White Richard H, Chew Helen K, Zhou Hong, Parikh-Patel Arti, Harris David, Harvey Danielle, Wun Theodore
Departments of Internal Medicine, Medicine, Medicine and Statistics, and Public Health Sciences, University of California Davis, Sacramento, CA 95817, USA.
Arch Intern Med. 2005;165(15):1782-7. doi: 10.1001/archinte.165.15.1782.
It is unclear how frequently unprovoked venous thromboembolism (VTE) reflects the presence of an occult cancer.
The California Cancer Registry was used to identify diagnosed cases of 19 common malignancies during a 6-year period. Cases were linked to a hospital discharge database to identify incident VTE events in the year before the cancer diagnosis date. The standardized incidence ratio (SIR) of unprovoked VTE was determined by using the age-, race-, and sex-specific incidence rates in California.
Among 528,693 cancer cases, 596 (0.11%) were associated with a diagnosis of unprovoked VTE within 1 year of the cancer diagnosis, compared with 443.0 expected cases (SIR, 1.3; 95% confidence interval, 1.2-1.5; P<.001). Among cases with metastatic-stage cancer, the SIR was 2.3 (95% confidence interval, 2.0-2.6; P<.001), whereas for all other stages, the SIR was 1.07 (95% confidence interval, 0.97-1.18; P = .09). The incidence of preceding VTE was increased over that expected only during the 4-month period immediately preceding the cancer diagnosis date (P<.001). Only 7 cancer types were associated with a significantly elevated SIR: acute myelogenous leukemia; non-Hodgkin lymphoma; and renal cell, ovarian, pancreatic, stomach, and lung cancer (SIR range, 1.8-4.2).
In the year preceding the diagnosis of cancer, the number of cases with unprovoked VTE was modestly higher than expected, and almost all of the unexpected VTE cases were associated with a diagnosis of metastatic-stage cancer within 4 months. Given the timing and advanced stage of the unexpected cases, it is unlikely that earlier diagnosis of these cancers would have significantly improved long-term survival.
不明原因的静脉血栓栓塞症（VTE）反映隐匿性癌症存在的频率尚不清楚。
利用加利福尼亚癌症登记处来识别6年间确诊的19种常见恶性肿瘤病例。将这些病例与医院出院数据库相链接，以识别癌症诊断日期前一年的VTE事件。通过使用加利福尼亚州特定年龄、种族和性别的发病率来确定不明原因VTE的标准化发病率（SIR）。
在528,693例癌症病例中，596例（0.11%）在癌症诊断后1年内被诊断为不明原因VTE，而预期病例为443.0例（SIR为1.3；95%置信区间为1.2 - 1.5；P <.001）。在转移性癌症病例中，SIR为2.3（95%置信区间为2.0 - 2.6；P <.001），而对于所有其他阶段，SIR为1.07（95%置信区间为0.97 - 1.18；P = 0.09）。仅在癌症诊断日期前4个月期间，先前VTE的发病率高于预期（P <.001）。只有7种癌症类型与显著升高的SIR相关：急性髓细胞白血病、非霍奇金淋巴瘤以及肾细胞癌、卵巢癌、胰腺癌、胃癌和肺癌（SIR范围为1.8 - 4.2）。
在癌症诊断前一年，不明原因VTE病例数略高于预期，几乎所有意外的VTE病例都与4个月内转移性癌症的诊断相关。鉴于意外病例的时间和晚期阶段，早期诊断这些癌症不太可能显著改善长期生存率。
