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Advanced cancer stage at diagnosis increases blood clot risk
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More advanced disease at the time of cancer diagnosis increased risk for venous thromboembolism, according to a study published in Journal of Thrombosis and Haemostasis.
Patients with cancer have a greater risk for VTE and pulmonary embolism, leading to poorer survival outcomes. However, this risk can vary by cancer site, disease stage and time since diagnosis.
“The pathophysiology differs between cancer types, so clustering of cancer types may mask different VTE risks for the different cancer types,” Inger Lise Gade, MD, clinical assistant in the department of clinical medicine at Aalborg University in Denmark, and colleagues wrote. “Prior studies of single cancer types found that both regional spread and distant metastasis were associated with a higher risk for VTE than localized disease in most types of cancer, but few studies have assessed and compared the incidence rates of VTE in patients with different types and stages of cancer.”
Gade and colleagues calculated incidence rate (IR) and IR differences (IRD) for VTE according to initial cancer stages of patients with 10 types of solid cancers — lung, colorectal, upper gastrointestinal, pancreatic, breast, prostate, bladder, kidney, uterine and ovarian cancer.
The researchers used the Scandinavian Thrombosis and Cancer Cohort — which prospectively collects data regarding cancer types, stages and objectively confirmed VTE diagnoses — to identify 144,952 patients followed from 1993 to 2012 (median age at cancer diagnosis, 59.4 years; 51% men).
At cancer diagnosis, 38% of patients had localized cancer, 30% had regional spread and 17% had distant metastases.
Among 335 VTE events that occurred during follow-up, 182 occurred the first year after cancer diagnosis (IR = 21.2; 85% CI, 18.3-24.5), 111 occurred from 1 year to 5 years after diagnosis (IR = 5.9; 95% CI, 4.9-7.1), and 42 occurred more than 5 years after diagnosis (IR = 4.3; 95% CI, 3.2-5.8).
Regional spread (IRD = 14.9 x 10–3 person-years; 95% CI, 8.3-21.5) and distant metastasis (IRD = 57.1 x 10–3 person-years; 95% CI, 41.5-72.8) appeared associated with an increased IRD of VTE during the first year after cancer diagnosis compared with localized disease for all cancers combined.
Although IRDs remained positive and significant for both regional spread and distant metastasis 5 years after diagnosis, the majority of VTEs that contributed to IRDs during the first 5 years occurred in patients with distant metastases within the first year.
The IRD for regional spread vs. localized disease during the first year after cancer diagnosis varied by cancer type. The highest IRD occurred for uterine cancer (IRD = 37.6 x 10–3 person-years; 95% CI, –23.7 to 99), whereas breast and prostate cancer demonstrated an IRD slightly over zero.
The IRD of VTE in patients with distant metastasis vs. localized disease also varied, with the highest observed in pancreatic cancer (IRD = 187 x 10–3 person-years; 95% CI, –6.7 to 380.8), and the lowest in prostate cancer (IRD = 3.7 x 10–3 person-years; 95% CI, –7 to 15.2).
“When each type of cancer was examined, the number of VTE events was rather low in some of the groups, so the IRD could merely indicate trends,” Gade and colleagues wrote.
In the regression analysis of all cancer types combined, regional spread (HR = 2.6; 95% CI, 1.7-4) and distant metastasis (HR = 6.8; 95% CI, 4.5-10.4) increased risk for VTE compared with localized disease in the first year after cancer diagnosis. This association appeared strongest for distant metastatic colorectal (HR = 16.5; 95% CI, 3.6-74.6), upper gastrointestinal (HR = 9.1; 95% CI, 1.1-78.8) and bladder (HR = 7.6; 95% CI, 1.3-46) cancers.
Regional spread also increased risk for VTE during the first year after diagnosis of colorectal cancer (HR = 7.3; 95% CI, 1.7-30.1). The researchers observed a trend toward higher risk for VTE in patients with regional spread of lung, upper gastrointestinal, pancreatic and uterine cancers.
“Our data contribute to an emerging understanding that cancer stage may not be an independent risk factor for VTE in all cancer types as such, but that the risk actually depends more on the cancer type for some cancers,” Gade and colleagues wrote. – by Kristie L. Kahl
Disclosures: The researchers report no relevant financial disclosures.
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