Use of inferior vena caval filters and survival in patients with malignancy.
BACKGROUND
Inferior vena cava (IVC) filters have proven to be a viable alternative to anticoagulation therapy for the prevention of life-threatening pulmonary emboli (PE) for patients who have contraindications to anticoagulation therapy. The clinical benefit of placing IVC filters in patients with advanced-stage cancer is controversial. The current study reported the authors' experience with IVC filters in patients with cancer.


METHODS
Between January 2000 and May 2003, IVC filters were placed in 308 patients with venous thromboembolic (VTE) disease. Of these patients, 267 had solid tumors and 41 had liquid tumors. Outcome was reviewed retrospectively with regards to patient survival as well as procedural and filter-related complications. Patients with solid and liquid tumors were used to generate Kaplan-Meier estimates for survival and the probability of surviving 30, 90, and 365 days was also calculated. The prognostic effect of age, primary malignancy, gender, extent of disease, indication, admission to the intensive care unit, and IVC thrombus on overall survival was also evaluated using univariate and multivariate Cox models for patients with solid tumors.


RESULTS
The median survival periods for patients with solid and liquid tumors were 145 days and 207 days, respectively. The probability of survival at 30, 90, and 365 days was 0.81, 0.60, and 0.35, respectively, for patients with solid tumors and 0.85, 0.67, and 0.48, respectively, for patients with liquid tumors. There was no statistically significant difference in survival based on primary malignancy for solid tumors (P = 0.628) or between solid and liquid tumors (P = 0.16). For patients with solid tumors, a statistically significant difference in survival was found by extent of disease (P = 0.002). Patients with solid tumors classified as local disease (n = 15), locally advanced disease (n = 95), and widely metastatic or disseminated disease (n = 153) had a probability of survival at 30 days of 0.93, 0.87, and 0.76, respectively. Compared with patients with local disease, patients with metastatic or disseminated disease were 3.7 times more likely to die (P = 0.013). Patients with a history of deep venous thrombosis (DVT) and hemorrhage were 2 times more likely to die than patients with DVT and no history of hemorrhage (P = 0.0057). Documented complications occurred in 22 of 308 (7.1%) patients and included PE (n = 4), new caval thrombosis (n = 14), retroperitoneal hemorrhage (n = 2), and maldeployed filters (n = 2).


CONCLUSIONS
IVC filters were shown to be safe and highly effective in preventing PE-related deaths in patients with cancer with VTE disease. Patients with a history of DVT and bleeding or metastatic/disseminated stage of disease had the lowest survival after IVC filter placement.
Wallace
Michael J
MJ
Section of Vascular and Interventional Radiology, Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. mwallace@di.mdacc.tmc.edu
Jean
James L
JL
Gupta
Sanjay
S
Eapen
George A
GA
Johnson
Marcella M
MM
Ahrar
Kamran
K
Madoff
David C
DC
Morello
Frank A
FA
Murthy
Ravi
R
Hicks
Marshall E
ME
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011655:Pulmonary Embolism / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*