

Abstract Background Rapid stratification and appropriate treatment on admission are critical to saving lives of patients with acute pulmonary embolism (PE). None of the clinical prediction tools perform well when applied to all patients with acute PE. It may be important to integrate respiratory features into the 2014 European Society of Cardiology model. First, we aimed to assess the relationship between the arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FIO2) ratio and in-hospital mortality, determine the optimal cutoff value of PaO2/FIO2, and determine if this value, which is quick and easy to obtain on admission, is a predictor of in-hospital mortality in this population. Second, we aimed to evaluate the potential additional determinants including laboratory parameters that may affect the in-hospital mortality. We hypothesized that the PaO2/FiO2 ratio would be a clinical prediction tool for in-hospital mortality in patients with acute PE. Methods A prospective single-center observational cohort study was conducted in Beijing Hospital from January 2010 to November 2017. Arterial blood gas analysis data captured on admission, clinical characteristics, risk factors, laboratory data, imaging findings, and in-hospital mortality were compared between survivors and non-survivors. The area under the receiver operating characteristic curve (AUC) for in-hospital mortality based on the PaO2/FiO2 value was determined, and the association between the parameters and in-hospital mortality was analyzed by using logistic regression analysis. Results Body mass index, history of cancer, PaO2/FiO2 value, pulse rate, cardiac troponin I level, lactate dehydrogenase level, white blood cell count, D-dimer level, and risk stratification measurements differed between survivors and non-survivors. The optimal cutoff value of PaO2/FiO2 for predicting mortality was 265 (AUC = 0.765, P < 0.001). Only a PaO2/FiO2 ratio < 265 (95% confidence interval [CI] 1.823–21.483, P = 0.004), history of cancer (95% CI 1.161–15.927, P = 0.029), and risk stratification (95% CI 1.047–16.957, P = 0.043) continued to be associated with an increased risk of in-hospital mortality of acute PE. Conclusion A simple determination of the PaO2/FiO2 ratio at <265 may provide important information on admission about patients’ in-hospital prognosis, and PaO2/FiO2 ratio < 265, history of cancer, and risk stratification are predictors of in-hospital mortality of acute PE.

尽管近20年来对动脉性肺动脉高压(PAH)的认识不断深入,也发表了许多随机对照研究,许多新的靶向药物应用于临床,PAH仍然是严重威胁人们健康的一类疾病.研究表明,PAH危险分层有助于判断患者的预后及指导治疗.综合临床、运动、右心功能及血流动力学参数提出的新的危险分层标准,与原有标准对于预后的判断具有较好的一致性,而且临床实用性明显增加.根据危险分层制定合适的初始治疗方案,并在随访中不断评估患者的危险分层,可及时发现可能的恶化并调整治疗方案,改善患者的预后.

