Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
JAMA Netw Open. 2024 Feb 5;7(2):e2354352. doi: 10.1001/jamanetworkopen.2023.54352.
The risks and benefits of thromboprophylaxis therapy after cancer surgery are debated. Studies that determine thrombosis risk after cancer surgery with high accuracy are needed.
To evaluate 1-year risk of venous thromboembolic events after major cancer surgery and how these events vary over time.
DESIGN, SETTING, AND PARTICIPANTS: This register-based retrospective observational matched cohort study included data on the full population of Sweden between 1998 and 2016. All patients who underwent major surgery for cancer of the bladder, breast, colon or rectum, gynecologic organs, kidney and upper urothelial tract, lung, prostate, or gastroesophageal tract were matched in a 1:10 ratio with cancer-free members of the general population on year of birth, sex, and county of residence. Data were analyzed from February 13 to December 5, 2023.
Major surgery for cancer.
The main outcome was incidence of venous thromboembolic events within 1 year after the surgery. Crude absolute risks and risk differences of events within 1 year and adjusted time-dependent cause-specific hazard ratios (HRs) of postdischarge events were calculated.
A total of 432 218 patients with cancer (median age, 67 years [IQR, 58-75 years]; 68.7% women) and 4 009 343 cancer-free comparators (median age, 66 years [IQR, 57-74 years]; 69.3% women) were included in the study. The crude 1-year cumulative risk of pulmonary embolism was higher among the cancer surgery population for all cancers, with the following absolute risk differences: for bladder cancer, 2.69 percentage points (95% CI, 2.33-3.05 percentage points); for breast cancer, 0.59 percentage points (95% CI 0.55-0.63 percentage points); for colorectal cancer, 1.57 percentage points (95% CI, 1.50-1.65 percentage points); for gynecologic organ cancer, 1.32 percentage points (95% CI, 1.22-1.41 percentage points); for kidney and upper urinary tract cancer, 1.38 percentage points (95% CI, 1.21-1.55 percentage points); for lung cancer, 2.61 percentage points (95% CI, 2.34-2.89 percentage points); for gastroesophageal cancer, 2.13 percentage points (95% CI, 1.89-2.38 percentage points); and for prostate cancer, 0.57 percentage points (95% CI, 0.49-0.66 percentage points). The cause-specific HR of pulmonary embolism comparing patients who underwent cancer surgery with matched comparators peaked just after discharge and generally plateaued 60 to 90 days later. At 30 days after surgery, the HR was 10 to 30 times higher than in the comparison cohort for all cancers except breast cancer (colorectal cancer: HR, 9.18 [95% CI, 8.03-10.50]; lung cancer: HR, 25.66 [95% CI, 17.41-37.84]; breast cancer: HR, 5.18 [95% CI, 4.45-6.05]). The hazards subsided but never reached the level of the comparison cohort except for prostate cancer. Similar results were observed for deep vein thrombosis.
This cohort study found an increased rate of venous thromboembolism associated with cancer surgery. The risk persisted for about 2 to 4 months postoperatively but varied between cancer types. The increased rate is likely explained by the underlying cancer disease and adjuvant treatments. The results highlight the need for individualized venous thromboembolism risk evaluation and prophylaxis regimens for patients undergoing different surgery for different cancers.
癌症手术后血栓预防治疗的风险和益处存在争议。需要进行能够准确确定癌症手术后血栓风险的研究。
评估主要癌症手术后 1 年内静脉血栓栓塞事件的风险，以及这些事件随时间的变化情况。
设计、设置和参与者：本基于注册的回顾性匹配队列研究纳入了 1998 年至 2016 年期间瑞典所有人群的数据。所有接受膀胱癌、乳腺癌、结直肠癌或直肠、妇科器官、肾脏和上尿路、肺癌、前列腺或胃食管癌症主要手术的患者，按照出生年份、性别和居住县与癌症患者的普通人群进行 1:10 匹配。数据分析于 2023 年 2 月 13 日至 12 月 5 日进行。
癌症的主要手术。
主要结局为手术后 1 年内静脉血栓栓塞事件的发生率。计算了 1 年内事件的粗绝对风险和风险差异，以及出院后事件的调整时间依赖性特定原因的危险比（HR）。
共纳入 432218 例癌症患者（中位年龄 67 岁[IQR，58-75 岁]；68.7%为女性）和 4009343 例无癌症对照者（中位年龄 66 岁[IQR，57-74 岁]；69.3%为女性）。所有癌症患者中，癌症手术人群的 1 年累积肺栓塞风险较高，绝对风险差异如下：膀胱癌为 2.69 个百分点（95%CI，2.33-3.05 个百分点）；乳腺癌为 0.59 个百分点（95%CI，0.55-0.63 个百分点）；结直肠癌为 1.57 个百分点（95%CI，1.50-1.65 个百分点）；妇科器官癌为 1.32 个百分点（95%CI，1.22-1.41 个百分点）；肾脏和上尿路癌为 1.38 个百分点（95%CI，1.21-1.55 个百分点）；肺癌为 2.61 个百分点（95%CI，2.34-2.89 个百分点）；胃食管癌为 2.13 个百分点（95%CI，1.89-2.38 个百分点）；前列腺癌为 0.57 个百分点（95%CI，0.49-0.66 个百分点）。与匹配对照者相比，接受癌症手术的患者发生肺栓塞的特定原因 HR 在出院后立即达到峰值，通常在 60 至 90 天后趋于平稳。手术后 30 天，除乳腺癌外（结直肠癌：HR，9.18[95%CI，8.03-10.50]；肺癌：HR，25.66[95%CI，17.41-37.84]），所有癌症患者的 HR 比对照组高 10 至 30 倍。除前列腺癌外，（HR，5.18[95%CI，4.45-6.05]），危险度持续下降，但从未达到对照组水平。深静脉血栓形成也观察到类似的结果。
本队列研究发现癌症手术后静脉血栓栓塞的发生率增加。该风险持续约 2 至 4 个月，但在不同癌症类型之间存在差异。这种增加的发生率可能是由潜在的癌症疾病和辅助治疗引起的。研究结果强调了需要为不同癌症的不同手术患者进行个体化静脉血栓栓塞风险评估和预防方案。
