Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
Department of Anesthesiology and Intensive Care, Danube Hospital, Langobardenstraße 122, Vienna 1220, Austria.
Eur Heart J. 2021 Jun 14;42(23):2299-2307. doi: 10.1093/eurheartj/ehab171.
An interrelation between cancer and thrombosis is known, but population-based studies on the risk of both arterial thromboembolism (ATE) and venous thromboembolism (VTE) have not been performed.
International Classification of Disease 10th Revision (ICD-10) diagnosis codes of all publicly insured persons in Austria (0-90 years) were extracted from the Austrian Association of Social Security Providers dataset covering the years 2006-07 (n = 8 306 244). Patients with a history of cancer or active cancer were defined as having at least one ICD-10 'C' diagnosis code, and patients with ATE and/or VTE as having at least one of I21/I24 (myocardial infarction), I63/I64 (stroke), I74 (arterial embolism), and I26/I80/I82 (venous thromboembolism) diagnosis code. Among 158 675 people with cancer, 8559 (5.4%) had an ATE diagnosis code and 7244 (4.6%) a VTE diagnosis code. In contrast, among 8 147 569 people without cancer, 69 381 (0.9%) had an ATE diagnosis code and 29 307 (0.4%) a VTE diagnosis code. This corresponds to age-stratified random-effects relative risks (RR) of 6.88 [95% confidence interval (CI) 4.81-9.84] for ATE and 14.91 (95% CI 8.90-24.95) for VTE. ATE proportion was highest in patients with urinary tract malignancies (RR: 7.16 [6.74-7.61]) and lowest in patients with endocrine cancer (RR: 2.49 [2.00-3.10]). The corresponding VTE proportion was highest in cancer of the mesothelium/soft tissue (RR: 19.35 [17.44-21.47]) and lowest in oropharyngeal cancer (RR: 6.62 [5.61-7.81]).
The RR of both ATE and VTE are significantly higher in persons with cancer. Our population-level meta-data indicate a strong association between cancer, ATE and VTE, and support the concept of shared risk factors and pathobiology between these diseases.Relative risk of ATE and VTE in persons with a cancer diagnosis code versus persons without a cancer diagnosis code.
已知癌症与血栓之间存在关联，但尚未开展基于人群的动脉血栓栓塞（ATE）和静脉血栓栓塞（VTE）风险研究。
从涵盖 2006-07 年的奥地利社会保障提供者数据集（奥地利协会）中提取所有公共保险人群（0-90 岁）的国际疾病分类第 10 版（ICD-10）诊断代码。患有癌症或活动性癌症的患者被定义为至少有一个 ICD-10“C”诊断代码，患有 ATE 和/或 VTE 的患者至少有一个 I21/I24（心肌梗死）、I63/I64（中风）、I74（动脉栓塞）和 I26/I80/I82（静脉血栓栓塞）诊断代码。在 158675 名癌症患者中，8559 名（5.4%）有 ATE 诊断代码，7244 名（4.6%）有 VTE 诊断代码。相比之下，在 8147569 名无癌症的患者中，69381 名（0.9%）有 ATE 诊断代码，29307 名（0.4%）有 VTE 诊断代码。这对应于年龄分层随机效应的相对风险（RR）分别为 6.88（95%置信区间[CI]为 4.81-9.84）的 ATE 和 14.91（95%CI 为 8.90-24.95）的 VTE。在患有泌尿道恶性肿瘤的患者中 ATE 比例最高（RR：7.16[6.74-7.61]），在患有内分泌癌的患者中比例最低（RR：2.49[2.00-3.10]）。相应的 VTE 比例在间皮/软组织癌症（RR：19.35[17.44-21.47]）中最高，在口咽癌中最低（RR：6.62[5.61-7.81]）。
癌症患者的 ATE 和 VTE 的 RR 明显更高。我们的人群水平荟萃数据分析表明癌症、ATE 和 VTE 之间存在很强的关联，并支持这些疾病之间存在共同风险因素和病理生物学的概念。
患有癌症诊断代码的人与无癌症诊断代码的人相比，ATE 和 VTE 的相对风险。
