深静脉血栓形成与后续症状性癌症的发生率

Deep-vein thrombosis and the incidence of subsequent symptomatic cancer.

作者信息

Prandoni P, Lensing A W, Büller H R, Cogo A, Prins M H, Cattelan A M, Cuppini S, Noventa F, ten Cate J W

机构信息

Second Department of Internal Medicine, University Hospital of Padua, Italy.

出版信息

N Engl J Med. 1992 Oct 15;327(16):1128-33. doi: 10.1056/NEJM199210153271604.

DOI:10.1056/NEJM199210153271604

PMID:1528208

Abstract

BACKGROUND

In contrast to the established relation between overt cancer and subsequent venous thromboembolism, it is unclear whether symptomatic deep-vein thrombosis is associated with a risk of subsequent overt malignant disease.

METHODS

Two hundred sixty consecutive patients with symptomatic, venographically proved deep-vein thrombosis were enrolled in a study, of whom 250 were followed during a two-year period. Among those assessed during follow-up, the incidence of subsequently detected cancer in the 105 patients with secondary venous thrombosis (i.e., thrombosis associated with a well-recognized risk factor other than cancer) was compared with the incidence of cancer in the 145 patients with idiopathic venous thrombosis.

RESULTS

Routine examination at the time of diagnosis of the venous thrombosis revealed cancer in 5 of the 153 enrolled patients with idiopathic venous thrombosis (3.3 percent) and in none of the 107 enrolled patients with secondary venous thrombosis. During follow-up, overt cancer developed in 2 of the 105 patients with secondary venous thrombosis (1.9 percent) and in 11 of the 145 patients with idiopathic venous thrombosis (7.6 percent; odds ratio, 2.3; 95 percent confidence interval, 1.0 to 5.2; P = 0.043). Of the 145 patients with idiopathic venous thrombosis, 35 had confirmed recurrent thromboembolism. Overt cancer subsequently developed in 6 of the 35 (17.1 percent). The incidence of cancer in the patients with recurrent idiopathic venous thrombosis was higher than that in the patients with secondary venous thrombosis (P = 0.008; odds ratio, 9.8; 95 percent confidence interval, 1.8 to 52.2) or in the patients with idiopathic venous thrombosis that did not recur (P = 0.024; odds ratio, 4.3; 95 percent confidence interval, 1.2 to 15.3).

CONCLUSIONS

There is a statistically significant and clinically important association between idiopathic venous thrombosis and the subsequent development of clinically overt cancer, especially among patients in whom venous thromboembolism recurs during follow-up.

摘要

背景

与已明确的显性癌症和随后发生静脉血栓栓塞之间的关系不同，有症状的深静脉血栓形成是否与随后发生显性恶性疾病的风险相关尚不清楚。

方法

连续纳入260例经静脉造影证实有症状的深静脉血栓形成患者，其中250例在两年期间接受随访。在随访期间接受评估的患者中，将105例继发性静脉血栓形成（即与癌症以外的公认危险因素相关的血栓形成）患者中随后检测到癌症的发生率与145例特发性静脉血栓形成患者中癌症的发生率进行比较。

结果

在诊断静脉血栓形成时的常规检查发现，153例纳入研究的特发性静脉血栓形成患者中有5例（3.3%）患有癌症，而107例纳入研究的继发性静脉血栓形成患者中均未发现癌症。在随访期间，105例继发性静脉血栓形成患者中有2例（1.9%）发生显性癌症，145例特发性静脉血栓形成患者中有11例（7.6%）发生显性癌症；比值比为2.3，95%置信区间为1.0至5.2，P = 0.043。在145例特发性静脉血栓形成患者中，35例确诊有复发性血栓栓塞。随后，35例中有6例（17.1%）发生显性癌症。复发性特发性静脉血栓形成患者中癌症的发生率高于继发性静脉血栓形成患者（P = 0.008；比值比为9.8，95%置信区间为1.8至52.2）或未复发的特发性静脉血栓形成患者（P = 0.024；比值比为4.3，95%置信区间为1.2至15.3）。