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Thromb Haemost
DOI: 10.1055/a-2661-2326
Stroke, Systemic or Venous Thromboembolism

Risk Factors and Outcomes of Subsegmental versus More Central Pulmonary Embolism in Patients with Lung Cancer

Delun Yang 
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
,
Jiajun Deng
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
,
Shenghao Huang
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
,
Hua He
2   Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, People's Republic of China
,
Chenyang Dai   *
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
,
Deping Zhao   *
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
,
Chang Chen   *
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
› Author Affiliations
Funding This work was supported by the National Key Research and Development Program of China (2022YFC2407406 and 2024YFC3044600); the Natural Science Foundation of Shanghai (23ZR1453200); the Research-Oriented Physician Talent Program of Shanghai Pulmonary Hospital (LYRC292410); the Tongji University Medicine–X Interdisciplinary Research Initiative (2025-0554-YB-12); and the Shanghai Oriental Young Talent Project (QNWS2024015). The funding agencies had no involvement in the study's design, execution, data interpretation, manuscript preparation, or submission.
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Abstract

Background

The clinical significance of lung cancer-associated subsegmental pulmonary embolism (PE) remains unclear.

Methods

This study retrospectively included 902 patients with lung cancer-associated PE (160 subsegmental PE, 742 more central PE). Cox proportional hazards regression was used to assess the risk of all-cause death. Fine-Gray tests and competing risk models were applied to evaluate the risks (hazard ratio [HR] [95% confidence interval]) of venous thromboembolism (VTE) recurrence and major bleeding. All-cause death was treated as a competing event for both VTE recurrence and major bleeding.

Results

Compared with the more central PE group, the subsegmental PE group showed no significant differences in the adjusted risks of VTE recurrence (HR 0.99 [0.62–1.57], p = 0.95) and all-cause death (HR 0.83 [0.52–1.34], p = 0.45), and this finding was consistent across subgroups. Compared with patients with subsegmental PE without anticoagulation, those with anticoagulation had a lower adjusted risk of VTE recurrence (HR 0.16 [0.05–0.53], p = 0.003). The adjusted risks of major bleeding (HR 0.30 [0.05–1.70], p = 0.18) and all-cause death (HR 0.43 [0.13–1.42], p = 0.17) did not reach statistical significance. Independent predictors of VTE recurrence included symptomatic deep vein thrombosis (HR 2.71 [1.63–4.52], p < 0.001), tumor–node–metastasis stage (HR 2.07 [1.19–3.60], p = 0.010), EGFR mutations (HR 0.62 [0.39–0.98], p = 0.041), and anticoagulation (HR 0.32 [0.20–0.52], p < 0.001).

Conclusion

The risk of recurrent VTE is not miniscule in patients with lung cancer-associated subsegmental PE.

Keywords

subsegmental pulmonary embolism - lung cancer - ROS Proto-oncogene 1 (ROS1) - epidermal growth factor receptor (EGFR) - anticoagulant therapy

Data Availability Statement

For inquiries regarding the original data, please contact Chang Chen at chenthoracic@163.com.


Ethics Approval Statement

This study was approved by the institutional review board of Shanghai Pulmonary Hospital, and the requirement for written informed consent was waived (Approval No. L24-028).


Authors' Contribution

D.Y. contributed to conceptualization of the study, performed data collection and analysis, and drafted the manuscript; J.D., S.H., and H.H. contributed to data collection, analysis, and manuscript preparation; C.D., D.Z., and C.C. contributed to involved in drafting, providing critical revisions, and overseeing the project.


* These authors contributed equally to this work as co-senior authors.


Supplementary Material



Publication History

Received: 14 October 2024

Accepted: 18 July 2025

Accepted Manuscript online:
21 July 2025

Article published online:
14 August 2025

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