Incidence of venous thromboembolism and the impact on survival in breast cancer patients
Incidence of venous thromboembolism and the impact on survival in breast cancer patients
复制标题
DOI：
10.1200/jco.2006.07.4393
复制
发表时间：
2007-01-01
影响因子：
45.3
通讯作者：
White, Richard H.
中科院分区：
文献类型：
--
作者：
Chew, Helen K.;Wun, Theodore;White, Richard H.
目的：在一项以乳腺癌患者为基础的大型人群研究中，尚未报道静脉血栓栓塞（VTE）的发生率和与VTE发展相关的危险因素。患者和方法将加利福尼亚癌症登记处与患者出院数据集合并，并确定1993年至1999年诊断的患者中静脉血栓栓塞事件的数量。结果在108,255例乳腺癌患者中，2年累计静脉血栓栓塞发生率为1.2%，上半年和下半年的发生率分别为1.2和0.6件/100患者-年。与普通人群相比，1年静脉血栓栓塞发生率显著增加（静脉血栓栓塞标准化发生率为4.2；95% CI为3.9 ~ 4.4）。在一个多变量模型中，2年内发生静脉血栓栓塞的重要预测因素是：年龄（危险比[HR]，如果bb0 ~ 75岁v < 45，则为2.0;95% CI, 1.6 ~ 2.6）、慢性医学合共病的数量（危险比[HR]，如果3岁v < 45，则为2.9;95% CI, 2.4 ~ 3.5）和癌症分期进展（危险比[HR]， 6.3；转移性疾病和局部疾病，95% CI, 5.3 ~ 7.5）。在多变量模型中，静脉血栓栓塞是2年生存率降低的重要预测因子（HR, 2.3; 95% CI， 2.1至2.6），当按初始癌症分期分层时，与转移性癌症患者相比，局部癌症患者（HR, 5.1; 95% CI， 3.6至7.1）或局部癌症患者（HR, 3.5; 95% CI， 2.5至4.8）的影响最高（HR, 1.9; 95% CI， 1.5至2.4）。结论约1%的乳腺癌患者在2年内发生静脉血栓栓塞，其中诊断后的前6个月发生率最高。转移性疾病和合并症是最强的预测因子。静脉血栓栓塞的诊断与2年内较高的死亡风险相关。
Purpose The incidence of venous thromboembolism (VTE) and the risk factors associated with development of VTE have not been reported in a large population-based study of breast cancer patients.Patients and Methods The California Cancer Registry was merged with the Patient Discharge Data Set, and the number of VTE events determined among patients diagnosed between 1993 and 1999.Results Among 108,255 patients with breast cancer, the 2-year cumulative VTE incidence was 1.2%, with a rate of 1.2 and 0.6 events/100 patient-years during the first and second half-year, respectively. The 1-year incidence of VTE was significantly increased compared with the general population (standardized incidence ratio of VTE, 4.2; 95% CI, 3.9 to 4.4). In a multivariate model, significant predictors of developing VTE within 2 years were: age (hazard ratio [HR], 2.0 if >75 years v < 45; 95% CI, 1.6 to 2.6), the number of chronic medical comorbidities (HR, 2.9 if 3 v 0; 95% CI, 2.4 to 3.5), and advancing cancer stage (HR, 6.3; 95% CI, 5.3 to 7.5 for metastatic v local disease). In multivariate models, VTE was a significant predictor of decreased 2-year survival (HR, 2.3; 95% CI, 2.1 to 2.6) and when stratified by initial cancer stage, the effect was highest in patients with localized (HR, 5.1; 95% CI, 3.6 to 7.1) or regional stage (HR, 3.5; 95% CI, 2.5 to 4.8) cancer compared with patients with metastatic disease (HR, 1.9; 95% CI, 1.5 to 2.4).Conclusion Approximately 1% of breast cancer patients developed VTE within 2 years, with the highest incidence in the first 6 months after diagnosis. Metastatic disease and comorbidities were the strongest predictors. The diagnosis of VTE was associated with a higher risk of death within 2 years.