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Variation in the risk of venous thromboembolism in people with colorectal cancer: a population-based cohort study from England.

Walker AJ, West J, Card TR, Humes DJ, Grainge MJ - J. Thromb. Haemost. (2014)

Bottom Line: However, our understanding of which patients are at increased risk, and to what extent, is limited.Rates were compared by the use of Cox regression.However, Dukes B and Dukes C patients receiving postoperative chemotherapy have a longer duration of risk.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Patients with colorectal cancer are at high risk of developing venous thromboembolism(VTE), and recent international guidelines have advised extended prophylaxis for some of these patients following surgery or during chemotherapy. However, our understanding of which patients are at increased risk, and to what extent, is limited.

Objectives: To determine absolute and relative rates of VTE among patients with colorectal cancer according to Dukes stage, surgical intervention,and chemotherapy.

Methods: We analyzed data from four linked databases from 1997 to 2006: the Clinical Practice Research Datalink, linked to Hospital Episode Statistics, Cancer Registry data, and Office for National Statistics cause of death data, all from England. Rates were compared by the use of Cox regression.

Results: There were 10 309 patients with colorectal cancer, and 555 developed VTE (5.4%). The incidence varied by Dukes stage, being three-fold higher among Dukes D patients than among Dukes A patients (hazard ratio [HR] 3.08, 95% confidence interval [CI] 1.95–4.84), and 40% higher for those receiving chemotherapy than for those not receiving chemotherapy(HR 1.39, 95% CI 1.14–1.69). The risk following surgery varied by stage of disease and chemotherapy, with Dukes A patients having a low incidence of VTE (0.74%; 95% CI 0.28–1.95) at 6 months,with all events occurring within 28 days of surgery, as compared with Dukes B and Dukes C patients, whose risk at 6 months was ~ 2%.

Conclusion: Twenty-eight days of prophylaxis following surgery for colorectal cancer is appropriate for Dukes A patients. However, Dukes B and Dukes C patients receiving postoperative chemotherapy have a longer duration of risk.

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Distribution of patients by surgery, chemotherapy, and stage of disease.
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fig01: Distribution of patients by surgery, chemotherapy, and stage of disease.

Mentions: In the 10 years between 1997 and 2006, 10 309 colorectal cancer patients were identified from cancer registry data (Table1). The median age at diagnosis was 74 years, and the median follow-up time was 2.2 years. VTE occurred in 555 cases, leading to a rate of 15.8 per 1000 person-years (95% CI 14.5–17.1). Cancer stage was determinable in 71.7% of patients. Among those with a known stage, 8.8% had Dukes A, a large majority had Dukes B and C (37.2% and 33.8%, respectively), and 20.2% had Dukes D. In total, 7407 (71.8%) patients underwent surgery, with 25% of these patients receiving chemotherapy following surgery, and the greatest proportion of chemotherapy being received by Dukes C patients. Among those not undergoing surgery, 338 (11.6%) received palliative chemotherapy. (Fig.1 shows the distribution of stage by surgery and chemotherapy.) Among patients whose Dukes stage could not be determined, 6% had an ambiguous Dukes stage (recorded only as numerical stage I) and were excluded from analyses involving stage. The overall 5-year survival rate in our cohort was 43.9%, and this varied by stage, with Dukes A patients having the most favorable survival and Dukes D the worst (Table S1). Those with an undetermined stage also had poor survival.


Variation in the risk of venous thromboembolism in people with colorectal cancer: a population-based cohort study from England.

Walker AJ, West J, Card TR, Humes DJ, Grainge MJ - J. Thromb. Haemost. (2014)

Distribution of patients by surgery, chemotherapy, and stage of disease.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230392&req=5

fig01: Distribution of patients by surgery, chemotherapy, and stage of disease.
Mentions: In the 10 years between 1997 and 2006, 10 309 colorectal cancer patients were identified from cancer registry data (Table1). The median age at diagnosis was 74 years, and the median follow-up time was 2.2 years. VTE occurred in 555 cases, leading to a rate of 15.8 per 1000 person-years (95% CI 14.5–17.1). Cancer stage was determinable in 71.7% of patients. Among those with a known stage, 8.8% had Dukes A, a large majority had Dukes B and C (37.2% and 33.8%, respectively), and 20.2% had Dukes D. In total, 7407 (71.8%) patients underwent surgery, with 25% of these patients receiving chemotherapy following surgery, and the greatest proportion of chemotherapy being received by Dukes C patients. Among those not undergoing surgery, 338 (11.6%) received palliative chemotherapy. (Fig.1 shows the distribution of stage by surgery and chemotherapy.) Among patients whose Dukes stage could not be determined, 6% had an ambiguous Dukes stage (recorded only as numerical stage I) and were excluded from analyses involving stage. The overall 5-year survival rate in our cohort was 43.9%, and this varied by stage, with Dukes A patients having the most favorable survival and Dukes D the worst (Table S1). Those with an undetermined stage also had poor survival.

Bottom Line: However, our understanding of which patients are at increased risk, and to what extent, is limited.Rates were compared by the use of Cox regression.However, Dukes B and Dukes C patients receiving postoperative chemotherapy have a longer duration of risk.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Patients with colorectal cancer are at high risk of developing venous thromboembolism(VTE), and recent international guidelines have advised extended prophylaxis for some of these patients following surgery or during chemotherapy. However, our understanding of which patients are at increased risk, and to what extent, is limited.

Objectives: To determine absolute and relative rates of VTE among patients with colorectal cancer according to Dukes stage, surgical intervention,and chemotherapy.

Methods: We analyzed data from four linked databases from 1997 to 2006: the Clinical Practice Research Datalink, linked to Hospital Episode Statistics, Cancer Registry data, and Office for National Statistics cause of death data, all from England. Rates were compared by the use of Cox regression.

Results: There were 10 309 patients with colorectal cancer, and 555 developed VTE (5.4%). The incidence varied by Dukes stage, being three-fold higher among Dukes D patients than among Dukes A patients (hazard ratio [HR] 3.08, 95% confidence interval [CI] 1.95–4.84), and 40% higher for those receiving chemotherapy than for those not receiving chemotherapy(HR 1.39, 95% CI 1.14–1.69). The risk following surgery varied by stage of disease and chemotherapy, with Dukes A patients having a low incidence of VTE (0.74%; 95% CI 0.28–1.95) at 6 months,with all events occurring within 28 days of surgery, as compared with Dukes B and Dukes C patients, whose risk at 6 months was ~ 2%.

Conclusion: Twenty-eight days of prophylaxis following surgery for colorectal cancer is appropriate for Dukes A patients. However, Dukes B and Dukes C patients receiving postoperative chemotherapy have a longer duration of risk.

Show MeSH
Related in: MedlinePlus