Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Cancer. 2015 Oct 15;121(20):3692-9. doi: 10.1002/cncr.29535. Epub 2015 Jul 6.
Venous thromboembolism (VTE) is a serious complication of cancer. It is unknown whether comorbidity interacts clinically with prostate cancer (PC) to increase the VTE rate beyond that explained by PC and comorbidity alone, for example, by delaying diagnosis or precluding treatment.
A nationwide, registry-based cohort study of all 44,035 Danish patients diagnosed with PC from 1995 to 2011 and 213,810 men from the general population matched 5:1 on age, calendar time, and comorbidities. The authors calculated VTE rate ratios and the interaction contrast as a measure on the additive scale of the excess VTE rate explained by synergy between PC and comorbidity.
In total, 849 patients in the PC cohort and 2360 men from the general population had VTE during 5 years of follow-up, and their risk of VTE was 2.2% and 1.3%, respectively. The 1-year VTE standardized rate among PC patients who had high comorbidity levels was 15 per 1000 person-years (PYs) (95% confidence interval, 6.8-24 per 1000 PYs), and 29% of that rate was explained by an interaction between PC and comorbidity. The VTE risk was increased among older patients, those with metastases, those with high Gleason scores, those in the D'Amico high-risk group, and those who underwent surgery.
PC interacted clinically with high comorbidity levels and increased the VTE rate. Because of the large PC burden, reducing VTEs associated with comorbidities may have an impact on VTE risk and the potential to improve prognosis. Clinical interactions between high levels of comorbidity and PC on the risk of VTE were observed. Almost 30% of all episodes of VTE occurred among patients who had high levels of comorbidity.
静脉血栓栓塞症（VTE）是癌症的一种严重并发症。目前尚不清楚合并症是否会与前列腺癌（PC）在临床上相互作用，从而导致 VTE 发生率超过 PC 和合并症单独作用的解释，例如，延迟诊断或排除治疗。
本研究是一项全国范围内、基于登记的队列研究，纳入了 1995 年至 2011 年间所有 44035 名被诊断为 PC 的丹麦患者和 213810 名来自普通人群的男性，按年龄、日历时间和合并症以 5:1 的比例进行匹配。作者计算了 VTE 发生率比和交互对比，作为协同作用导致的 VTE 发生率超过预期的加性尺度的度量指标。
在 PC 队列中，共有 849 例患者和普通人群中的 2360 例男性在 5 年的随访期间发生了 VTE，他们的 VTE 风险分别为 2.2%和 1.3%。在合并症水平较高的 PC 患者中，1 年 VTE 标准化发生率为 15 例/1000 人年（95%置信区间，6.8-24 例/1000 人年），其中 29%的发生率是由 PC 和合并症之间的相互作用解释的。VTE 风险随着患者年龄的增加、出现转移、Gleason 评分较高、D'Amico 高危组和接受手术而增加。
PC 与高合并症水平在临床上相互作用，增加了 VTE 发生率。由于 PC 的负担较大，降低与合并症相关的 VTE 可能会对 VTE 风险和改善预后产生影响。观察到高合并症水平与 PC 之间的临床相互作用对 VTE 风险的影响。所有 VTE 发作中有近 30%发生在合并症水平较高的患者中。
