Hettiarachchi R J, Lok J, Prins M H, Büller H R, Prandoni P
Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands.
Cancer. 1998 Jul 1;83(1):180-5. doi: 10.1002/(sici)1097-0142(19980701)83:1<180::aid-cncr24>3.0.co;2-s.
The reported incidence of a subsequent diagnosis of malignancy in patients presenting with deep vein thrombosis (DVT) varies from 2-25%. Risk indicators and diagnostic procedures to be performed in these patients are controversial.
Four hundred consecutive patients with confirmed DVT included in a randomized clinical trial were followed prospectively for 6 months. The incidence of a subsequent diagnosis of malignancy was calculated and compared between patients with unexplained DVT and patients with secondary DVT. Potential risk indicators for subsequent malignant disease were evaluated.
Of the 400 patients, 70 already had been diagnosed with malignancy; another four patients were lost to follow-up. Of the remaining 326 patients, 10 new malignancies were diagnosed among 137 patients with unexplained DVT (7.3%) and 3 new malignancies were diagnosed in 189 patients with secondary DVT (1.6%). The relative risk was 4.6 (95% confidence interval, 1.3-16; P=0.009). Age, gender, or location of the DVT had no significant effect on the incidence of diagnosis when adjusted for unexplained DVT. Ten of these 13 patients (77%) had abnormal clinical findings suggestive of malignancy at the time of presentation with DVT.
Unexplained DVT is a significant risk indicator of underlying malignancy. The majority of patients with undiagnosed malignancy have some clinical abnormality suggestive of underlying malignancy at the time of presentation with unexplained DVT. A simple clinical evaluation comprised of medical history, physical examination, routine laboratory tests, and chest X-ray can detect such patients. Extensive screening of all patients presenting with unexplained DVT does not appear to be justified.
深静脉血栓形成（DVT）患者后续被诊断为恶性肿瘤的报告发病率在2%至25%之间不等。这些患者应进行的风险指标和诊断程序存在争议。
对纳入一项随机临床试验的400例确诊DVT患者进行了为期6个月的前瞻性随访。计算并比较了不明原因DVT患者和继发性DVT患者后续被诊断为恶性肿瘤的发病率。评估了后续恶性疾病的潜在风险指标。
400例患者中，70例已被诊断为恶性肿瘤；另有4例患者失访。在其余326例患者中，137例不明原因DVT患者中有10例被诊断为新发恶性肿瘤（7.3%），189例继发性DVT患者中有3例被诊断为新发恶性肿瘤（1.6%）。相对风险为4.6（95%置信区间，1.3 - 16；P = 0.009）。调整不明原因DVT后，年龄、性别或DVT部位对诊断发病率无显著影响。这13例患者中有10例（77%）在出现DVT时具有提示恶性肿瘤的异常临床表现。
不明原因DVT是潜在恶性肿瘤的重要风险指标。大多数未确诊恶性肿瘤的患者在出现不明原因DVT时具有一些提示潜在恶性肿瘤的临床异常表现。由病史、体格检查、常规实验室检查和胸部X线组成的简单临床评估可以检测出此类患者。对所有不明原因DVT患者进行广泛筛查似乎没有必要。
