Blood:1997年-2017年癌症患者的静脉血栓栓塞风险变化

2020-11-30 Nebula-Qin MedSci原创

早在1823年,就已明确癌症患者发生静脉血栓栓塞(VTE)的风险增加。VTE与抗癌治疗中断、生活质量下降、死亡率增加相关。随着医疗技术的发展、新的癌症治疗方法的开发、高分辨率成像技术的应用,癌症患者的

早在1823年,就已明确癌症患者发生静脉血栓栓塞(VTE)的风险增加。VTE与抗癌治疗中断、生活质量下降、死亡率增加相关。随着医疗技术的发展、新的癌症治疗方法的开发、高分辨率成像技术的应用,癌症患者的存活率不断提高,癌症患者静脉血栓栓塞的发生率可能也随之变化。

研究人员对丹麦1997年-2017年间医疗登记的首次被诊断为癌症的499,092名患者以及1,497,276名未患癌症的普通人群对照个体进行匹配分析。计算确诊癌症后6个月和12个月的静脉血栓栓塞症的累积发生率。

不同癌症的VTE风险

在癌症队列中,诊癌症后12个月的静脉血栓栓塞的累积发生率为2.3%(95% CI,2.2%-2.3%),在对照队列中相对应的发生率为0.35%(95% CI,0.34%-0.36%;风险比[HR] 8.5,95% CI,8.2-8.8)。

不同治疗方式下的VTE风险

癌症患者的重要危险因素是既往静脉血栓栓塞症(SHR,7.6,95%,CI,7.2-8.0)、远处转移(SHR 3.2,95%CI,2.9-3.4)、化疗(SHR 3.4,95%CI,3.1-3.7)、蛋白激酶抑制剂(SHR 4.1,95%CI 3.4-4.9)、抗血管生成治疗(SHR 4.4,95%CI,3.8-5.2)和免疫治疗(SHR 3.6,2.8-4.6)。

VTE风险随时间的变化情况

出乎意料的是,癌症患者的静脉血栓栓塞的发生率并未随之治疗的进步而降低,反而明显上升:癌症队列中12个月的累积发病率从1997年的1.0%(95% CI 0.9%-1.2%)上升到2017年的3.4%(95% CI 2.9%-4.0%);但是计算机断层扫描(CT)扫描、化疗和靶向治疗的使用都有所增加,12个月存活率也明显提高。

总而言之,癌症患者静脉血栓栓塞症的风险在稳步增加,是普通人群的9倍,需要临床医生密切关注。

原始出处:

Mulder Frits I,Horvàth-Puhó Erzsébet,van Es Nick et al. Venous thromboembolism in cancer patients: a population-based cohort study. Blood, 2020.

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    2021-08-25 fusion
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    2021-09-07 xue8602
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    2020-12-02 lifefamily@163

    #癌症#患者的#静脉血栓栓塞##VTE#风险,这可能有多种原因,其一现在的治疗多是免疫治疗和靶向治疗,其二,患者的生存期延长,#肿瘤#患者多是#高凝状态#,容易并发血栓。同时,如果适当的#抗血小板##抗凝#治疗,可能会有利于改善#肿瘤微环境#,有利于治疗。

    0

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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=903620, encodeId=c45390362056, content=癌症患者静脉血栓栓塞症的风险在稳步增加,是普通人群的9倍,需要临床医生密切关注。<a href='/topic/show?id=d8dbe130197' target=_blank style='color:#2F92EE;'>#癌症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71301, encryptionId=d8dbe130197, topicName=癌症)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210607/9f00a0de660e4b36b77a9a5f7620d6bf/98c22b17ddf7446fa7b9a618fabcb9f7.jpg, createdBy=a8fb2299762, createdName=Psycho.Dr Du, createdTime=Mon Nov 30 17:35:10 CST 2020, time=2020-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=903545, encodeId=a02f90354590, content=癌症患者静脉血栓栓塞症的风险在稳步增加,是普通人群的9倍,需要临床医生密切关注。所以在肿瘤科入院常规就是评估静脉血栓风险并长期关注。, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200901/629d1ce7d6f64d17a642c37c90dea72c/202f9333a3ea4b23a9b07ede3364e86b.jpg, createdBy=1a335163906, createdName=Sunny orchard, createdTime=Mon Nov 30 13:52:42 CST 2020, time=2020-11-30, status=1, ipAttribution=)]
    2020-11-30 Psycho.Dr Du

    癌症患者静脉血栓栓塞症的风险在稳步增加,是普通人群的9倍,需要临床医生密切关注。#癌症#

    0

  7. 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style='color:#2F92EE;'>#VTE#</a>风险,这可能有多种原因,其一现在的治疗多是免疫治疗和靶向治疗,其二,患者的生存期延长,<a href='/topic/show?id=aa0582e6946' target=_blank style='color:#2F92EE;'>#肿瘤#</a>患者多是<a href='/topic/show?id=ca06102195ec' target=_blank style='color:#2F92EE;'>#高凝状态#</a>,容易并发血栓。同时,如果适当的<a href='/topic/show?id=606b55e4466' target=_blank style='color:#2F92EE;'>#抗血小板#</a>和<a href='/topic/show?id=353b55219b8' target=_blank style='color:#2F92EE;'>#抗凝#</a>治疗,可能会有利于改善<a href='/topic/show?id=f0838291817' target=_blank style='color:#2F92EE;'>#肿瘤微环境#</a>,有利于治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=270, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71301, encryptionId=d8dbe130197, topicName=癌症), TopicDto(id=99179, encryptionId=5471991e9f3, topicName=静脉血栓栓塞), TopicDto(id=18553, encryptionId=4a481855350, topicName=VTE), TopicDto(id=82769, encryptionId=aa0582e6946, topicName=肿瘤), TopicDto(id=102195, encryptionId=ca06102195ec, topicName=高凝状态), TopicDto(id=55744, 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=903620, encodeId=c45390362056, content=癌症患者静脉血栓栓塞症的风险在稳步增加,是普通人群的9倍,需要临床医生密切关注。<a href='/topic/show?id=d8dbe130197' target=_blank style='color:#2F92EE;'>#癌症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71301, encryptionId=d8dbe130197, topicName=癌症)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210607/9f00a0de660e4b36b77a9a5f7620d6bf/98c22b17ddf7446fa7b9a618fabcb9f7.jpg, createdBy=a8fb2299762, createdName=Psycho.Dr Du, createdTime=Mon Nov 30 17:35:10 CST 2020, time=2020-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=903545, encodeId=a02f90354590, content=癌症患者静脉血栓栓塞症的风险在稳步增加,是普通人群的9倍,需要临床医生密切关注。所以在肿瘤科入院常规就是评估静脉血栓风险并长期关注。, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200901/629d1ce7d6f64d17a642c37c90dea72c/202f9333a3ea4b23a9b07ede3364e86b.jpg, createdBy=1a335163906, createdName=Sunny orchard, createdTime=Mon Nov 30 13:52:42 CST 2020, time=2020-11-30, status=1, ipAttribution=)]
    2020-11-30 Sunny orchard

    癌症患者静脉血栓栓塞症的风险在稳步增加,是普通人群的9倍,需要临床医生密切关注。所以在肿瘤科入院常规就是评估静脉血栓风险并长期关注。

    0

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