Venous thromboembolism and mortality in breast cancer: cohort study with systematic review and meta-analysis

BMC Cancer

Research Article

Sadaf Baig¹  Tim R. Card¹  Matthew J. Grainge¹  Umair T. Khan²  Alex J. Walker³  Cliona C. Kirwan⁴ 

[1] Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Medical School, NG7 2UH, Nottingham, UK;Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Medical School, NG7 2UH, Nottingham, UK;Institute of Translational Medicine, Molecular and Clinical Cancer Medicine, University of Liverpool, Crown Street, L69 3BX, Liverpool, UK;Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Medical School, NG7 2UH, Nottingham, UK;School of Life Sciences, University of Nottingham, Medical School, Queen’s Medical Centre, NG7 2UH, Nottingham, UK;Institute of Cancer, University of Manchester, South Manchester University Hospitals NHS Trust, Wythenshawe Hospital, Southmoor Road, M23 9PL, Manchester, UK;

关键词: Breast cancer;    Venous thromboembolism;    Pulmonary embolism;    Deep vein thrombosis;    Mortality;    Prognosis;    Cohort study;    Systematic review;    Meta-analysis;   

DOI  :  10.1186/s12885-017-3719-1

 received in 2016-11-30, accepted in 2017-10-30,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundBreast cancer patients are at an increased risk of venous thromboembolism (VTE). However, current evidence as to whether VTE increases the risk of mortality in breast cancer patients is conflicting. We present data from a large cohort of patients from the UK and pool these with previous data from a systematic review.MethodsUsing the Clinical Practice Research Datalink (CPRD) dataset, we identified a cohort of 13,202 breast cancer patients, of whom 611 were diagnosed with VTE between 1997 and 2006 and 12,591 did not develop VTE. Hazard ratios (HR) were used to compare mortality between the two groups. These were then pooled with existing data on this topic identified via a search of the MEDLINE and EMBASE databases (until January 2015) using a random-effects meta-analysis.ResultsWithin the CPRD, VTE was associated with increased mortality when treated as a time-varying covariate (HR = 2.42; 95% CI, 2.13–2.75), however, when patients were permanently classed as having VTE based on presence of a VTE event within 6 months of cancer diagnosis, no increased risk was observed (HR = 1.22; 0.93–1.60). The pooled HR from seven studies using the second approach was 1.69 (1.12–2.55), with no effect seen when restricted to studies which adjusted for key covariates.ConclusionA large HR for VTE in the time-varying covariate analysis reflects the known short-term mortality following a VTE. When breast cancer patients are fortunate to survive the initial VTE, the influence on longer-term mortality is less certain.

【 授权许可】

CC BY   
© The Author(s). 2017