Subscribe to RSS
DOI: 10.1055/a-1742-0177
Incidence and Outcomes Associated with 6,841 Isolated Distal Deep Vein Thromboses in Patients with 13 Common Cancers
Funding The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention's National Program of Cancer Registries, under cooperative agreement 5NU58DP006344; the National Cancer Institute's Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors. T.W. is supported by UL1TR001860 from the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health.Abstract
Introduction The epidemiology of isolated distal deep venous thrombosis (iDDVT) among cancer patients is not well described, particularly the incidence of recurrent venous thromboembolism (rVTE) and effect on mortality by cancer type.
Methods The cumulative incidence (CI) of iDDVT was determined for patients with 13 common cancers between 2005 and 2017 using the California Cancer Registry linked to the California Patient Discharge and Emergency Department Utilization datasets. The CI of rVTE was calculated and association of incident cancer-associated thrombosis (CT) location with rVTE was determined using Cox proportional hazards regression models. The association of incident CT location with overall and cancer-specific mortality was determined using Cox models, stratified by cancer site, and adjusted for individual characteristics.
Results Among 942,109 cancer patients, CT occurred in 62,003 (6.6%): of these, 6,841 (11.0%) were iDDVT. Compared with more proximal sites of CT, iDDVT was associated with similar risk for rVTE. IDDVT was associated with increased mortality across all cancer types when compared with patients without CT (hazard ratio: 1.56–4.60). The effect of iDDVT on mortality was similar to that of proximal DVT (pDVT) for most cancers except lung, colorectal, bladder, uterine, brain, and myeloma, where iDDVT was associated with a lesser association with mortality.
Conclusion iDDVT represented 11% of CT. The risk of rVTE after iDDVT was similar to other sites of CT and rVTE occurred in more proximal locations after an incident iDDVT. IDDVT was associated with increased mortality and this effect was similar to that of pulmonary embolism or pDVT for most cancer types.
Author Contributions
A.M., A.B., and T.W. designed the study, acquired and analyzed the data, and drafted the manuscript. All authors made revisions and approved the final manuscript.
Publication History
Received: 22 July 2021
Accepted: 14 January 2022
Accepted Manuscript online:
17 January 2022
Article published online:
10 March 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Vormittag R, Simanek R, Ay C. et al. High factor VIII levels independently predict venous thromboembolism in cancer patients: the cancer and thrombosis study. Arterioscler Thromb Vasc Biol 2009; 29 (12) 2176-2181
- 2 Sallah S, Wan JY, Nguyen NP. Venous thrombosis in patients with solid tumors: determination of frequency and characteristics. Thromb Haemost 2002; 87 (04) 575-579
- 3 Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood 2013; 122 (10) 1712-1723
- 4 Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 2006; 166 (04) 458-464
- 5 Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 2007; 5 (03) 632-634
- 6 Mulder FI, Horvàth-Puhó E, van Es N. et al. Venous thromboembolism in cancer patients: a population-based cohort study. Blood 2021; 137 (14) 1959-1969
- 7 Galanaud JP, Sevestre MA, Genty C. et al; OPTIMEV-SFMV investigators. Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep vein thrombosis. J Thromb Haemost 2014; 12 (04) 436-443
- 8 Galanaud JP, Sevestre-Pietri MA, Bosson JL. et al; OPTIMEV-SFMV Investigators. Comparative study on risk factors and early outcome of symptomatic distal versus proximal deep vein thrombosis: results from the OPTIMEV study. Thromb Haemost 2009; 102 (03) 493-500
- 9 Galanaud JP, Quenet S, Rivron-Guillot K. et al; RIETE INVESTIGATORS. Comparison of the clinical history of symptomatic isolated distal deep-vein thrombosis vs. proximal deep vein thrombosis in 11 086 patients. J Thromb Haemost 2009; 7 (12) 2028-2034
- 10 Barco S, Corti M, Trinchero A. et al. Survival and recurrent venous thromboembolism in patients with first proximal or isolated distal deep vein thrombosis and no pulmonary embolism. J Thromb Haemost 2017; 15 (07) 1436-1442
- 11 Ageno W, Mantovani LG, Haas S. et al. Patient management strategies and long-term outcomes in isolated distal deep-vein thrombosis versus proximal deep-vein thrombosis: findings from XALIA. TH Open 2019; 3 (01) e85-e93
