Venous thromboembolism and cancer risk

Abstract

Cancer increases the risk of venous thromboembolism (VTE) and about 20 % of all VTE are associated with cancer. VTE can also be used as a marker for occult cancer. The objective was to examine the correlation between VTE and cancer regarding predictors for a subsequent cancer diagnosis. Patients treated for VTE between January 1st 2006 and December 31th 2011 were extracted from the Swedish national quality register AuriculA and crossmatched with the Swedish National Patient Register. In total 7854 patients corresponding to 14284 treatments years were examined. Primary VTE was found in 6451 patients, with 3936 first and 2515 recurrent VTE. There were 1403 patients with secondary VTE. After a first or recurrent primary VTE the incidence of cancer diagnose was high being 9.4–10.0 % the first year compared to 2.7–2.5 % during the second year. Cancer in the digestive organs was the most common type of cancer among those with first primary VTE with 19.2 % of diagnoses. In multivariable analysis age was found to increase the risk of cancer diagnosis after both first and recurrent primary VTE HR 1.02 (CI 1.02–1.03) and HR 1.02 (CI 1.01–1.03). For a first primary VTE anemia HR 2.13 (CI 1.48–3.08) and male sex HR 1.38 (CI 1.09–1.76) increased the risk while hypertension HR 0.74 (0.57–0.96), dementia HR 0.30 (CI 0.10–0.95) and history of major bleeding HR 0.52 (CI 0.28–0.97) reduced the risk of a subsequent cancer diagnosis. There is a substantial proportion of patients being diagnosed with cancer the first year after a primary VTE, anaemia and male sex confers an increased risk.

A clinical practice-based evaluation of the RIETE score in predicting occult cancer in patients with venous thromboembolism

“…Consistent with prior studies [ 4 , 16 ], the vast majority (94%, 44/47) of new cancer cases in our cohort were diagnosed within 12 months of VTE diagnosis. The RIETE score was developed to identify patients with an elevated risk of new cancer diagnosis within 24 months, and many previous studies have employed a 24-month follow-up.…”

“…Indeed, age is a component of the RIETE score. In line with this, other studies with higher mean/median age tend to have higher incidences of new cancer diagnoses, such as Sandén et al [ 4 ], Ferreyro et al [ 15 ] and Prandoni et al [ 7 ], with 9.6%, 9.2% and 9.2% new cancer diagnoses, respectively.…”

“…The incidence of occult cancer was higher in our cohort compared to several recent studies [ 4 – 9 , 14 ]. The median age was also higher in our cohort compared to many of these studies [ 6 , 8 , 9 ], conceivably due to the unselected nature of our clinical practice-based approach, which could explain the higher incidence of new cancer diagnosis.…”

“…VTE may also be the earliest sign of occult cancer. Approximately 7–10% of patients with an unprovoked VTE (in the absence of a major risk factor) receive a new cancer diagnosis within 1 year [ 3 , 4 ]. The incidence of occult cancer in patients with provoked VTE is less investigated, but is considered much lower [ 3 ].…”

Occult cancer and thromboembolism: current epidemiology and its practical implication

“…32 Hypertension (HR, 0.74; CI, 0.57-0.96), dementia (HR, 0.30; CI, 0.10-0.95), and a history of major bleeding (HR, 0.52; CI, 0.28-0.97) reduced the risk of cancer diagnosis. 32 In a post hoc analysis of the MVTEP study, age of 50 years or older, male sex, leukocytosis (≥10 g/l), and thrombocytosis (≥350 g/l) were associated with increased rates of occult cancer detection. 33 The risk of cancer was 12.9% in patients with leukocytosis and 15.4% in those with thrombocytosis, which was much higher than the risk of 6.4% in the whole study population.…”