Objective: To compare the clinical characteristics and outcomes of patients with lung cancer, gastrointestinal (GI) cancer and urologic cancer with venous thromboembolism (VTE). Methods: From January 2003 to January 2013, 192 lung cancer, GI cancer and urologic cancer patients with VTE were retrospectively evaluated for the clinical characteristics and outcomes. Results: Among 192 patients, 82 cases of lung cancer, 78 cases of GI cancer, 32 cases of urologic cancer were involved. The Eastern Cooperative oncology Group Performance Status score of GI cancer group was significantly higher than those of the lung cancer and urologic cancer groups[(2.4±1.1) vs (2.0±1.4), (1.8±1.0), both P<0.05]. The proportion of smoking patients in lung cancer group was significantly higher than that in GI cancer and urologic cancer groups (79.3% vs 30.8%, 53.1%, both P<0.05), while the proportion of operation was significantly lower than that in the latter two groups (35.4% vs 53.8%, 68.8%, both P<0.05). Pathological types of cancer were mostly adenocarcinoma, and the proportion of adenocarcinoma in lung cancer and GI cancer groups was significantly higher than that in urologic cancer group (76.9%, 73.8% vs 37.9%, both P<0.001). The proportion of moderately and/or poorly differentiated histodifferentiation in the first two groups was significantly higher than that of urologic cancer group (90.0%, 95.7% vs 40.0%, both P<0.001). The proportion of patients with TNM stage Ⅲ-Ⅳ in lung cancer group was significantly higher than that of the urological cancer group (87.0% vs 64.3%, P<0.05). The incidence of VTE in lung cancer group was significantly higher than those of GI cancer and urologic cancer groups within 6 months after tumor diagnosis, chemotherapy and operation (79.3% vs 60.3%, 46.9%; 76.5% vs 48.6%, 36.4%; 92.3% vs 57.9%, 59.1%; all P<0.05). The case fatality rate within one year in lung cancer and GI cancer groups was significantly higher than that in urologic cancer group (51.2%, 52.6% vs 18.8%, both P<0.01). The median survival time of the lung cancer and GI cancer groups was significantly shorter than that of the urological cancer group (P=0.001, 0.010, respectively). Conclusions: Adenocarcinoma, advanced cancer, and poor histodifferentiation are risk factors of VTE in cancer patients. Most events of VTE occur within 6 months after a diagnosis of cancer. The prognosis of lung cancer and GI cancer complicated with VTE is worse than that of urologic cancer with VTE.

Objective: To investigate the clinical characteristics and outcomes of overweight and obese patients with pulmonary embolism. Methods: This was a retrospective study of patients with pulmonary thromboembolism(PTE) in Beijing Hospital between 2009 and 2017. Data were analyzed and compared based on body mass index (BMI), and patients were classified into normal weight, overweight, and obese. Results: Among 372 patients with PTE, 159 were normal, 143 were overweight and 70 were obese. The mean age was (67.8±13.4) years, and 159(47.0%) were males. There was no significant difference in age, sex, smoking ratio, and underlying disease between the 3 groups (all P>0.05). Chest pain was less frequent in the obese group than the overweight group (P<0.05), and swollen of lower limbs was more prevalent in the obese group than the first 2 groups (all P<0.05). The levels of hemoglobin and hematocrit in the obese group were significantly higher than those in the normal group(P<0.05), while the serum uric acid levels were significantly higher than that in the normal group (P<0.05). Anticoagulation was more frequent in the overweight than the normal group(P<0.05) and Warfarin use was more frequent in the overweight and the obese than the normal group(both P<0.05). The mortality rate was higher in the normal group than those in the overweight and the obese groups (both P<0.01). Multiple logistic regression analysis after adjusting for age and sex showed that malignancy (OR=3.716, 95%CI: 1.733-7.972, P=0.001) and high risk PTE (OR=13.815, 95%CI: 4.093-46.624, P<0.001) were predictors of mortality, whereas anticoagulation (OR=0.155, 95%CI: 0.056-0.428, P<0.001), BMI≥24 (OR=0.142, 95%CI: 0.045-0.446, P=0.001) and BMI≥28 (OR=0.272, 95%CI: 0.085-0.872, P=0.029) were the predictors of survival. Conclusions: Proportion of hypertension, diabetes, coronary heart disease and hyperlipidemia were not significantly different in patients with overweight and obesity compared to patients with normal weight. Obese patients had higher levels of uric acid and hemoglobin than normal weight. Overweight and obese patients had a better survival.

