Risk factors for venous thromboembolism in metastatic colorectal cancer with contemporary treatment: A SEER-Medicare analysis.
Risk factors for venous thromboembolism in metastatic colorectal cancer with contemporary treatment: A SEER-Medicare analysis.
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DOI：
10.1002/cam4.4581
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发表时间：
2022-04
期刊：
影响因子：
4
通讯作者：
Littenberg, Benjamin
中科院分区：
文献类型：
--
作者：
Ades, Steven;Pulluri, Bhargavi;Holmes, Chris E.;Lal, Inder;Kumar, Santosh;Littenberg, Benjamin
转移性结直肠癌(MCRC)和静脉血栓栓塞症(VTE)之间的关系在现代还没有明确的定义。我们的目的是在现代老年mCRC队列中检查可能的危险因素，包括新的治疗和抗血管生成治疗对VTE发生率和存活率的影响。这是SEER-Medicare对2004-2009年确诊的mCRC患者进行的队列分析。风险因素分析采用COX模型对性别、诊断年龄、种族、原发肿瘤部位、合并症和既往静脉血栓栓塞史进行调整，并将癌症治疗作为时变协变量。主要结果是VTE发生率和总存活率。10,976例结直肠癌，平均年龄77.9岁(65-107岁)，女性占49.7%，白人占83.5%。VTE患者1306例，1年发生率为13.7%，3年发生率为20.3%。独立的VTE预测因素包括女性(HR 1.27；95%CI 1.14~1.42)、非裔美国人(HR 1.49；1.27~1.73)、既往VTE病史(HR 16.3；12.1~22.1)和右侧肿瘤(HR 1.16；1.04~1.29)。调整后，所有治疗和贝伐单抗(HR 0.68，0.58~0.78)均有保护作用。1年的总生存率为40.1%(39.4-41.3)，但任何治疗都能显著改善。诊断为mCRC后的VTE与低OS相关(HR 1.09；1.02-1.15)。在这个庞大的当代mCRC队列中，包括抗血管生成治疗在内的有效的系统治疗与较低的VTE风险相关。总体存活率很低，如果患者在治疗期间的任何时候发生VTE，情况略有恶化。在一个较大的当代SEER-Medicare队列中，1年累计发病率保持在14%的高水平。目前包括贝伐单抗在内的晚期结肠癌的标准疗法与较低的VTE风险和显著的生存增加有关。
The relationship between metastatic colorectal cancer (mCRC) and venous thromboembolism (VTE) is poorly defined in the modern era. Our objective was to examine impact of putative risk factors including newer treatments and anti‐angiogenic therapy on VTE incidence and survival in a modern older mCRC cohort. This is a SEER‐Medicare cohort analysis of mCRC patients diagnosed in 2004–2009. Risk factor analysis was conducted using Cox models adjusted for sex, diagnosis age, race, primary tumor location, comorbidity, and prior VTE history, with cancer treatments as time‐varying covariates. Main outcomes were VTE incidence and overall survival. Ten thousand nine hundred and seventy six mCRC cases with mean age 77.9 years (range 65–107), 49.7% women, 83.5% white. There were 1306 VTE cases corresponding to 13.7% incidence at 1 year and 20.3% at 3 years. Independent VTE predictors included female sex (HR 1.27; 95% CI 1.14–1.42), African American race (HR 1.49; 1.27–1.73), prior VTE history (HR 16.3; 12.1–22.1), and right sided cancers (HR 1.16; 1.04–1.29). After adjustment, any therapy and bevacizumab (HR 0.68, 0.58–0.78) in particular were protective. Overall survival was 40.1% (39.4–41.3) at 1 year but improved significantly with any treatment. VTE following diagnosis of mCRC was associated with inferior OS (HR 1.09; 1.02–1.15). In this large contemporary mCRC cohort, effective systemic therapy including anti‐angiogenic treatment was associated with lower VTE risk. Overall survival was poor, and modestly worse if a patient had a VTE at any time during treatment. In a large contemporary SEER‐Medicare cohort, the cumulative 1‐year incidence remains high at 14%. Current standard therapies for advanced colon cancer including bevacizumab are associated with lower VTE risk and significant survival gains.
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