Unit for Thrombosis and Drug Research, Department of Cardiology.
Unit Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
Am J Med. 2021 Jul;134(7):868-876.e5. doi: 10.1016/j.amjmed.2021.01.031. Epub 2021 Feb 22.
The incidence of cancer-associated venous thromboembolism has increased, but whether short-term mortality after cancer-associated venous thromboembolism has changed remains uncertain. We investigated whether the increasing incidence of venous thromboembolism in cancer patients is associated with a change in mortality.
We used administrative medical registries to identify a cohort of all Danish patients diagnosed with a first primary cancer from 2006 to 2017. We examined temporal changes in 1-year risks of venous thromboembolism and in mortality risks at 30 days and 1 year after venous thromboembolism. Cox regression was used to assess changes in mortality rate ratios over time.
We included 350,272 cancer patients (median age 68 years, 49.1% female), of whom 8167 developed venous thromboembolism within 1 year after cancer diagnosis. The cumulative 1-year risk of venous thromboembolism was 1.8% in 2006-2008, increasing to 2.8% for patients diagnosed in 2015-2017. The 30-day mortality after venous thromboembolism decreased from 15.1% in 2006-2008 to 12.7% in 2015-2017, and the 1-year mortality decreased from 52.4% to 45.8%, equivalent to a hazard ratio (HR) of 0.83 (95% confidence interval [CI], 0.75-0.90). This pattern of declining 1-year mortality was consistent for patients with pulmonary embolism, HR 0.79 (95% CI, 0.69-0.90), and deep venous thrombosis, HR 0.76 (95% CI, 0.67-0.87). Lower mortality over time was evident across all strata of cancer stage, cancer type, and cancer treatment.
The 1-year risk of venous thromboembolism after a first primary cancer diagnosis in Denmark increased during 2006-2017. This increase was accompanied by declining mortality.
癌症相关静脉血栓栓塞的发病率有所增加，但癌症相关静脉血栓栓塞后的短期死亡率是否发生变化仍不确定。我们研究了癌症患者中静脉血栓栓塞发病率的增加是否与死亡率的变化有关。
我们使用行政医疗登记处确定了一个从 2006 年至 2017 年被诊断出患有第一原发性癌症的所有丹麦患者队列。我们检查了静脉血栓栓塞的 1 年风险和静脉血栓栓塞后 30 天和 1 年的死亡率风险的时间变化。Cox 回归用于评估死亡率随时间的变化率比值。
我们纳入了 350272 名癌症患者（中位年龄 68 岁，49.1%为女性），其中 8167 人在癌症诊断后 1 年内发生静脉血栓栓塞。2006-2008 年，静脉血栓栓塞的累积 1 年风险为 1.8%，而 2015-2017 年诊断出的患者则上升至 2.8%。静脉血栓栓塞后 30 天的死亡率从 2006-2008 年的 15.1%下降至 2015-2017 年的 12.7%，1 年死亡率从 52.4%下降至 45.8%，相当于危险比（HR）为 0.83（95%置信区间[CI]，0.75-0.90）。对于肺栓塞患者，这种 1 年死亡率下降的模式为 HR 0.79（95%CI，0.69-0.90），对于深静脉血栓形成患者，模式为 HR 0.76（95%CI，0.67-0.87）。随着时间的推移，在所有癌症分期、癌症类型和癌症治疗的分层中都明显降低了死亡率。
丹麦首次原发性癌症诊断后静脉血栓栓塞的 1 年风险在 2006-2017 年间有所增加。这种增加伴随着死亡率的下降。
