Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT The Arctic University of Norway, Tromsø, Norway.
J Thromb Haemost. 2017 Aug;15(8):1567-1575. doi: 10.1111/jth.13752. Epub 2017 Jul 11.
Essentials Impact of cancer stage on venous thromboembolism (VTE) risk is not well-known in all cancers. The Scandinavian Thrombosis and Cancer Cohort provides person-time data and validated VTEs. Impact of cancer stage on VTE incidence tended to vary with cancer type. Cancer stage may not per se be a risk factor for VTE in all cancer types.
Background Absolute measures of the impact of cancer stage on the incidence of venous thromboembolism (VTE) in patients with distinct cancer types have not been investigated in a large population-based cohort study. Objectives To investigate differences in the incidence rates of objectively confirmed VTE according to the development of cancer in a large population-based cohort study. Cancer type and stage at the time of diagnosis were taken into account. Patients and Methods The Scandinavian Thrombosis and Cancer Cohort includes data regarding cancer types, stages and objectively confirmed VTE diagnoses among 144 952 participants followed from 1993 to 2012. We studied stage-specific incidence rates of VTE, and calculated incidence rate differences (IRDs) for VTE according to stages in patients with 10 types of solid cancer. Results During the entire follow-up, 335 VTEs occurred, of which 293 occurred within 5 years. The IRD of VTE in patients with distant metastasis as compared with those with localized disease indicated large variation depending on cancer type. The highest IRD was observed for pancreatic cancer (IRD of 187.0 × 10 person-years [p-y]; 95% confidence interval [CI] - 6.7 to 380.8), and the lowest IRD was observed for prostate cancer (IRD of 3.7 × 10 p-y; 95% CI - 7 to 15.2). Regional spread as compared with localized disease also indicated large variation depending on cancer type; the highest IRD was observed for uterine cancer (IRD of 37.6 × 10 p-y; 95% CI - 23.7 to 99), and the IRDs for breast and prostate cancer were close to zero. Conclusion More advanced cancer at the time of diagnosis was associated with a higher risk of VTE, but the strength of the associations differed substantially between cancer types.
在一项大型基于人群的队列研究中，尚未调查不同癌症类型患者的癌症分期对静脉血栓栓塞症（VTE）发生率的绝对影响。
斯堪的纳维亚血栓形成和癌症队列包括 144952 名参与者的数据，这些参与者从 1993 年至 2012 年进行了癌症类型、分期和客观确认的 VTE 诊断的随访。我们研究了 VTE 的分期特异性发生率，并根据 10 种实体癌患者的分期计算了 VTE 的发病率差异（IRD）。
在整个随访期间，发生了 335 例 VTE，其中 293 例发生在 5 年内。与局限性疾病相比，转移性疾病患者 VTE 的 IRD 差异根据癌症类型而有很大差异。胰腺癌的 IRD 最高（187.0×10 人年[py]；95%置信区间[CI]为 6.7 至 380.8），前列腺癌的 IRD 最低（3.7×10 py；95%CI 为-7 至 15.2）。与局限性疾病相比，区域性扩散也因癌症类型而异；子宫癌的 IRD 最高（37.6×10 py；95%CI 为 23.7 至 99），而乳腺癌和前列腺癌的 IRD 接近零。
诊断时更晚期的癌症与 VTE 风险增加相关，但关联强度在癌症类型之间存在显著差异。