Objective To identify the clinical picture and outcomes of acute pulmonary thromboembolism (PTE) patients with syncope.Methods From January 2011 to December 2015,289 consecutive patients with confirmed acute symptomatic PTE in Beijing hospital were divided in with and without syncope groups.The clinical factors including age,gender,predisposing factors,symptoms,labs,imagings,classification of PTE,therapeutic regimen and outcomes were recorded.Results From 289 patients,25 (8.7%) had syncope which included 14 men and 11 women (median age:62.0±14.0 year).There were no significant difference about age,gender,predisposing factors and comorbiditys between two groups.Compared to patients without syncope,those with syncope had a higher frequency of palpitation (36.0% vs 13.3%,P=0.002),cyanosis (24.0% vs 9.5%,P=0.03).SⅠQⅢTⅢ in ECG (16.6% vs 2.9%,P=0.001).RV/LV anteroposterior diameter ratio increase in echocardiographic findings were more common in syncope group(50.0% vs 27.3%,P=0.034).More patients with syncope involved lobe or main pulmonary artery (55.0% vs 29.8%,X2=5.34,P=0.021).There were more high and intermediate risk stratification patients in syncope group (76.0% vs 32.6%,X2=18.60,P<0.001).All-cause mortality in hospital showed no significant difference between two groups (12.0% vs 9.8%,X2=0.117,P=0.730),but more patients were dead of PTE in syncope group (12.0% vs 2.6%,X2=5.87,P=0.015).Conclusions More PTE patients with syncope involved lobe or main pulmonary artery and suffered right ventricle disfunction.The risk stratification was more severe.PTE with syncope might be a sign of deterioration.

Objective To explore the clinical characteristics and prognosis of patients with malignant tumor of digestive system combined with venous thromboembolism(VTE).Methods The clinical data of 77 patients admitted in Beijing Hospital from January 2003 to April 2013 with digestive system malignant tumor complicated with VTE were retrospectively analyzed.The incidence,clinical features and prognosis of the patients with digestive system cancer were analyzed.Results Among 77 patients,57 cases of male and 20 cases of female were involved,with an average age of(68.7 ± 12.4)years,including 60 cases(77.9 ％)of adenocarcinoma.The pathological results showed that differentiated tumors accounted for 61.0％ (47/77).Among the 77 patients,pulmonary thromboembolism (PTE) accounted for 33.8 ％ (26 cases) and deep vein thrombosis(DVT)in the low extremities accounted for 66.2 ％ (51 cases).Among all the patients,the most common symptoms were dyspnea and swelling or pain in the extremities.The incidence of VTE was 24.7％ (19/77),13.0％(10/77),19.5％(15/77),5.2％(4/77),5.2％ (4/77),32.5％ (25/77) at 1,3,6,9,12,＞ 12 months after diagnosis of digestive system malignancies,respectively.By April 2013,the 54.5 ％ (42/77) patients died,among which 73.8 ％ (31/42) died of digestive system malignancies,11.9 ％ (5/42) died of PTE,14.3 ％ (6/42) died of other causes.The mortality rates at 1,3,6,9,12,＞ 12 months after the diagnosis of VTE were 20.8％ (16/77),6.5 ％ (5/77),13.0 ％ (10/77),5.2 ％ (4/77),2.6 ％ (2/77),6.5 ％ (5/77),respectively.The difference in VTE incidence between the group aged ≥65 years and group aged ＜65 years at 1,3,6,9 and 12 months after the diagnosis of tumors was not statistically significant(P =0.309).The differences in mortality(P =0.357) and in the median survival time(x2 =0.290,P =0.591) between the two groups were not statistically significant at 1,3,6,9 and 12 months after the diagnosis of VTE.Conclusions The risks for VTE are high in patients with digestive tract malignant tumor,advanced malignant tumor,poor histologic grade(poorly or moderately differentiation),and chemotherapy or surgery,which mostly occurs within 3-6 months after diagnosis.Most deaths occur within the 1st year after the diagnosis of VTE.

