Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT - The Arctic University of Norway, Tromsø, Norway.
Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
J Thromb Haemost. 2017 Jul;15(7):1361-1367. doi: 10.1111/jth.13714. Epub 2017 May 28.
Essentials Recurrence risk after an occult cancer-related incident venous thromboembolism (VTE) is unknown. We compared the risk of VTE recurrence in occult-, overt- and non-cancer related first VTE. Patients with occult-cancer related first VTE had the highest risk of VTE recurrence. The high recurrence risk in occult cancer is likely due to the advanced cancers.
Background Although venous thromboembolism (VTE) is associated with a high recurrence rate, the absolute recurrence rates for cancer-related VTE, particularly occult cancer, are not well known. Objectives To investigate the risk of VTE recurrence in patients with occult and overt cancer-related VTE. Methods Incident VTE events among participants of the first to sixth Tromsø surveys occurring in the period 1994-2012 were included. Occult cancer was defined as cancer diagnosed within a year following a VTE, and overt cancer was defined as cancer diagnosed within the 2 years before a VTE. Results Among 733 patients with incident VTE, 110 had overt cancer and 40 had occult cancer. There were 95 recurrent VTE events during a median of 3.2 years of follow-up. The 1-year cumulative incidence of VTE recurrence was 38.6% in subjects with occult cancer, 15.5% in subjects with overt cancer, and 3.8% in non-cancer subjects. The 1-year risk of recurrence was 12-fold (hazard ratio [HR] 12.4, 95% confidence interval [CI] 5.9-26.3) higher in subjects with occult cancer and four-fold (HR 4.3, 95% CI 2.0-9.2) higher in subjects with overt cancer than in non-cancer subjects. The occult cancers associated with VTE recurrence were typically located at prothrombotic sites (i.e. lung and gastrointestinal) and presented at advanced stages. The majority (69%) of recurrences in subjects with occult cancer occurred before or shortly after cancer diagnosis, and were therefore not treatment-related. Conclusion Our findings suggest that the increased risk of recurrence in patients with occult cancer is mainly attributable to the advanced cancers in these patients.
静脉血栓栓塞症（VTE）与较高的复发率相关，但是癌症相关 VTE（尤其是隐匿性癌症）的绝对复发率尚不清楚。目的：调查隐匿性和显性癌症相关 VTE 患者发生 VTE 复发的风险。方法：纳入 1994 年至 2012 年期间第 1 至第 6 次特罗姆瑟调查中首次发生 VTE 的参与者。隐匿性癌症定义为 VTE 发生后 1 年内确诊的癌症，显性癌症定义为 VTE 发生前 2 年内确诊的癌症。结果：在 733 例首发 VTE 患者中，110 例患者存在显性癌症，40 例患者存在隐匿性癌症。在中位 3.2 年的随访期间，发生 95 例复发性 VTE 事件。隐匿性癌症患者 1 年 VTE 复发累积发生率为 38.6%，显性癌症患者为 15.5%，非癌症患者为 3.8%。隐匿性癌症患者的 1 年复发风险比（HR）为 12.4（95%置信区间 [CI]：5.9-26.3），显性癌症患者为 4.3（95%CI：2.0-9.2），显著高于非癌症患者。与 VTE 复发相关的隐匿性癌症通常位于促血栓形成部位（即肺和胃肠道），且处于晚期。隐匿性癌症患者的复发中有 69%（69%）发生在癌症诊断之前或之后不久，因此与治疗无关。结论：我们的研究结果表明，隐匿性癌症患者的复发风险增加主要归因于这些患者的癌症已处于晚期。
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