title: Incidence of Ct scan-detected pulmonary embolism in patients with oncogene-addicted, advanced lung adenocarcinoma.
abstract: BACKGROUND
  Patients with stage IIIB-IV lung adenocarcinoma are at high-risk for pulmonary embolism (PE). In these patients, EGFR and KRAS mutations as well as EML4/ALK rearrangements are recognized as "drivers" and as targets for therapy. Data on the incidence of PE in oncogene-addicted lung cancer patients are limited.
  
  
  OBJECTIVE
  The aims of this study were to evaluate the incidence of CT scan-detected PE in patients with stage IIIB-IV lung adenocarcinoma and to assess the potential correlation between the presence of these oncogenes and the PE risk.
  
  
  METHODS
  Baseline staging or re-staging chest contrast-enhanced CT scans of patients with stage IIIB-IV lung adenocarcinoma were retrospectively reviewed and adjudicated for the presence of PE. Data on the oncogene drivers (EGFR, KRAS or EML4/ALK) of the same patients were collected.
  
  
  RESULTS
  A total of 173 patients with lung adenocarcinoma were included in the study. 24.8% of patients were EGFR mutated (31/125), 21.6% were KRAS mutated (27/125) and 13.6% hadan EML4/ALK rearrangement (17/125). 41 patients had a CT-detected PE (23.7%). A PE was observed in 5 patients with EGFR mutation (16.2%), in 5 patients with KRAS mutation (18.5%), in 8 patients with ELM4/ALK mutation (47.1%). The presence of ELM4/ALK rearrangement was associated with an increased risk of PE [HR:2.06 (95%CI 1.08- 3.55)]. Risk of PE was not found to be associated with EGFR or KRAS mutations.
  
  
  CONCLUSIONS
  Patients with advanced lung adenocarcinoma were at high risk for PE. The presence of EML4/ALK rearrangement was associated with an increased PE risk.
authors.affiliation: Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy. Electronic address: melina.verso@unipg.it.
authors.forename: Melina
authors.initials: M
authors.lastname: Verso
authors.affiliation: Medical Oncology, Perugia Hospital, Perugia, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Chiari
authors.affiliation: Department of Diagnostic Imaging, Perugia Hospital, Perugia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Mosca
authors.affiliation: Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Franco
authors.affiliation: Department of Diagnostic Imaging, Perugia Hospital, Perugia, Italy.
authors.forename: Matthias
authors.initials: M
authors.lastname: Fischer
authors.affiliation: Medical Oncology, Perugia Hospital, Perugia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Paglialunga
authors.affiliation: Medical Oncology, Perugia Hospital, Perugia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Bennati
authors.affiliation: Department of Diagnostic Imaging, Perugia Hospital, Perugia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Scialpi
authors.affiliation: Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000473:pathology; D000077192:Adenocarcinoma of Lung; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009857:Oncogenes; D011655:Pulmonary Embolism / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Clinically unexpected VTE; Lung adenocarcinoma; Oncogene addiction; Pulmonary embolism