Objective To describe the clinical characteristics of pulmonary thromboembolism (PTE) combining with primary antiphospholipid syndrome (PAPS).Methods We described a case of PAPS combining with PTE and reviewed 32 cases reported in literatures.Results 33 patients (eighteen males and fifteen females) had the most common symptoms such as dyspnea,chest pain,hemoptysis,and lower extremity pain.The ratio of triple syndrome of dyspnea,chest pain,and hemoptysis was 42.4%, while ratios of double lower limbs venous thrombosis and bilateral pulmonary embolism were 38.7% and 87.1%,respectively.The ratio of right atrium and (or) right ventricular enlargement was 56.3%,and that of pulmonary hypertension was 75.0%.The platelet level in some patients was decreased and activated partial thromboplastin time was significantly prolonged.Prompt diagnosis and treatment could achieve good therapeutic effect.Conclusions In patients with PTE combining with PAPS,the incidence rate of PTE triple syndrome is high,and moreover,right atrium and (or) ventricular enlargement, thrombocytopenia and abnormal clotting mechanism,and extensive thrombus are common.Prompt diagnosis and treatment can achieve good therapeutic effect.

目的 通过对致死性肺栓塞(FPE)导致心脏骤停患者的临床特点的描述,结合系统文献回顾,总结FPE的救治要点,提高FPE的诊治水平.方法 回顾分析2例FPE导致心脏骤停患者的救治过程.在Medline(1950～ 2014年)和EMbase(1980～ 2014年)两个文献检索系统中检索关于应用溶栓剂治疗FPE导致心脏骤停的文献,对FPE的治疗加以系统总结.结果 2例患者均为外科手术后发生FPE,经心肺复苏、溶栓及抗凝治疗好转,但其中1例患者在抗凝期间发生大出血.共检索到6篇关于FPE导致心脏骤停的文献,共分析72 473例患者,主要为肺栓塞所致心脏骤停或血流动力学不稳定的高危肺栓塞患者,溶栓药物为重组组织型纤溶酶原激活物或链激酶,各研究中给药的方式和剂量均不相同.总体来讲,溶栓治疗可以缩短患者自主循环恢复的时间,提高患者的生存率,但是出血风险有所增加.结论 FPE导致心脏骤停有很高的病死率,临床医生必须及时甄别.早期应用溶栓治疗非常重要,可以改善患者预后.

Objective To identify the clinical features of cancer patients with venous thromboembolism ( VTE) , including types , stages and differentiation of the primary cancers , in order to identify high-risk patients, improve awareness of prevention and control, and reduce the occurrence of the disease .Methods A total of 280 cancer patients who were diagnosed with VTE in our hospital from January 2003 to January 2013 were recruited in this study.Their demographic and clinical data , including age, gender, differentiation, pathological types , TNM stages , chemotherapeutic regimens and prognosis were collected and retrospectively analyzed .Results A total of 280 cancer patients with VTE were enrolled , including 157 males and 123 females at an age of (66.60 ±12.60) years.There were 41 cases of isolated pulmonary thromboembolism (PTE), 189 of deep vein thrombosis (DVT) and 50 of PTE combined with DVT.Among them, 82 patients were lung cancers , 78 gastrointestinal cancer , 32 urinary tract tumor , 27 gynecological tumor , 27 haematological tumor , 12 breast cancer , and 22 other cancers .Compared with the cancer patients without VTE , VTE was more common in the patients with lung, gynecological and other cancers (P<0.05).Among all the patients, 151(53.9%) were diagnosed with adenocarcinoma, and 206 patients (73.6%) presented advanced cancer when developing VTE .For the 247 patients with explicit TNM stage, 187(66.8%) of them were at stage Ⅲ-Ⅳ.Among the 144 patients with definite cancer differentiation , 120(85.4%) were at moderate and poor differentiation .Till the end of follow-up, 130 patients died with a median survival time of (24.0 ±7.8) months.The cumulative mortality rates within 3, 6, 9 and 12 months were 46.9%, 69.2%, 80.0% and 82.3% respectively.The top 3 causes of death were cancer, PTE and infection.Conclusion Cancer is closely associated with VTE .Adenocarcinoma, advanced cancer, low differentiation of tumor and chemotherapeutic regimens containing platinum are more prone to developing VTE.&nbsp;Clinicians should pay attention to these patients , perform VTE risk evaluation , and take the necessary precautionary measures to reduce the incidence of VTE .

