Venous thromboembolism and mortality in breast cancer: cohort study with systematic review and meta-analysis.
Venous thromboembolism and mortality in breast cancer: cohort study with systematic review and meta-analysis.
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DOI：
10.1186/s12885-017-3719-1
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发表时间：
2017-11-10
期刊：
影响因子：
3.8
通讯作者：
Grainge MJ
中科院分区：
文献类型：
--
作者：
Khan UT;Walker AJ;Baig S;Card TR;Kirwan CC;Grainge MJ
乳腺癌患者发生静脉血栓栓塞（VTE）的风险增加。然而，目前关于静脉血栓栓塞是否会增加乳腺癌患者死亡风险的证据是相互矛盾的。我们提供了来自英国的大量患者的数据，并将这些数据与以前系统评价的数据汇总在一起。使用临床实践研究数据链（CPRD）数据集，我们确定了一个13202例乳腺癌患者的队列，其中611例在1997年至2006年间被诊断为静脉血栓栓塞，12591例未发生静脉血栓栓塞。采用危险比（HR）比较两组的死亡率。然后使用随机效应荟萃分析将这些数据与MEDLINE和EMBASE数据库（截至2015年1月）检索到的关于该主题的现有数据合并。在CPRD中，当作为时变协变量处理时，静脉血栓栓塞与死亡率增加相关（HR = 2.42; 95% CI, 2.13-2.75），然而，当患者在癌症诊断后6个月内存在静脉血栓栓塞事件而被永久归类为静脉血栓栓塞时，未观察到风险增加（HR = 1.22; 0.93-1.60）。使用第二种方法的7项研究的总风险比为1.69(1.12-2.55)，当仅限于调整关键协变量的研究时，没有发现任何影响。在时变协变量分析中，静脉血栓栓塞的大HR反映了静脉血栓栓塞后已知的短期死亡率。当乳腺癌患者幸运地从最初的静脉血栓栓塞中存活下来时，对长期死亡率的影响就不那么确定了。本文的在线版本（10.1186/s12885-017-3719-1）包含补充内容，仅供授权用户使用。
Breast cancer patients are at an increased risk of venous thromboembolism (VTE). However, current evidence as to whether VTE increases the risk of mortality in breast cancer patients is conflicting. We present data from a large cohort of patients from the UK and pool these with previous data from a systematic review. Using the Clinical Practice Research Datalink (CPRD) dataset, we identified a cohort of 13,202 breast cancer patients, of whom 611 were diagnosed with VTE between 1997 and 2006 and 12,591 did not develop VTE. Hazard ratios (HR) were used to compare mortality between the two groups. These were then pooled with existing data on this topic identified via a search of the MEDLINE and EMBASE databases (until January 2015) using a random-effects meta-analysis. Within the CPRD, VTE was associated with increased mortality when treated as a time-varying covariate (HR = 2.42; 95% CI, 2.13–2.75), however, when patients were permanently classed as having VTE based on presence of a VTE event within 6 months of cancer diagnosis, no increased risk was observed (HR = 1.22; 0.93–1.60). The pooled HR from seven studies using the second approach was 1.69 (1.12–2.55), with no effect seen when restricted to studies which adjusted for key covariates. A large HR for VTE in the time-varying covariate analysis reflects the known short-term mortality following a VTE. When breast cancer patients are fortunate to survive the initial VTE, the influence on longer-term mortality is less certain. The online version of this article (10.1186/s12885-017-3719-1) contains supplementary material, which is available to authorized users.
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影响因子：
45.3
作者：
Chew, Helen K.;Wun, Theodore;White, Richard H.
通讯作者：
White, Richard H.
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
3.4
作者：
Herrett, Emily;Thomas, Sara L.;Hall, Andrew J.
通讯作者：
Hall, Andrew J.
影响因子：
2.6
作者：
Boggon, Rachael;van Staa, Tjeerd P.;Richards, Mike A.
通讯作者：
Richards, Mike A.
影响因子：
5.7
作者：
Gross, Cary P.;Galusha, Deron H.;Krumholz, Harlan M.
通讯作者：
Krumholz, Harlan M.