Pulmonary arterial blowout syndrome as a serious adverse event in patients with advanced lung cancer: a 12-year retrospective study.

[OBJECTIVE] Massive haemoptysis due to central pulmonary artery (CPA) rupture in patients with advanced lung cancer is a fatal complication with limited early diagnostic tools. This study aimed to identify risk factors associated with pulmonary artery rupture and to propose a grading model to facilitate early diagnosis and timely endovascular intervention.

[MATERIALS AND METHODS] This retrospective study included patients with advanced lung cancer who experienced in-hospital sudden haemoptysis-related death and received endovascular treatment for CPA abnormalities. Propensity score matching (PSM; 1:2) balanced covariates between haemoptysis-related and other in-hospital deaths. Following PSM, multivariable logistic regression was performed to identify independent risk factors. Patients were categorised into two cohorts: Group A (2012-2018) and Group B (2019-2024), the latter reflecting the implementation of early detection and endovascular management. Overall survival (OS) was compared using Kaplan-Meier analysis and log-rank testing.

[RESULTS] Among 886 in-hospital deaths, sudden haemoptysis accounted for 4.63% (41/886), with 90.24% (37/41) exhibiting CPA abnormalities. CPA abnormalities, tumour necrosis, cavitation, and progressive bloody or malodorous sputum were identified as significant risk factors (p < 0.05). The haemoptysis group had significantly shorter OS than controls (p < 0.001). A three-tier grading system for pulmonary arterial blowout syndrome (PABS) was developed, with acute PABS being the most prevalent (67.26%). Patients in Group B demonstrated significantly improved OS compared with Group A (p < 0.001).

[CONCLUSION] The PABS grading model enables risk stratification of life-threatening haemoptysis secondary to CPA rupture. Early identification and endovascular intervention may significantly improve clinical outcomes in advanced lung cancer.

[KEY POINTS] Question What are the clinical characteristics and risk stratification criteria for life-threatening haemoptysis arising from CPA rupture in advanced lung cancer? Findings In-hospital sudden haemoptysis mortality was 4.63% and strongly associated with CPA abnormalities. A PABS grading model characterises this fatal condition. Clinical relevance The PABS grading system enables early recognition of high-risk CPA rupture in advanced lung cancer. Prompt identification and endovascular intervention may substantially improve patient outcomes.