Objective To explore the clinical characteristics and outcomes of lung cancer patients with venous thromboembolism ( VTE).Methods The clinical data of 80 lung cancer patients with VTE hospitalized from January 2003 to April 2013 at our hospital were reviewed.The clinical factors of age , gender , clinical manifestations , pathological type , clinical stage , performance status and therapeutic regimen were recorded and analyzed.And the pulmonary thromboembolism ( PTE ) patients with deep venous thrombosis ( DVT) were enrolled into PTE group.The occurrences , clinical manifestations and prognosis of VTE were evaluated.Results A total of 80 patients were enrolled.There were 40 males and 40 females with a mean age of (65.8 ±11.3) years.Adenocarcimoma was identified in 58 (72.5%) patients and advanced lung cancer in 71 (88.8%) patients.Among 37 (46.3%) patients with histodifferentiation results , 89.2%(33/37) of them were moderately and/or poorly differentiated.In 32 (40.0%) patients on chemotherapy , 71.9% ( 23/32 ) of them received a platinum-based regimen.There were 35 ( 43.8%) pulmonary thromboembolism embolism ( PTE ) and 45 ( 56.2%) DVT patients.Among PTE patents , 14 ( 40.0%) were identified incidentally.Dyspnea and swollen of limb were the most common symptoms.Only 20.0%(16/80) patients received VTE prophylaxis.After a definite diagnosis of cancer , 73.8%, 77.5%, 82.5%and 85.0%of patients experienced an event within 3, 6, 9 and 12 months respectively.Up to April 2014, among 53 deceased patients , 77.4% ( 41/53 ) died from lung cancer , 9.3% ( 5/53 ) PTE while 13.2%(7/53) due to other causes.The cumulative mortality rates within 3, 6, 9 and 12 months after VTE eventwere 49.1%, 67.9%, 77.4% and 79.2% respectively.Conclusions Adenocarcimoma , advanced lung cancer, poor histodifferentiation and platinum-based chemotherapy regimen are the risk factors of VTE in lung cancer patients.Most events of VTE occur within 3-6 months after a diagnosis of lung cancer while most mortality cases within 1 year after VTE events.

Objective To identify the clinical features and outcomes of lung cancer in the elderly with venous thromboembolism( VTE). Methods From January 2003 to April 2013,49 elderly lung cancer patients with VTE and 30 young patients were evaluated for clinical presentations and outcomes. The clinical data including age,gender,clinical manifestations,pathological type,TNM stages,performance status,chemotherapeutic regimens and prognosis were collected. Results The mean age of the elderly was( 72. 8 ± 5. 56) years and that of the younger was( 54. 2 ± 8. 26) years. The incidence rate of comorbidity in the elderly was higher than that of the younger patients; meanwhile,the scores for immobilization and performance status were significantly higher in the elderly( P = 0. 048 and 0. 02,respectively). Most patients in both groups were with non-small cell lung cancer( NSCLC) with adenocarcimoma types and advanced stages. The elderly patients were more likely to present with dyspnea( 36. 74% vs 13. 33%,P = 0. 028). The pulmonary embolism severity index( PESI) was also higher in the elderly( 116. 92 ± 21. 34 vs 100. 5 ± 18. 12,P = 0. 04). The incidences of VTE were 71. 4%,77. 6%,83. 7% and 87. 8% in the elderly patients within 3,6,9 and 12 months,respectively,while those in the younger were 76. 7%,80%, 83. 3% and 83. 3%,respectively. A total of 32 patients died in the elderly group while 20 patients passed away. There were no significant difference in the median survival time between the two groups( [6. 0 ± 2. 25]months vs [9 ± 7. 48]months, P = 0. 657). Conclusion Comorbidity may occur more in elderly lung cancer patients with VTE,and the immobilization rate is also higher. More elderly patients present with dyspnea in the elderly and the severity of disease is higher. Prognosis of the elderly is worse than that of the younger.