老年肾细胞癌患者静脉血栓栓塞事件发生率增加：SEER-医疗保险数据的回顾性队列研究。

Older renal cell cancer patients experience increased rates of venous thromboembolic events: a retrospective cohort study of SEER-Medicare data.

出版信息

BMC Cancer. 2013 Apr 27;13:209. doi: 10.1186/1471-2407-13-209.

PMID:23621951

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3648500/

Abstract

BACKGROUND

Venous thromboembolic co-morbidities can have a significant impact on treatment response, treatment options, quality of life, and ultimately, survival from cancer. The extent of venous thromboembolic co-morbidity among older renal cell cancer patients is poorly described in the literature. It is important to understand the scope of venous thromboembolic events, before and after diagnosis, in order to offer renal cell cancer patients optimal care and improved quality of life.

METHODS

The main goal of this study was to estimate and describe the incidence of venous thromboembolic events before and after renal cell cancer diagnosis. SEER-Medicare linked data (1991-2003) was utilized for this retrospective cohort analysis (n = 11,950) of older renal cell cancer patients (≥ 65 years). Incidence rates and proportions in addition to multivariable Cox proportional hazard and logistic regression models were utilized to describe the incidence and relative risk of venous thromboembolic events.

RESULTS

We observed that in the 12 months after diagnosis, 8.3% of renal cell cancer patients experienced a deep venous thrombosis, 2.4% experienced a pulmonary embolism, and 3.9% experienced other thromboembolic events. Nearly 70% of venous thromboembolic events occurred in the first 90 days after renal cell cancer diagnosis. Renal cell cancer patients were 2-4 times more likely to have a venous thromboembolic event in the 12 months after cancer diagnosis than non-cancer patients followed during the same time frame. Recent history of a venous event substantially increased the risk of that same event in the 12 months after diagnosis (HR = 5.2-18.8).

CONCLUSION

Venous thromboembolic events are common and serious co-morbidities that should be closely monitored in older renal cell cancer patients, particularly during the first 3 months following diagnosis and among those with a recent history of a venous thromboembolic event.

摘要

背景

静脉血栓栓塞合并症会对治疗反应、治疗选择、生活质量，以及最终的癌症患者生存产生重大影响。老年肾细胞癌患者静脉血栓栓塞合并症的程度在文献中描述得很少。了解诊断前后静脉血栓栓塞事件的范围对于为肾细胞癌患者提供最佳护理和提高生活质量非常重要。

方法

本研究的主要目的是估计和描述肾细胞癌诊断前后静脉血栓栓塞事件的发生率。利用 SEER-Medicare 关联数据（1991-2003 年）对 11950 例老年肾细胞癌患者（≥65 岁）进行回顾性队列分析。使用发病率比率和比例以及多变量 Cox 比例风险和逻辑回归模型来描述静脉血栓栓塞事件的发生率和相对风险。

结果

我们观察到，在诊断后的 12 个月内，8.3%的肾细胞癌患者发生深静脉血栓形成，2.4%发生肺栓塞，3.9%发生其他血栓栓塞事件。近 70%的静脉血栓栓塞事件发生在肾细胞癌诊断后的前 90 天。与同期接受治疗的非癌症患者相比，肾细胞癌患者在癌症诊断后 12 个月内发生静脉血栓栓塞事件的可能性高 2-4 倍。近期静脉事件史大大增加了诊断后 12 个月内发生相同事件的风险（HR=5.2-18.8）。