静脉血栓栓塞对癌症患者死亡率的影响：一项基于人群的队列研究。
Impact of venous thromboembolism on the mortality in patients with cancer: a population-based cohort study.
作者信息
Sørensen Henrik Toft, Pedersen Lars, van Es Nick, Büller Harry R, Horváth-Puhó Erzsébet
机构信息
Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
Clinical Excellence Research Center, Stanford University, Stanford, CA, USA.
出版信息
Lancet Reg Health Eur. 2023 Sep 28;34:100739. doi: 10.1016/j.lanepe.2023.100739. eCollection 2023 Nov.
BACKGROUND
Despite recent improvements in the treatment of cancer, little is known about the long-term survival in patients with cancer and venous thromboembolism. We aimed to examine the five-year mortality of venous thromboembolism in cancer patients in a large population-based cohort study.
METHODS
Using Danish healthcare registries from 1995 to 2020, we obtained data on cancer patients with venous thromboembolism and comparison cohorts of cancer patients without venous thromboembolism, matched in terms of cancer type, age, sex, and year of cancer diagnosis, and adjusted for level of comorbidity and frailty using the Charlson Comorbidity Index Score and Hospital Frailty Risk Score, marital status, use of selected medications, and recent surgery (<90 days).
FINDINGS
During the study period, 886,536 patients were diagnosed with cancer. Of 1882 cancer patients diagnosed at the time of their venous thromboembolism, 44.4% (835/1882) had distant metastases. In this cohort, the one- and five-year mortality cumulative incidences were 68% (1284/1882) and 84% (1578/1882), respectively, in contrast to 38% (2135/5549) and 67% (3653/5549) in the comparison cohort. The mortality rate ratio was 4.34 (95% confidence interval [CI], 3.95-4.78) for the first year of follow-up and 3.44 (95% CI 3.17-3.73) for the five-year follow-up period. Of the 23,366 patients diagnosed with venous thromboembolism after cancer diagnosis, 18% (4183/23,366) had distant metastases at the time of cancer diagnosis. The cumulative incidence of death at one year was 45% (10,465/23,366; mortality rate ratio 3.48, 95% CI 3.37-3.60) and at five years 69% (15,669/23,366; mortality rate ratio 2.57, 95% CI 2.50-2.63).
INTERPRETATION
Despite improved cancer treatment, venous thromboembolism in cancer patients is strongly associated with a poor prognosis.
FUNDING
The study was supported by grants from the Independent Research Fund Denmark (record no. 3101-00102B) and the Karen Elise Jensen Foundation.
背景
尽管近期癌症治疗有所改善，但对于患有癌症和静脉血栓栓塞症的患者的长期生存情况知之甚少。我们旨在通过一项基于大规模人群的队列研究，考察癌症患者静脉血栓栓塞症的五年死亡率。
方法
利用丹麦1995年至2020年的医疗保健登记数据，我们获取了患有静脉血栓栓塞症的癌症患者的数据，以及无静脉血栓栓塞症的癌症患者对照队列的数据，这些对照队列在癌症类型、年龄、性别和癌症诊断年份方面进行了匹配，并使用查尔森合并症指数评分和医院衰弱风险评分、婚姻状况、所选药物的使用情况以及近期手术（<90天）对合并症水平和衰弱程度进行了调整。
研究结果
在研究期间，886,536名患者被诊断患有癌症。在1882名在静脉血栓栓塞症诊断时被诊断出癌症的患者中，44.4%（835/1882）有远处转移。在这个队列中，1年和5年死亡率的累积发生率分别为68%（1284/1882）和84%（1578/1882），而对照队列分别为38%（2135/5549）和67%（3653/5549）。随访第一年的死亡率比为4.34（95%置信区间[CI]，3.95 - 4.78），五年随访期的死亡率比为3.44（95% CI 3.17 - 3.73）。在癌症诊断后被诊断出静脉血栓栓塞症的23,366名患者中，18%（4183/23,366）在癌症诊断时已有远处转移。1年时的死亡累积发生率为45%（10,465/23,366；死亡率比3.48，95% CI 3.37 - 3.60），5年时为69%（15,66,9/23,366；死亡率比2.57，95% CI 2.50 - 2.63）。
解读
尽管癌症治疗有所改善，但癌症患者的静脉血栓栓塞症与预后不良密切相关。
资金来源
该研究得到了丹麦独立研究基金（记录编号3101 - 00102B）和卡伦·伊丽莎白·詹森基金会的资助。
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