Smith Angela B, Horvath-Puhó Erzsébet, Nielsen Matthew E, Lash Timothy L, Baron John A, Sørensen Henrik T
Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Urol Oncol. 2014 May;32(4):466-72. doi: 10.1016/j.urolonc.2013.07.008.
Venous thromboembolism (VTE) is associated with renal cell carcinoma (RCC), but data on the effect of comorbidities are limited. Therefore, our purpose was to determine the effect of comorbidity on VTE risk among patients with RCC.
A population-based cohort of all patients with RCC (n = 8,633) diagnosed in Denmark between 1995 and 2010 and a comparison cohort selected from the general population and matched on age, sex, and comorbidities (n = 83,055) were identified. Risk of subsequent VTE was estimated with 95% CI for the first 3 months, 1 year, and 5 years following cancer diagnosis. We stratified by Charlson comorbidity index (CCI) scores to estimate excess risk in patients with RCC vs. the comparison cohort within comorbidity strata. We also performed subanalyses for postoperative VTE and metastases.
VTE risk was higher in the RCC compared with comparison cohort, particularly during the initial year following diagnosis (risk difference = 9.9 per 1,000 persons [95% CI: 7.7-12.2]). After stratifying by CCI, excess risk declined with increasing comorbidities. The risk difference was 12.3 per 1,000 persons (95% CI: 9.1-15.5) for CCI = 0 and 0.5 (95% CI: 6.0-7.0) for CCI = 4. Excess risk also declined with increasing comorbidities among patients with postoperative VTE and among those with metastases.
RCC is associated with increased risk of VTE when compared with a matched general population cohort. Risk did not appear to increase with added comorbidity burden. Clinical attention to VTE risk in patients with RCC is appropriate regardless of the presence or absence of comorbidities.
静脉血栓栓塞症（VTE）与肾细胞癌（RCC）相关，但关于合并症影响的数据有限。因此，我们的目的是确定合并症对RCC患者VTE风险的影响。
确定了1995年至2010年间在丹麦诊断的所有RCC患者的基于人群的队列（n = 8633），以及从普通人群中选取的按年龄、性别和合并症匹配的对照队列（n = 83055）。在癌症诊断后的前3个月、1年和5年，估计随后发生VTE的风险及95%置信区间。我们按查尔森合并症指数（CCI）评分进行分层，以估计RCC患者与对照队列在合并症分层内的额外风险。我们还对术后VTE和转移进行了亚分析。
与对照队列相比，RCC患者的VTE风险更高，尤其是在诊断后的最初一年（风险差异为每1000人9.9例[95%置信区间：7.7 - 12.2]）。按CCI分层后，随着合并症增加，额外风险降低。CCI = 0时风险差异为每1000人12.3例（95%置信区间：9.1 - 15.5），CCI = 4时为0.5例（95%置信区间：6.0 - 7.0）。术后VTE患者和有转移的患者中，额外风险也随着合并症增加而降低。
与匹配的普通人群队列相比，RCC与VTE风险增加相关。风险似乎并未随着合并症负担的增加而增加。无论有无合并症，对RCC患者的VTE风险给予临床关注都是合适的。
