Eide Nikolai H, Langholm Camilla, Rinde Fridtjof B, Van Es Nick, Hveem Kristian, Brækkan Sigrid K, Hansen John-Bjarne, Morelli Vânia M
Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø.
Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences Pulmonary Hypertension and Thrombosis, Amsterdam.
Haematologica. 2025 Jun 1;110(6):1328-1338. doi: 10.3324/haematol.2024.286407. Epub 2025 Feb 13.
Venous thromboembolism (VTE) is a common and serious condition among cancer patients. The diagnostic and therapeutic strategies for cancer and VTE have improved during the last three decades. It remains unclear whether mortality after cancer-related VTE (CRVTE) has decreased in this period. Therefore, we investigated the mortality risk after CRVTE over the last three decades in a population-based cohort. In total, 111,119 participants from Tromsø4-7 (1994-2016) and HUNT2-3 (1995-2008) surveys were followed through 2019, and all first-lifetime cancer and VTE events were recorded. CRVTE patients were compared with participants neither exposed to cancer nor VTE (disease-free group), and those with cancer. We estimated hazard ratios (HR) with 95% confidence intervals (CI) for all-cause mortality using Cox regression with cancer and VTE as time-dependent exposures, and 1-year cumulative incidence of mortality after CRVTE. Analyses were performed for three time periods: 1994-2002, 2003-2011, and 2012-2019. The age- and sex-adjusted HR for mortality after CRVTE versus disease-free group decreased from 25.3 (95% CI: 20.5-31.3) in 1994-2002 to 22.6 (95% CI: 19.2-26.6) in 2003-2011, and 16.9 (95% CI: 14.3-20.0) in 2012-2019. The HR for mortality after CRVTE versus cancer group remained stable (approx. 3-fold higher) along the three time periods. Similar estimates were obtained after further adjustments for comorbidities. The 1-year cumulative incidence of mortality after CRVTE decreased from 61.8% (95% CI: 52.9-70.8%) in 1994-2002 to 55.6% (95% CI: 49.0-62.4%) in 2003-2011, and 45.5% (95% CI: 39.3-52.1%) in 2012-2019. Our results indicate a decrease in mortality risk after CRVTE over the last three decades, which might be mainly the result of considerable advances in cancer management.
静脉血栓栓塞症（VTE）在癌症患者中是一种常见且严重的病症。在过去三十年中，癌症和VTE的诊断及治疗策略有所改进。在此期间，癌症相关VTE（CRVTE）后的死亡率是否下降仍不清楚。因此，我们在一个基于人群的队列中调查了过去三十年CRVTE后的死亡风险。总共对来自特罗姆瑟4 - 7（1994 - 2016年）和HUNT2 - 3（1995 - 2008年）调查的111,119名参与者进行随访至2019年，并记录了所有首次发生的癌症和VTE事件。将CRVTE患者与既未患癌症也未发生VTE的参与者（无病组）以及癌症患者进行比较。我们使用Cox回归将癌症和VTE作为时间依赖性暴露因素，估计全因死亡率的风险比（HR）及其95%置信区间（CI），以及CRVTE后1年的累积死亡率。分析在三个时间段进行：1994 - 2002年、2003 - 2011年和2012 - 2019年。与无病组相比，CRVTE后死亡的年龄和性别调整后的HR从1994 - 2002年的25.3（95%CI：20.5 - 31.3）降至2003 - 2011年的22.6（95%CI：19.2 - 26.6），以及2012 - 2019年的16.9（95%CI：14.3 - 20.0）。在三个时间段内，与癌症组相比，CRVTE后死亡的HR保持稳定（约高3倍）。在对合并症进行进一步调整后获得了类似的估计值。CRVTE后1年的累积死亡率从1994 - 2002年的61.8%（95%CI：52.9 - 70.8%）降至2003 - 2011年的55.6%（95%CI：49.0 - 62.4%），以及2012 - 2019年的45.5%（95%CI：39.3 - 52.1%）。我们的结果表明，在过去三十年中CRVTE后的死亡风险有所降低，这可能主要是癌症管理取得显著进展的结果。
