DEEP-VEIN THROMBOSIS AND THE INCIDENCE OF SUBSEQUENT SYMPTOMATIC CANCER
DEEP-VEIN THROMBOSIS AND THE INCIDENCE OF SUBSEQUENT SYMPTOMATIC CANCER
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DOI：
10.1056/nejm199210153271604
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发表时间：
1992-10-15
影响因子：
158.5
通讯作者：
TENCATE, JW
中科院分区：
文献类型：
--
作者：
PRANDONI, P;LENSING, AWA;TENCATE, JW
背景资料。与显性癌症和随后的静脉血栓栓塞症之间已确定的关系相反，目前尚不清楚症状性深静脉血栓形成是否与随后显性恶性疾病的风险有关。260名经静脉造影证实的有症状的深静脉血栓形成患者参加了一项研究，其中250人在两年内接受了跟踪调查。在随访期间评估的患者中，105例继发性静脉血栓(即与癌症以外的公认危险因素相关的血栓形成)患者随后发现的癌症的发生率与145例特发性静脉血栓患者的癌症发生率进行了比较。确诊静脉血栓形成时的常规检查显示，153名登记的特发性静脉血栓形成患者中有5名(3.3%)患有癌症，107名登记的继发性静脉血栓形成患者中没有一名发现癌症。在随访期间，继发性静脉血栓形成患者中有2例(1.9%)和特发性静脉血栓形成患者中有11例(7.6%；优势比，2.3；95%可信区间，1.0%至5.2%；P=0.043)发展为显性癌症。在145例特发性静脉血栓形成患者中，35例确诊为复发性血栓栓塞症。35名患者中有6名(17.1%)随后发生了明显的癌症。复发的特发性静脉血栓患者的癌症发生率高于继发性静脉血栓患者(P=0.008；优势比9.8；95%可信区间1.8~5 2.2)和未复发的患者(P=0.024；优势比4.3；95%可信区间1.2~15.3)。特发性静脉血栓形成与临床显性癌症的后续发展之间有统计学意义和重要的临床相关性，特别是在静脉血栓栓塞症在随访期间复发的患者中。
Background. In contrast to the established relation between overt cancer and subsequent venous thromboembolism, it is unclear whether symptomatic deep-vein thrombosis is associated with a risk of subsequent overt malignant disease.Methods. Two hundred sixty consecutive patients with symptomatic, venographically proved deep-vein thrombosis were enrolled in a study, of whom 250 were followed during a two-year period. Among those assessed during follow-up, the incidence of subsequently detected cancer in the 105 patients with secondary venous thrombosis (i.e., thrombosis associated with a well-recognized risk factor other than cancer) was compared with the incidence of cancer in the 145 patients with idiopathic venous thrombosis.Results. Routine examination at the time of diagnosis of the venous thrombosis revealed cancer in 5 of the 153 enrolled patients with idiopathic venous thrombosis (3.3 percent) and in none of the 107 enrolled patients with secondary venous thrombosis. During follow-up, overt cancer developed in 2 of the 105 patients with secondary venous thrombosis (1.9 percent) and in 11 of the 145 patients with idiopathic venous thrombosis (7.6 percent; odds ratio, 2.3; 95 percent confidence interval, 1.0 to 5.2; P = 0.043). Of the 145 patients with idiopathic venous thrombosis, 35 had confirmed recurrent thromboembolism. Overt cancer subsequently developed in 6 of the 35 (17.1 percent). The incidence of cancer in the patients with recurrent idiopathic venous thrombosis was higher than that in the patients with secondary venous thrombosis (P = 0.008; odds ratio, 9.8; 95 percent confidence interval, 1.8 to 52.2) or in the patients with idiopathic venous thrombosis that did not recur (P = 0.024; odds ratio, 4.3; 95 percent confidence interval, 1.2 to 15.3).Conclusions. There is a statistically significant and clinically important association between idiopathic venous thrombosis and the subsequent development of clinically overt cancer, especially among patients in whom venous thromboembolism recurs during follow-up.