Kristensen Frederik Pagh Bredahl, Horváth-Puhó Erzsébet, Szépligeti Szimonetta Komjáthiné, Troelsen Frederikke Schoenfeldt, Sørensen Henrik Toft
Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark.
TH Open. 2024 Mar 26;8(1):e146-e154. doi: 10.1055/a-2275-9590. eCollection 2024 Jan.
Bleeding and venous thromboembolism (VTE) are adverse outcomes after colorectal cancer (CRC) surgery. Type 2 diabetes (T2D) clusters with bleeding and VTE risk factors. We examined the bleeding and VTE risk in patients with T2D undergoing CRC surgery and the prognosis after these adverse outcomes. We conducted a prognostic population-based cohort study of 48,295 patients with and without T2D undergoing surgery for incident CRC during 2005 to 2019. Patients with T2D were diagnosed in a hospital setting or had redeemed a glucose-lowering drug prescription; the remaining cohort was patients without diabetes. We estimated the 30-day and 1-year risks of bleeding and VTE and used a Fine-Gray model to compute age-, sex-, and calendar year-adjusted subdistribution hazard ratios (SHRs). The Kaplan-Meier method was used to calculate 1-year mortality after bleeding or VTE. Within 30 days after CRC surgery, the risk of bleeding was 2.7% in patients with T2D and 2.0% in patients without diabetes (SHR: 1.30 [95% confidence interval [CI]: 1.10-1.53]). For VTE, the 30-day risks were 0.6% for patients with T2D and 0.6% for patients without diabetes (SHR: 1.01 [95% CI: 0.71-1.42]). The SHRs for bleeding and VTE within 1 year after CRC surgery were similar. The 1-year mortality was 26.0% versus 24.9% in the bleeding cohort and 25.8% versus 27.5% in the VTE cohort for patients with T2D versus without diabetes, respectively. Although absolute risks were low, patients with T2D have an increased risk of bleeding but not VTE after CRC surgery.
出血和静脉血栓栓塞（VTE）是结直肠癌（CRC）手术后的不良结局。2型糖尿病（T2D）与出血和VTE风险因素聚集在一起。我们研究了接受CRC手术的T2D患者的出血和VTE风险以及这些不良结局后的预后情况。
我们进行了一项基于人群的预后队列研究，纳入了2005年至2019年间48295例因新发CRC接受手术的有或无T2D的患者。T2D患者在医院环境中被诊断或已兑换降糖药物处方；其余队列是无糖尿病患者。我们估计了出血和VTE的30天和1年风险，并使用Fine-Gray模型计算年龄、性别和日历年调整后的亚分布风险比（SHR）。采用Kaplan-Meier方法计算出血或VTE后的1年死亡率。
在CRC手术后30天内，T2D患者的出血风险为2.7%，无糖尿病患者为2.0%（SHR：1.30[95%置信区间（CI）：1.10 - 1.53]）。对于VTE，T2D患者的30天风险为0.6%，无糖尿病患者为0.6%（SHR：1.01[95%CI：0.71 - 1.42]）。CRC手术后1年内出血和VTE的SHR相似。在出血队列中，T2D患者与无糖尿病患者的1年死亡率分别为26.0%和24.9%；在VTE队列中，分别为25.8%和27.5%。
尽管绝对风险较低，但T2D患者在CRC手术后出血风险增加，而VTE风险未增加。
