Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
Medical student, Stanford University School of Medicine, Stanford, California.
JAMA Facial Plast Surg. 2018 Dec 1;20(6):453-459. doi: 10.1001/jamafacial.2018.0331.
Although malignancy is an established risk factor for venous thromboembolism (VTE), the risk of VTE specifically in patients with keratinocyte carcinoma (KC) has not been previously studied.
To determine the risk of VTE in patients with KC compared with patients not diagnosed with cancer and with patients diagnosed with common malignant neoplasms associated with VTE.
DESIGN, SETTING, AND PARTICIPANTS: Population-based retrospective analysis of patient insurance claims made between January 1, 2007, and December 31, 2014, from the Truven MarketScan Commercial and Medicare Supplemental Databases. Patients treated across the United States were divided into 3 cohorts: patients with KC, patients with pancreatic cancer or acute myelogenous leukemia who are thus at high risk for VTE, and patients without a history of common malignant neoplasms. Patients were excluded from the KC cohort if they had a history of another type of cancer. Data were analyzed between April 1, 2017, and January 15, 2018.
Diagnosis of VTE within 1 year following the index date (for the KC and high-risk cohorts, the date of the initial diagnosis of cancer; for the control cohort, the date following 365 days of continuous insurance enrollment). Logistic regression was used to assess the risk of VTE in the KC cohort compared with the high-risk and control cohorts before and after matching across patient characteristics and known risk factors for VTE.
Of 5 753 613 potentially eligible patients, the final sample consisted of 740 246 patients (12.8%) across 3 cohorts. Of the 740 246 study participants, 417 839 were in the KC cohort (223 986 [53.6%] men, mean [SD] age, 64.2 [13.6] years); 314 736 were in the control cohort (135 203 [43.0%] men, 42.9 [15.2] years); and 7671 were in the high-risk cohort (3502 [45.7%] men, 59.4 [14.4] years) The risk of VTE in the KC cohort was lower compared with the high-risk cohort in univariable analysis (odds ratio [OR], 0.22; 95% CI, 0.20-0.23; P < .001), multivariable analysis (OR, 0.29; 95% CI, 0.26-0.32; P < .001), and after matching across patient characteristics and known risk factors (OR, 0.52; 95% CI, 0.35-0.78; P = .001). The risk of VTE in the KC cohort was higher in the univariable analysis (OR, 2.31; 95% CI, 2.23-2.41; P < .001), lower in the multivariable analysis (OR, 0.85; 95% CI, 0.80-0.90; P < .001), and not different after matching of patient characteristics and risk factors (OR, 0.95; 95% CI, 0.89-1.01; P = .08) than that of the control cohort.
The results of this study provided no evidence supporting the increased risk of VTE in the KC cohort compared with the control cohort. Given the inherent risks of chemoprophylaxis, the need for prophylactic anticoagulation in patients with KC who are scheduled for surgery should be carefully considered.
NA.
虽然恶性肿瘤是静脉血栓栓塞症（VTE）的既定危险因素，但角化细胞癌（KC）患者的 VTE 风险尚未得到研究。
确定与未诊断为癌症的患者和与 VTE 相关的常见恶性肿瘤诊断的患者相比，KC 患者的 VTE 风险。
设计、设置和参与者：2007 年 1 月 1 日至 2014 年 12 月 31 日期间，从 Truven MarketScan 商业和 Medicare 补充数据库中进行的基于人群的回顾性患者保险索赔分析。接受全美治疗的患者被分为 3 个队列：KC 患者、胰腺癌或急性髓样白血病患者（这些患者的 VTE 风险较高）和没有常见恶性肿瘤病史的患者。如果 KC 队列的患者有其他类型的癌症病史，则将其排除在外。数据分析于 2017 年 4 月 1 日至 2018 年 1 月 15 日进行。
在索引日期后 1 年内（对于 KC 和高危队列，为癌症的初始诊断日期；对于对照组，为连续保险登记后 365 天）诊断为 VTE。使用逻辑回归评估 KC 队列与高危和对照组在患者特征和 VTE 已知危险因素匹配前后的 VTE 风险。
在 5753613 名潜在合格患者中，最终样本由 3 个队列的 740246 名患者（417839 名男性[53.6%]，平均[SD]年龄 64.2[13.6]岁；314736 名女性[43.0%]，42.9[15.2]岁）组成。在 740246 名研究参与者中，7671 人在高危队列中（3502 名男性[45.7%]，59.4[14.4]岁）；314736 人在对照组中（135203 名男性[43.0%]，42.9[15.2]岁）；740246 人在 KC 队列中（417839 名男性[53.6%]，64.2[13.6]岁）。在单变量分析中，KC 队列的 VTE 风险低于高危队列（比值比[OR]，0.22；95%CI，0.20-0.23；P<0.001），多变量分析（OR，0.29；95%CI，0.26-0.32；P<0.001），以及在患者特征和已知危险因素匹配后（OR，0.52；95%CI，0.35-0.78；P=0.001）。在单变量分析中，KC 队列的 VTE 风险更高（OR，2.31；95%CI，2.23-2.41；P<0.001），在多变量分析中更低（OR，0.85；95%CI，0.80-0.90；P<0.001），并且在患者特征和危险因素匹配后没有差异（OR，0.95；95%CI，0.89-1.01；P=0.08）比对照组。
本研究结果没有证据支持 KC 队列的 VTE 风险高于对照组。鉴于化学预防的固有风险，应仔细考虑计划手术的 KC 患者预防性抗凝的需要。
无。
