Christensen Diana Hedevang, Horváth-Puhó Erzsébet, Thomsen Reimar Wernich, Knudsen Søren Tang, Dekkers Olaf, Prandoni Paolo, Sørensen Henrik Toft
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Norrebrogade 44, 8000 Aarhus C, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark.
J Diabetes Complications. 2016 May-Jun;30(4):603-7. doi: 10.1016/j.jdiacomp.2016.01.011. Epub 2016 Jan 15.
Venous thromboembolism (VTE) has long been regarded as a marker of underlying malignancy in the general population. Patients with diabetes mellitus are at increased risk of developing VTE, but it is unclear whether VTE in diabetes patients is also a harbinger of occult cancer.
From Danish medical health databases, we identified all diabetes patients (N=8783) with a first-time diagnosis of VTE during 1978-2011. We followed the patients until a first-time diagnosis of cancer, emigration, death, or study end, whichever came first. We calculated one-year absolute cancer risk and overall and site-specific standardized incidence ratios (SIRs) for cancer based on national cancer incidence.
During the total study period 878 cancers were observed. The one-year absolute cancer risk was 4.1% and the corresponding SIR was 3.28 (95% confidence interval [CI]: 2.94-3.64). The highest SIRs were observed for cancers of the gallbladder and biliary tract (SIR 13.59; 6.77-24.31), the pancreas (SIR 10.16; 6.85-14.50), the ovary (SIR 9.85; 5.63-16.00), and the liver (SIR 9.39; 4.30-17.84). After the first year of follow-up, the overall cancer SIR associated with VTE and diabetes decreased to 1.05 (95% CI: 0.97-1.15).
VTE may be a marker of underlying cancer in patients with diabetes mellitus.
长期以来，静脉血栓栓塞症（VTE）一直被视为普通人群潜在恶性肿瘤的一个标志。糖尿病患者发生VTE的风险增加，但尚不清楚糖尿病患者的VTE是否也是隐匿性癌症的先兆。
我们从丹麦医疗卫生数据库中识别出1978年至2011年间首次诊断为VTE的所有糖尿病患者（N = 8783）。我们对这些患者进行随访，直至首次诊断出癌症、移民、死亡或研究结束，以先发生者为准。我们根据国家癌症发病率计算了一年期绝对癌症风险以及癌症的总体和特定部位标准化发病率（SIR）。
在整个研究期间，共观察到878例癌症。一年期绝对癌症风险为4.1%，相应的SIR为3.28（95%置信区间[CI]：2.94 - 3.64）。胆囊和胆道癌（SIR 13.59；6.77 - 24.31）、胰腺癌（SIR 10.16；6.85 - 14.50）、卵巢癌（SIR 9.85；5.63 - 16.00）和肝癌（SIR 9.39；4.30 - 17.84）的SIR最高。随访第一年之后，与VTE和糖尿病相关的总体癌症SIR降至1.05（95% CI：0.97 - 1.15）。
VTE可能是糖尿病患者潜在癌症的一个标志。
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