Laurent Bertoletti MD, PhD , Olga Madridano MD, PhD , David Jiménez MD, PhD , Alfonso Muriel PhD , Behnood Bikdeli MD, MS , Cihan Ay MD, PhD , Javier Trujillo-Santos MD, PhD , Marijan Bosevski MD, PhD , Patricia Sigüenza MD , Manuel Monreal MD, PhD
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Conversely, there was a decline in patients with prostate cancer (from 11.7% to 6.6%; <em>P <</em> 0.001) or carcinoma of unknown origin (from 3.5% to 0.7%; <em>P <</em> 0.001). At the 30-day follow-up, a reduction was observed in the proportion of patients experiencing symptomatic VTE recurrences (from 3.1% to 1.1%; <em>P <</em> 0.001), major bleeding (from 3.1% to 2.2%; <em>P =</em> 0.004), and death (from 11.9% to 8.4%; <em>P <</em> 0.001). Multivariable analyses revealed a decreased risk over time for VTE recurrence (adjusted subdistribution HR [asHR]: 0.94 per year; 95% CI: 0.92-0.98), major bleeding (asHR: 0.98; 95% CI: 0.96-0.99), and death (aHR: 0.97; 95% CI: 0.96-0.98).</p></div><div><h3>Conclusions</h3><p>In this multicenter study of cancer patients with VTE, there was a decline in thrombotic, hemorrhagic, and fatal events from 2001 to 2020. (Registro Informatizado de la Enfermedad Trombo Embólica [RIETE]; <span>NCT02832245</span><svg><path></path></svg>)</p></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":null,"pages":null},"PeriodicalIF":12.0000,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087323002983/pdfft?md5=e7cca0e9b87c399fbf0103ea79b716ce&pid=1-s2.0-S2666087323002983-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Cancer-Associated Thrombosis\",\"authors\":\"Laurent Bertoletti MD, PhD , Olga Madridano MD, PhD , David Jiménez MD, PhD , Alfonso Muriel PhD , Behnood Bikdeli MD, MS , Cihan Ay MD, PhD , Javier Trujillo-Santos MD, PhD , Marijan Bosevski MD, PhD , Patricia Sigüenza MD , Manuel Monreal MD, PhD\",\"doi\":\"10.1016/j.jaccao.2023.09.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Despite advances in cancer and venous thromboembolism (VTE) management, the epidemiology of cancer-associated thrombosis management over time remains unclear.</p></div><div><h3>Objectives</h3><p>We analyzed data from the RIETE (Registro Informatizado de la Enfermedad Trombo Embólica) registry spanning 2001 to 2020 to investigate temporal trends in clinical characteristics and treatments for cancer-associated thrombosis.</p></div><div><h3>Methods</h3><p>Using multivariable survival regression, we examined temporal trends in risk-adjusted rates of symptomatic VTE recurrences, major bleeding, and death within 30 days after incident VTE.</p></div><div><h3>Results</h3><p>Among the 17,271 patients with cancer-associated thrombosis, there was a progressive increase in patients presenting with pulmonary embolism (from 44% in 2001-2005 to 55% in 2016-2020; <em>P <</em> 0.001 for trend), lung (from 12.7% to 18.1%; <em>P <</em> 0.001) or pancreatic cancer (from 3.8% to 5.6%; <em>P =</em> 0.003), and utilization of immunotherapy (from 0% to 7.4%; <em>P <</em> 0.001). Conversely, there was a decline in patients with prostate cancer (from 11.7% to 6.6%; <em>P <</em> 0.001) or carcinoma of unknown origin (from 3.5% to 0.7%; <em>P <</em> 0.001). At the 30-day follow-up, a reduction was observed in the proportion of patients experiencing symptomatic VTE recurrences (from 3.1% to 1.1%; <em>P <</em> 0.001), major bleeding (from 3.1% to 2.2%; <em>P =</em> 0.004), and death (from 11.9% to 8.4%; <em>P <</em> 0.001). Multivariable analyses revealed a decreased risk over time for VTE recurrence (adjusted subdistribution HR [asHR]: 0.94 per year; 95% CI: 0.92-0.98), major bleeding (asHR: 0.98; 95% CI: 0.96-0.99), and death (aHR: 0.97; 95% CI: 0.96-0.98).</p></div><div><h3>Conclusions</h3><p>In this multicenter study of cancer patients with VTE, there was a decline in thrombotic, hemorrhagic, and fatal events from 2001 to 2020. 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引用次数: 0
