Department of Medicine I, Medical University of Vienna, Vienna, Austria.
Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
J Thromb Haemost. 2017 Jul;15(7):1368-1374. doi: 10.1111/jth.13702. Epub 2017 May 18.
Essentials Data on long-term cancer risk are controversial in patients with venous thromboembolism (VTE). We assessed long-term rates and risk factors of cancer in patients with VTE. Cancer risk after anticoagulation is not higher in VTE patients than in the general population. VTE recurrence is not predictive of a future cancer diagnosis.
Background Patients with venous thromboembolism (VTE) are at risk of having a subsequent cancer diagnosis. The risk is highest during the first 6 months. Reports on cancer rates thereafter are controversial. We aimed to assess long-term rates and risk factors of cancer in patients with VTE. Methods and Results We followed patients with a first unprovoked VTE after discontinuation of anticoagulation, and excluded those receiving long-term antithrombotic therapy or with major thrombophilia. The study endpoint was the occurrence of cancer. Sixty-two (5.2%) of 1188 patients developed cancer during a median follow-up of 98 months. The cumulative incidence rates of cancer were 0.7% (95% confidence interval [CI] 0.2-1.2%), 3.1% (95% CI 2.0-4.1%) and 9% (95% CI 6.5-11.5) after 1, 5 and 15 years; these were not significantly different from those in the matched general population (0.6%, 3.4%, and 12.2%, respectively). The corresponding standardized incidence ratios (ratio of the observed cancer cases and the number of cases based on national cancer incidence rates) of 1.1 (95% CI 0.5-2.5), 1.0 (95% CI 0.6-1.4) and 0.9 (95% CI 0.7-1.2) did not indicate a difference in cancer incidence between our cohort and the general population. Advancing age (hazard ratio [HR] per decade 1.5, 95% CI 1.2-2.0) and shorter duration of anticoagulation (HR per 1-month decrease 1.3, 95% CI 1.1-1.6) were associated with an increased cancer risk, whereas VTE recurrence was not (HR 1.17, 95% CI 0.66-2.07). Conclusions Asymptomatic patients with unprovoked VTE who have completed anticoagulation therapy do not have a higher cancer risk. The inverse association between the duration of anticoagulation and the incidence of cancer warrants further investigation.
静脉血栓栓塞症（VTE）患者有发生后续癌症诊断的风险。在最初的 6 个月内风险最高。此后关于癌症发生率的报告存在争议。我们旨在评估 VTE 患者的长期癌症发生率和风险因素。
我们随访了抗凝治疗后首次发生无诱因 VTE 的患者，并排除了长期接受抗血栓治疗或有主要血栓形成倾向的患者。研究终点是癌症的发生。在中位随访 98 个月期间，1188 例患者中有 62 例（5.2%）发生癌症。癌症的累积发生率分别为 0.7%（95%置信区间[CI]0.2-1.2%）、3.1%（95%CI2.0-4.1%）和 9%（95%CI6.5-11.5%），1、5 和 15 年后，这些与匹配的普通人群（分别为 0.6%、3.4%和 12.2%）无显著差异。相应的标准化发病率比（观察到的癌症病例数与基于国家癌症发病率的病例数之比）分别为 1.1（95%CI0.5-2.5）、1.0（95%CI0.6-1.4）和 0.9（95%CI0.7-1.2），这表明我们的队列与普通人群之间的癌症发生率无差异。年龄增长（每增加十年的风险比[HR]为 1.5，95%CI1.2-2.0）和抗凝时间缩短（每减少 1 个月的 HR 为 1.3，95%CI1.1-1.6）与癌症风险增加相关，而 VTE 复发则不然（HR1.17，95%CI0.66-2.07）。
已完成抗凝治疗的无诱因 VTE 无症状患者的癌症风险没有增加。抗凝时间与癌症发生率之间的反比关系需要进一步研究。
