METHODS: We examined the risk of, and factors associated with, late VTE among adolescents and young adults (AYA, 15-39 years) diagnosed with cancer (2006-2018) who survived ≥2 years. Data were obtained from the California Cancer Registry linked to hospitalization, emergency department and ambulatory surgery data. We used non-parametric models and Cox proportional hazard regression for analyses.
RESULTS: Among 59,343 survivors, the 10-year cumulative incidence of VTE was 1.93 % (CI 1.80-2.07). The hazard of VTE was higher among those who had active cancer, including progression from lower stages to metastatic disease (Hazard Ratio (HR) = 10.41, 95 % confidence interval (CI): 8.86-12.22), second primary cancer (HR = 2.58, CI:2.01-3.31), or metastatic disease at diagnosis (HR = 2.38, CI:1.84-3.09). The hazard of late VTE was increased among survivors who underwent hematopoietic cell transplantation, those who received radiotherapy, had a VTE history, public insurance (vs private) or non-Hispanic Black/African American race/ethnicity (vs non-Hispanic White). Patients with leukemias, lymphomas, sarcoma, melanoma, colorectal, breast, and cervical cancers had a higher VTE risk than those with thyroid cancer.
CONCLUSIONS: VTE risk remained elevated ≥2 years following cancer diagnosis in AYA survivors. Active cancer is a significant risk factor for VTE. Future studies might determine if late VTE should prompt evaluation for recurrence or second malignancy, if not already known.
方法:我们检查了以下风险:以及与之相关的因素,青少年和年轻人的晚期VTE(AYA,15-39岁)诊断为癌症(2006-2018),存活≥2年。数据来自加州癌症登记处与住院相关,急诊科和门诊手术数据。我们使用非参数模型和Cox比例风险回归进行分析。
结果:在59,343名幸存者中,VTE的10年累积发病率为1.93%(CI1.80~2.07).在患有活动性癌症的人群中,VTE的风险更高,包括从低分期到转移性疾病的进展(危险比(HR)=10.41,95%置信区间(CI):8.86-12.22),第二原发癌(HR=2.58,CI:2.01-3.31),或诊断时的转移性疾病(HR=2.38,CI:1.84-3.09)。在接受造血细胞移植的幸存者中,晚期VTE的危险增加。那些接受放射治疗的人,有VTE历史,公共保险(vs私人)或非西班牙裔黑人/非裔美国人种族/种族(vs非西班牙裔白人)。白血病患者,淋巴瘤,肉瘤,黑色素瘤,结直肠,乳房,宫颈癌的VTE风险高于甲状腺癌患者.
结论:AYA幸存者在癌症诊断后≥2年VTE风险仍然升高。活动性癌症是VTE的重要风险因素。未来的研究可能会确定晚期VTE是否应提示复发或第二恶性肿瘤的评估。如果还不知道。