摘要
背景尽管癌症和静脉血栓栓塞症(VTE)治疗取得了进展,但随着时间的推移,癌症相关血栓管理的流行病学仍不清楚。目的我们分析了 RIETE(Registro Informatizado de la Enfermedad Trombo Embólica)登记处 2001 年至 2020 年的数据,以调查癌症相关血栓的临床特征和治疗的时间趋势。方法通过多变量生存回归,我们研究了发生 VTE 后 30 天内无症状 VTE 复发、大出血和死亡的风险调整率的时间趋势。结果在17271例癌症相关血栓形成患者中,肺栓塞(从2001-2005年的44%增至2016-2020年的55%;趋势P< 0.001)、肺癌(从12.7%增至18.1%;P< 0.001)或胰腺癌(从3.8%增至5.6%;P = 0.003)以及使用免疫疗法(从0%增至7.4%;P< 0.001)的患者逐渐增多。相反,前列腺癌患者(从11.7%降至6.6%;P <0.001)或不明原因癌患者(从3.5%降至0.7%;P <0.001)则有所减少。在30天的随访中,观察到出现无症状VTE复发(从3.1%降至1.1%;P <;0.001)、大出血(从3.1%降至2.2%;P = 0.004)和死亡(从11.9%降至8.4%;P <;0.001)的患者比例有所下降。多变量分析显示,随着时间的推移,VTE复发(调整后的亚分布HR [asHR]:每年0.94;95% CI:0.92-0.98)、大出血(asHR:0.98;95% CI:0.96-0.99)和死亡(aHR:0.97;95% CI:0.96-0.98)的风险降低。(Registro Informatizado de la Enfermedad Trombo Embólica [RIETE];NCT02832245)
Despite advances in cancer and venous thromboembolism (VTE) management, the epidemiology of cancer-associated thrombosis management over time remains unclear.
Objectives
We analyzed data from the RIETE (Registro Informatizado de la Enfermedad Trombo Embólica) registry spanning 2001 to 2020 to investigate temporal trends in clinical characteristics and treatments for cancer-associated thrombosis.
Methods
Using multivariable survival regression, we examined temporal trends in risk-adjusted rates of symptomatic VTE recurrences, major bleeding, and death within 30 days after incident VTE.
Results
Among the 17,271 patients with cancer-associated thrombosis, there was a progressive increase in patients presenting with pulmonary embolism (from 44% in 2001-2005 to 55% in 2016-2020; P < 0.001 for trend), lung (from 12.7% to 18.1%; P < 0.001) or pancreatic cancer (from 3.8% to 5.6%; P = 0.003), and utilization of immunotherapy (from 0% to 7.4%; P < 0.001). Conversely, there was a decline in patients with prostate cancer (from 11.7% to 6.6%; P < 0.001) or carcinoma of unknown origin (from 3.5% to 0.7%; P < 0.001). At the 30-day follow-up, a reduction was observed in the proportion of patients experiencing symptomatic VTE recurrences (from 3.1% to 1.1%; P < 0.001), major bleeding (from 3.1% to 2.2%; P = 0.004), and death (from 11.9% to 8.4%; P < 0.001). Multivariable analyses revealed a decreased risk over time for VTE recurrence (adjusted subdistribution HR [asHR]: 0.94 per year; 95% CI: 0.92-0.98), major bleeding (asHR: 0.98; 95% CI: 0.96-0.99), and death (aHR: 0.97; 95% CI: 0.96-0.98).
Conclusions
In this multicenter study of cancer patients with VTE, there was a decline in thrombotic, hemorrhagic, and fatal events from 2001 to 2020. (Registro Informatizado de la Enfermedad Trombo Embólica [RIETE]; NCT02832245)
期刊介绍:
JACC: CardioOncology is a specialized journal that belongs to the esteemed Journal of the American College of Cardiology (JACC) family. Its purpose is to enhance cardiovascular care for cancer patients by publishing high-quality, innovative scientific research and sharing evidence-based knowledge.
The journal aims to revolutionize the field of cardio-oncology and actively involve and educate professionals in both cardiovascular and oncology fields. It covers a wide range of topics including pre-clinical, translational, and clinical research, as well as best practices in cardio-oncology. Key areas of focus include understanding disease mechanisms, utilizing in vitro and in vivo models, exploring novel and traditional therapeutics (across Phase I-IV trials), studying epidemiology, employing precision medicine, and investigating primary and secondary prevention.
Amyloidosis, cardiovascular risk factors, heart failure, and vascular disease are some examples of the disease states that are of particular interest to the journal. However, it welcomes research on other relevant conditions as well.