Walker Alex J, Grainge Matthew J, Card Tim R, West Joe, Ranta Susanna, Ludvigsson Jonas F
Division of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital, NG5 1PB UK; Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit.
Division of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital, NG5 1PB UK; Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit.
Thromb Res. 2014 Mar;133(3):340-4. doi: 10.1016/j.thromres.2013.12.021. Epub 2013 Dec 21.
Cancer is a known risk factor for venous thromboembolism (VTE) in adults, but population-based data in children are scarce.
We conducted a cohort study utilising linkage of the Clinical Practice Research Database (primary care), Hospital Episodes Statistics (secondary care), UK Cancer Registry data and Office for National Statistics cause of death data. From these databases, we selected 498 children with cancer diagnosed between 1997 and 2006 and 20,810 controls without cancer. We calculated VTE incidence rates in children with cancer vs. controls, and hazard ratios (HRs) using Cox regression.
We identified four VTE events in children with cancer compared with four events in the larger control population corresponding to absolute risks of 1.52 and 0.06 per 1000 person-years respectively. The four children with VTE and cancer were diagnosed with hematological, bone or non-specified cancer. Childhood cancer was hence associated with a highly increased risk of VTE (HR adjusted for age and sex: 28.3; 95%CI=7.0-114.5).
Children with cancer are at increased relative risk of VTE compared to those without cancer. Physicians could consider thromboprophylaxis in children with cancer to reduce their excess risk of VTE however the absolute risk is extremely small and the benefit gained therefore would need to be balanced against the risk invoked of implementing such a strategy.
NOVELTY & IMPACT STATEMENTS: While there is a reasonable level of knowledge about the risk of VTE in adult populations, it is not well known whether this risk is reflected in paediatric patients. We found a substantial increase in risk of VTE in children with cancer compared to a child population without cancer. While this finding is important, the absolute risk of VTE is still low and must be balanced with the risks of anticoagulation.
癌症是成人静脉血栓栓塞症（VTE）的已知风险因素，但儿童的基于人群的数据稀缺。
我们进行了一项队列研究，利用临床实践研究数据库（初级保健）、医院事件统计（二级保健）、英国癌症登记数据和国家统计局死因数据的关联。从这些数据库中，我们选择了1997年至2006年间诊断出的498名癌症儿童和20,810名无癌症对照。我们计算了癌症儿童与对照的VTE发病率以及使用Cox回归的风险比（HRs）。
我们在癌症儿童中识别出4例VTE事件，而在较大的对照人群中也有4例事件，相应的每1000人年的绝对风险分别为1.52和0.06。4例患有VTE和癌症的儿童被诊断患有血液、骨骼或未特定的癌症。因此，儿童癌症与VTE风险的大幅增加相关（根据年龄和性别调整后的HR：28.3；95%CI = 7.0 - 114.5）。
与无癌症儿童相比，癌症儿童发生VTE的相对风险增加。医生可考虑对癌症儿童进行血栓预防以降低其VTE的额外风险，然而绝对风险极小，因此获得的益处需要与实施该策略带来的风险相权衡。
虽然对成人人群中VTE风险有一定程度的了解，但尚不清楚这种风险在儿科患者中是否存在。我们发现与无癌症儿童人群相比，癌症儿童的VTE风险大幅增加。虽然这一发现很重要，但VTE的绝对风险仍然很低，必须与抗凝风险相平衡。
