静脉血栓栓塞症诊断后新诊断的癌症——来自COMMAND VTE注册研究-2的见解
Newly Diagnosed Cancer After Diagnosis of Venous Thromboembolism - Insights From the COMMAND VTE Registry-2.
作者信息
Yamashita Yugo, Morimoto Takeshi, Chatani Ryuki, Nishimoto Yuji, Ikeda Nobutaka, Kobayashi Yohei, Ikeda Satoshi, Kim Kitae, Inoko Moriaki, Takase Toru, Tsuji Shuhei, Oi Maki, Takada Takuma, Otsui Kazunori, Sakamoto Jiro, Ogihara Yoshito, Inoue Takeshi, Usami Shunsuke, Chen Po-Min, Togi Kiyonori, Koitabashi Norimichi, Hiramori Seiichi, Doi Kosuke, Mabuchi Hiroshi, Tsuyuki Yoshiaki, Murata Koichiro, Takabayashi Kensuke, Nakai Hisato, Sueta Daisuke, Shioyama Wataru, Dohke Tomohiro, Nishikawa Ryusuke, Kaneda Kazuhisa, Ono Koh, Kimura Takeshi
机构信息
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Department of Data Science/Clinical Epidemiology, Hyogo Medical University.
出版信息
Circ J. 2024 Dec 21. doi: 10.1253/circj.CJ-24-0786.
BACKGROUND
Previous randomized clinical trials did not support a benefit of screening for occult cancer after diagnosis of venous thromboembolism (VTE), although screening may be of potential benefit for selected high-risk patients.
METHODS AND RESULTS
The COMMAND VTE Registry-2 enrolled consecutive patients with acute symptomatic VTE between 2015 and 2020 from 31 centers across Japan. The 3,706 patients in the registry without known active cancer at the time of VTE diagnosis were divided into 2 groups: those with (n=250) and without (n=3,456) newly diagnosed cancer during the follow-up period. The cumulative incidence of newly diagnosed cancer was 1.5% at 30 days, 3.7% at 1 year, and 7.0% at 3 years. The multivariable Cox proportional hazard model demonstrated that older age (hazard ratio [HR] 1.02 per 1 year increase; 95% confidence interval [CI] 1.01-1.03; P<0.001), a history of cancer (HR 3.57; 95% CI 2.73-4.64; P<0.001), autoimmune disorders (HR 1.48; 95% CI 1.06-2.02; P=0.02), a history of major bleeding (HR 1.64; 95% CI 1.04-2.48; P=0.04), and the absence of transient provoking risk factors for VTE (HR 1.44; 95% CI 1.08-1.92; P=0.01) were independently associated with newly diagnosed cancer.
CONCLUSIONS
The incidence of newly diagnosed cancer after VTE diagnosis was 3.7% at 1 year, and several independent risk factors for newly diagnosed cancer after VTE diagnosis were identified.
背景
既往随机临床试验并不支持在诊断静脉血栓栓塞症（VTE）后进行隐匿性癌症筛查会带来益处，尽管筛查可能对部分选定的高危患者有潜在益处。
方法与结果
COMMAND VTE注册研究-2纳入了2015年至2020年间来自日本31个中心的连续性急性症状性VTE患者。该注册研究中3706例在VTE诊断时无已知活动性癌症的患者被分为两组：随访期间新诊断癌症的患者（n = 250）和未新诊断癌症的患者（n = 3456）。新诊断癌症的累积发生率在30天时为1.5%，1年时为3.7%，3年时为7.0%。多变量Cox比例风险模型显示，年龄较大（每增加1岁风险比[HR] 1.02；95%置信区间[CI] 1.01 - 1.03；P < 0.001）、有癌症病史（HR 3.57；95% CI 2.73 - 4.64；P < 0.001）、自身免疫性疾病（HR 1.48；95% CI 1.06 - 2.02；P = 0.02）、有大出血病史（HR 1.64；95% CI 1.04 - 2.48；P = 0.04）以及无VTE的短暂诱发危险因素（HR 1.44；95% CI 1.08 - 1.92；P = 0.01）与新诊断癌症独立相关。
结论
VTE诊断后1年新诊断癌症的发生率为3.7%，并确定了VTE诊断后新诊断癌症的几个独立危险因素。
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