Ahern Thomas P, Horváth-Puhó Erzsébet, Spindler Karen-Lise Garm, Sørensen Henrik Toft, Ording Anne G, Erichsen Rune
Departments of Surgery and Biochemistry, University of Vermont College of Medicine, 89 Beaumont Avenue, Given D317A, Burlington, VT 05405, USA.
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark.
Br J Cancer. 2016 Jan 12;114(1):96-102. doi: 10.1038/bjc.2015.406. Epub 2015 Dec 1.
Venous thromboembolism (VTE) is a major source of morbidity and mortality in cancer patients. Incident colorectal cancer (CRC) and comorbidity both predict VTE, but potential synergy between these factors has not been explored.
Danish nationwide cohort study of CRC cases diagnosed in 1995-2010 and a matched general population reference cohort of subjects without CRC who matched cases on age, sex, and comorbidities. We calculated the Charlson Comorbidity Index using diagnoses recorded in the Danish National Patient Registry. We calculated standardised incidence rates (SIRs) and interaction contrasts (IC) to measure additive interaction between comorbidity and CRC status with respect to 5-year VTE incidence.
Among 56 189 CRC patients, 1372 VTE cases were diagnosed over 145 211 person-years (SIR=9.5 cases per 1000 person-years). Among 271 670 reference subjects, 2867 VTE cases were diagnosed over 1 068 860 person-years (SIR=2.8 cases per 1000 person-years). CRC and comorbidity were positively and independently associated with VTE, but there was no evidence for biological interaction between these factors (e.g., comparing the 'severe comorbidity' stratum with the 'no comorbidity' stratum, IC=0.8, 95% CI: -3.3, 4.8).
There is neither a deficit nor a surplus of VTE cases among patients with both comorbidity and CRC, compared with rates expected from these risk factors in isolation.
静脉血栓栓塞症（VTE）是癌症患者发病和死亡的主要原因。初发性结直肠癌（CRC）和合并症均预示着VTE，但尚未探讨这些因素之间的潜在协同作用。
对1995 - 2010年诊断出的CRC病例进行丹麦全国队列研究，并建立一个匹配的普通人群对照队列，对照人群在年龄、性别和合并症方面与病例匹配。我们使用丹麦国家患者登记处记录的诊断信息计算查尔森合并症指数。我们计算标准化发病率（SIRs）和交互对比（IC），以衡量合并症和CRC状态在5年VTE发病率方面的相加交互作用。
在56189例CRC患者中，在145211人年期间诊断出1372例VTE病例（SIR =每1000人年9.5例）。在271670名对照受试者中，在1068860人年期间诊断出2867例VTE病例（SIR =每1000人年2.8例）。CRC和合并症与VTE呈正相关且相互独立，但没有证据表明这些因素之间存在生物学交互作用（例如，比较“重度合并症”组与“无合并症”组，IC = 0.8，95% CI：-3.3，4.8）。
与单独由这些风险因素预期的发病率相比，合并症和CRC患者中的VTE病例既没有不足也没有过剩。