- 12 Macdonald PS, Kahn SR, Miller N, Obrand D. Short-term natural history of isolated gastrocnemius and soleal vein thrombosis. J Vasc Surg 2003; 37 (03) 523-527
- 13 Righini M, Galanaud JP, Guenneguez H. et al. Anticoagulant therapy for symptomatic calf deep vein thrombosis (CACTUS): a randomised, double-blind, placebo-controlled trial. Lancet Haematol 2016; 3 (12) e556-e562
- 14 Dentali F, Pegoraro S, Barco S. et al. Clinical course of isolated distal deep vein thrombosis in patients with active cancer: a multicenter cohort study. J Thromb Haemost 2017; 15 (09) 1757-1763
- 15 Spencer FA, Kroll A, Lessard D. et al. Isolated calf deep vein thrombosis in the community setting: the Worcester Venous Thromboembolism study. J Thromb Thrombolysis 2012; 33 (03) 211-217
- 16 Kearon C, Akl EA, Ornelas J. et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149 (02) 315-352
- 17 Poudel SK, Park DY, Jia X. et al. Clinical outcomes of isolated distal deep vein thrombosis versus proximal venous thromboembolism in cancer patients: the cleveland clinic experience. J Thromb Haemost 2020; 18 (03) 651-659
- 18 Galanaud JP, Sevestre MA, Pernod G. et al. Long-term outcomes of cancer-related isolated distal deep vein thrombosis: the OPTIMEV study. J Thromb Haemost 2017; 15 (05) 907-916
- 19 Tao L, Foran JM, Clarke CA, Gomez SL, Keegan TH. Socioeconomic disparities in mortality after diffuse large B-cell lymphoma in the modern treatment era. Blood 2014; 123 (23) 3553-3562
- 20 Yost K, Perkins C, Cohen R, Morris C, Wright W. Socioeconomic status and breast cancer incidence in California for different race/ethnic groups. Cancer Causes Control 2001; 12 (08) 703-711
- 21 Surveillance E. End Results Program. Site Recode ICD-O-3/WHO 2008 definition. Published 2008. Accessed March 3 , 2015 at: http://seer.cancer.gov/siterecode/icdo3_dwhoheme/index.html
- 22 Gray R. A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 1988; 16 (03) 1141-1154
- 23 Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999; 94 (446) 496-509
- 24 Lévesque LE, Hanley JA, Kezouh A, Suissa S. Problem of immortal time bias in cohort studies: example using statins for preventing progression of diabetes. BMJ 2010; 340: b5087
- 25 Liu J, Weinhandl ED, Gilbertson DT, Collins AJ, St Peter WL. Issues regarding ‘immortal time’ in the analysis of the treatment effects in observational studies. Kidney Int 2012; 81 (04) 341-350
- 26 Giobbie-Hurder A, Gelber RD, Regan MM. Challenges of guarantee-time bias. J Clin Oncol 2013; 31 (23) 2963-2969
- 27 Allison PD. Survival Analysis Using SAS: A Practical Guide. 2nd ed.. Cary, NC: SAS Institute; 2010
- 28 Cong L, Liu Q, Zhang R. et al. Tumor size classification of the 8th edition of TNM staging system is superior to that of the 7th edition in predicting the survival outcome of pancreatic cancer patients after radical resection and adjuvant chemotherapy. Sci Rep 2018; 8 (01) 10383
- 29 Liu JY, Peng CW, Yang XJ, Huang CQ, Li Y. The prognosis role of AJCC/UICC 8th edition staging system in gastric cancer, a retrospective analysis. Am J Transl Res 2018; 10 (01) 292-303
- 30 Rosenberg SA. Validity of the Ann Arbor staging classification for the non-Hodgkin's lymphomas. Cancer Treat Rep 1977; 61 (06) 1023-1027
- 31 Trujillo-Santos J, Nieto JA, Tiberio G. et al; RIETE Registry. Predicting recurrences or major bleeding in cancer patients with venous thromboembolism. Findings from the RIETE Registry. Thromb Haemost 2008; 100 (03) 435-439
- 32 Prandoni P, Lensing AW, Piccioli A. et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002; 100 (10) 3484-3488
- 33 Galanaud JP, Blaise S, Sevestre MA. et al; OPTIMEV-SFMV investigators. Long-term outcomes of isolated superficial vein thrombosis in patients with active cancer. Thromb Res 2018; 171: 179-186
- 34 White RH, Garcia M, Sadeghi B. et al. Evaluation of the predictive value of ICD-9-CM coded administrative data for venous thromboembolism in the United States. Thromb Res 2010; 126 (01) 61-67
- 35 Dentali F, Barco S, Pegoraro S. et al. Residual vein obstruction in patients diagnosed with acute isolated distal deep vein thrombosis associated with active cancer. J Thromb Thrombolysis 2018; 46 (03) 404-408
- 36 Dentali F, Pegoraro S, Barco S. et al. OC-01 - Clinical history of cancer patients with isolated distal deep vein thrombosis: a multicenter cohort study. Thromb Res 2016; 140 (Suppl. 01) S168
- 37 Brateanu A, Patel K, Chagin K. et al. Probability of developing proximal deep-vein thrombosis and/or pulmonary embolism after distal deep-vein thrombosis. Thromb Haemost 2016; 115 (03) 608-614