Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Perugia, Italy.
Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Calabria, Italy.
Thromb Haemost. 2020 May;120(5):847-856. doi: 10.1055/s-0040-1709527. Epub 2020 May 5.
Venous thromboembolism (VTE) is a major cause of death in cancer patients. Although patients with cancer have numerous risk factors for VTE, the relative contribution of cancer treatments is unclear.
The objective of this study is to evaluate the association between cancer therapies and the risk of VTE.
From UK Clinical Practice Research Datalink, data on patients with first cancer diagnosis between 2008 and 2016 were extracted along with information on hospitalization, treatments, and cause of death. Primary outcome was active cancer-associated VTE. To establish the independent effects of risk factors, adjusted subhazard ratios (adj-SHR) were calculated using Fine and Gray regression analysis accounting for death as competing risk.
Among 67,801 patients with a first cancer diagnosis, active cancer-associated VTE occurred in 1,473 (2.2%). During a median observation time of 1.2 years, chemotherapy, surgery, hormonal therapy, radiation therapy, and immunotherapy were given to 71.1, 37.2, 17.2, 17.5, and 1.4% of patients with VTE, respectively. The active cancers associated with the highest risk of VTE-as assessed by incidence rates-included pancreatic cancer, brain cancer, and metastatic cancer. Chemotherapy was associated with an increased risk of VTE (adj-SHR: 3.17, 95% confidence interval [CI]: 2.76-3.65) while immunotherapy with a not significant reduced risk (adj-SHR: 0.67, 95% CI: 0.30-1.52). There was no association between VTE and radiation therapy (adj-SHR: 0.91, 95% CI: 0.65-1.27) and hormonal therapies.
VTE risk varies with cancer type. Chemotherapy was associated with an increased VTE risk, whereas with radiation and immunotherapy therapy, an association was not confirmed.
静脉血栓栓塞症（VTE）是癌症患者死亡的主要原因。尽管癌症患者有许多 VTE 的风险因素，但癌症治疗的相对贡献尚不清楚。
本研究旨在评估癌症治疗与 VTE 风险之间的关系。
从英国临床实践研究数据链接中提取了 2008 年至 2016 年间首次癌症诊断的患者数据，以及住院、治疗和死亡原因的信息。主要结局是活动性癌症相关 VTE。为了确定危险因素的独立影响，使用 Fine 和 Gray 回归分析计算了调整后的亚危险比（adj-SHR），该分析考虑了死亡作为竞争风险。
在 67801 例首次癌症诊断的患者中，活动性癌症相关 VTE 发生在 1473 例（2.2%）。在中位观察时间为 1.2 年期间，分别有 71.1%、37.2%、17.2%、17.5%和 1.4%的 VTE 患者接受了化疗、手术、激素治疗、放疗和免疫治疗。根据发病率评估，与 VTE 风险最高相关的活动性癌症包括胰腺癌、脑癌和转移性癌症。化疗与 VTE 风险增加相关（adj-SHR：3.17，95%置信区间[CI]：2.76-3.65），而免疫治疗则与风险降低无关（adj-SHR：0.67，95%CI：0.30-1.52）。VTE 与放疗（adj-SHR：0.91，95%CI：0.65-1.27）和激素治疗之间没有关联。
VTE 风险因癌症类型而异。化疗与 VTE 风险增加相关，而放疗和免疫治疗则未证实存在关联。
