Shantakumar Sumitra, Connelly-Frost Alexandra, Kobayashi Monica G, Allis Robert, Li Li
Worldwide Epidemiology, Research and Development, GlaxoSmithKline, 150 Beach Road, #26-00 Gateway West, Singapore, 189720 Singapore.
Frost Consulting, Epidemiologic Research and Grant Writing, Charlotte, NC USA.
Clin Sarcoma Res. 2015 Jul 26;5:18. doi: 10.1186/s13569-015-0033-z. eCollection 2015.
Venous thromboembolic co-morbidities can have a significant impact on treatment response, treatment options, quality of life, and ultimately, survival from cancer. There is a dearth of published information on venous thromboembolic co-morbidity among older soft tissue sarcoma patients.
SEER-Medicare linked data (1993-2005) was utilized for this retrospective cohort analysis (n = 3,480 soft tissue sarcoma patients). Non-cancer patients were frequency-matched by age to cancer patients at a ratio of 1:1; coverage and follow-up requirements were the same as for soft tissue sarcoma cases. Venous thromboembolic events were divided into three groups of interest: deep vein thrombosis, pulmonary embolism, and other thromboembolic events. Relative incidence rates of venous thromboembolic events in soft tissue sarcoma patients with a recent history of cardiovascular event or venous thromboembolic event (12 months before diagnosis) versus soft tissue sarcoma patients without such a recent history were calculated using the Cox proportional hazard models. The Cox proportional hazard model was used to build predictive models to identify important risk factors for each venous thromboembolic event of interest among soft tissue sarcoma patients. Relative incidence rate of VTEs in cancer patients (12 months after diagnosis) versus non-cancer cases (12 months after index date) was calculated using multivariable Cox proportional hazard models.
We observed that among older soft tissue sarcoma patients, 10.6% experienced a deep vein thrombosis, 3.0% experienced a pulmonary embolism, and 3.1% experienced other thromboembolic events in the 12 months after sarcoma diagnosis. On average, 60% of venous thromboembolic events occurred in the first 90 days after sarcoma diagnosis. The highest rates of deep vein thrombosis and pulmonary embolism after sarcoma diagnosis were seen in patients with sarcoma not otherwise specified (deep vein thrombosis: 204/1,000 p-y and pulmonary embolism: 50/1,000 p-y). Recent history of a venous thromboembolic event was the strongest predictor of a subsequent venous thromboembolic event after soft tissue sarcoma diagnosis.
Venous thromboembolic events are common and serious co-morbidities that should be closely monitored in older soft tissue sarcoma patients.
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生存率产生重大影响。关于老年软组织肉瘤患者静脉血栓栓塞合并症的已发表信息匮乏。
利用监测、流行病学与最终结果（SEER）医保关联数据（1993 - 2005年）进行这项回顾性队列分析（n = 3480例软组织肉瘤患者）。非癌症患者按年龄与癌症患者以1:1的比例进行频率匹配；覆盖范围和随访要求与软组织肉瘤病例相同。静脉血栓栓塞事件分为三组关注事件：深静脉血栓形成、肺栓塞和其他血栓栓塞事件。使用Cox比例风险模型计算近期有心血管事件或静脉血栓栓塞事件病史（诊断前12个月）的软组织肉瘤患者与无此类近期病史的软组织肉瘤患者静脉血栓栓塞事件的相对发病率。使用Cox比例风险模型构建预测模型，以识别软组织肉瘤患者中每种关注的静脉血栓栓塞事件的重要风险因素。使用多变量Cox比例风险模型计算癌症患者（诊断后12个月）与非癌症病例（索引日期后12个月）静脉血栓栓塞事件的相对发病率。
我们观察到，在老年软组织肉瘤患者中，10.6%在肉瘤诊断后的12个月内发生了深静脉血栓形成，3.0%发生了肺栓塞，3.1%发生了其他血栓栓塞事件。平均而言，60%的静脉血栓栓塞事件发生在肉瘤诊断后的前90天内。在未另行指定的肉瘤患者中，肉瘤诊断后深静脉血栓形成和肺栓塞的发生率最高（深静脉血栓形成：204/1000人年，肺栓塞：50/1000人年）。近期静脉血栓栓塞事件病史是软组织肉瘤诊断后后续静脉血栓栓塞事件的最强预测因素。
静脉血栓栓塞事件是常见且严重的合并症，在老年软组织肉瘤患者中应密切监测。
