Sørensen H T, Mellemkjaer L, Steffensen F H, Olsen J H, Nielsen G L
Center for Epidemiologisk Grundforskning, Aarhus Universitet.
Lakartidningen. 2000 Apr 19;97(16):1961-4.
We report a nationwide study based on a cohort of patients with a thromboembolic event (TE) defined as deep venous thrombosis and/or pulmonary embolism identified from the Danish National Registry of Patients from 1977 to 1993. Cancer occurrence in the cohort was determined by linkage to the Danish Cancer Registry. Expected number of cancer cases was estimated from age, sex and site-specific incidence rates. A total of 26,653 TE-cases were identified. We observed 1737 cases of cancer versus 1371 expected (SIR 1.3; 95% CI, 1.21 to 1.33). The risk was particularly high during the first months of follow-up, but declined rapidly hereafter to a constant level slightly above 1.0 one year after the TE. Forty percent of patients diagnosed with cancer within one year from the hospitalization for TE had distant metastases at the time of cancer diagnosis. The observed risk pattern provides evidence that most often a preclinical cancer gives rise to a subsequent TE. An aggressive search for hidden cancer in patients with TE is not warranted.
我们报告了一项基于队列研究的全国性研究，该队列研究的对象为1977年至1993年丹麦国家患者登记处确定的发生血栓栓塞事件（TE，定义为深静脉血栓形成和/或肺栓塞）的患者。通过与丹麦癌症登记处的数据关联来确定该队列中的癌症发生情况。根据年龄、性别和特定部位的发病率估计癌症病例的预期数量。共识别出26,653例TE病例。我们观察到1737例癌症病例，而预期为1371例（标准化发病比[SIR]为1.3；95%置信区间[CI]为1.21至1.33）。在随访的最初几个月风险特别高，但此后迅速下降，在TE发生一年后降至略高于1.0的恒定水平。在因TE住院后一年内被诊断出癌症的患者中，40%在癌症诊断时已有远处转移。观察到的风险模式表明，大多数情况下是临床前癌症导致随后发生TE。因此，对TE患者进行积极寻找隐匿性癌症的检查并无必要。
