Venous thromboembolism in patients with colorectal cancer: Incidence and effect on survival

Allison Alcalay, Theodore Wun, Vijay Khatri, Helen K Chew, Danielle J Harvey, Hong Zhou, Richard H White

Research output: Contribution to journalArticle

218 Citations (Scopus)

Abstract

Purpose: To describe the incidence and outcomes associated with venous thromboembolism (VTE) among patients with colorectal cancer. Methods: This was a retrospective analysis of all colorectal cancer patients diagnosed in California between 1993 and 1995 and 1997 to 1999. Principal outcomes were incident symptomatic VTE events and death. Associations between specific risk factors and principal outcomes were analyzed using Cox proportional hazards models. Results: Among 68, 142 colorectal cancer patients, 50% were women, mean age was 70 ± 15 years, and approximately 70% underwent a major operation. The 2-year cumulative incidence of VTE was 2,100 patients (3.1%), with an incidence rate that decreased significantly over time from 5.0% (events/100 patient-years) in months 0 to 6 to 1.4% during months 7 to 12 to 0.6% during the second year. Significant predictors of VTE included metastatic stage (hazard ratio [HR] = 3.2; 95% CI, 2.8 to 3.8) and three or more comorbid conditions (HR = 2.0; 95% CI, 1.7 to 2.3). The risk of VTE was significantly reduced among Asians/Pacific Islanders (HR = 0.4; 95% CI, 0.3 to 0.5.) and patients who underwent an abdominal operation (HR = 0.4; 95% CI, 0.3 to 0.4). In risk-adjusted models, VTE was a significant predictor of death within 1 year of cancer diagnosis among patients with local- (HR = 1.8; 95% CI, 1.4 to 2.3) or regional-stage disease (HR = 1.5; 95% CI, 1.3 to 1.8) but not among patients with metastatic disease (HR = 1.1; 95% CI, 1.0 to 1.2). Conclusion: The incidence of VTE among colorectal cancer patients was highest in the first 6 months after diagnosis and decreased rapidly thereafter. Metastatic disease and the number of medical comorbidities were the strongest predictors of VTE. Incident VTE reduced survival among patients with local or regional disease, suggesting that, in these patients, VTE may reflect the presence of a biologically more aggressive cancer.

Original languageEnglish (US)
Pages (from-to)1112-1118
Number of pages7
JournalJournal of Clinical Oncology
Volume24
Issue number7
DOIs
StatePublished - Mar 1 2006

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Venous Thromboembolism
Colorectal Neoplasms
Survival
Incidence
Proportional Hazards Models
Comorbidity
Neoplasms

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Venous thromboembolism in patients with colorectal cancer : Incidence and effect on survival. / Alcalay, Allison; Wun, Theodore; Khatri, Vijay; Chew, Helen K; Harvey, Danielle J; Zhou, Hong; White, Richard H.

In: Journal of Clinical Oncology, Vol. 24, No. 7, 01.03.2006, p. 1112-1118.

Research output: Contribution to journalArticle

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title = "Venous thromboembolism in patients with colorectal cancer: Incidence and effect on survival",
abstract = "Purpose: To describe the incidence and outcomes associated with venous thromboembolism (VTE) among patients with colorectal cancer. Methods: This was a retrospective analysis of all colorectal cancer patients diagnosed in California between 1993 and 1995 and 1997 to 1999. Principal outcomes were incident symptomatic VTE events and death. Associations between specific risk factors and principal outcomes were analyzed using Cox proportional hazards models. Results: Among 68, 142 colorectal cancer patients, 50{\%} were women, mean age was 70 ± 15 years, and approximately 70{\%} underwent a major operation. The 2-year cumulative incidence of VTE was 2,100 patients (3.1{\%}), with an incidence rate that decreased significantly over time from 5.0{\%} (events/100 patient-years) in months 0 to 6 to 1.4{\%} during months 7 to 12 to 0.6{\%} during the second year. Significant predictors of VTE included metastatic stage (hazard ratio [HR] = 3.2; 95{\%} CI, 2.8 to 3.8) and three or more comorbid conditions (HR = 2.0; 95{\%} CI, 1.7 to 2.3). The risk of VTE was significantly reduced among Asians/Pacific Islanders (HR = 0.4; 95{\%} CI, 0.3 to 0.5.) and patients who underwent an abdominal operation (HR = 0.4; 95{\%} CI, 0.3 to 0.4). In risk-adjusted models, VTE was a significant predictor of death within 1 year of cancer diagnosis among patients with local- (HR = 1.8; 95{\%} CI, 1.4 to 2.3) or regional-stage disease (HR = 1.5; 95{\%} CI, 1.3 to 1.8) but not among patients with metastatic disease (HR = 1.1; 95{\%} CI, 1.0 to 1.2). Conclusion: The incidence of VTE among colorectal cancer patients was highest in the first 6 months after diagnosis and decreased rapidly thereafter. Metastatic disease and the number of medical comorbidities were the strongest predictors of VTE. Incident VTE reduced survival among patients with local or regional disease, suggesting that, in these patients, VTE may reflect the presence of a biologically more aggressive cancer.",
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T1 - Venous thromboembolism in patients with colorectal cancer

T2 - Incidence and effect on survival

AU - Alcalay, Allison

AU - Wun, Theodore

AU - Khatri, Vijay

AU - Chew, Helen K

AU - Harvey, Danielle J

AU - Zhou, Hong

AU - White, Richard H

PY - 2006/3/1

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N2 - Purpose: To describe the incidence and outcomes associated with venous thromboembolism (VTE) among patients with colorectal cancer. Methods: This was a retrospective analysis of all colorectal cancer patients diagnosed in California between 1993 and 1995 and 1997 to 1999. Principal outcomes were incident symptomatic VTE events and death. Associations between specific risk factors and principal outcomes were analyzed using Cox proportional hazards models. Results: Among 68, 142 colorectal cancer patients, 50% were women, mean age was 70 ± 15 years, and approximately 70% underwent a major operation. The 2-year cumulative incidence of VTE was 2,100 patients (3.1%), with an incidence rate that decreased significantly over time from 5.0% (events/100 patient-years) in months 0 to 6 to 1.4% during months 7 to 12 to 0.6% during the second year. Significant predictors of VTE included metastatic stage (hazard ratio [HR] = 3.2; 95% CI, 2.8 to 3.8) and three or more comorbid conditions (HR = 2.0; 95% CI, 1.7 to 2.3). The risk of VTE was significantly reduced among Asians/Pacific Islanders (HR = 0.4; 95% CI, 0.3 to 0.5.) and patients who underwent an abdominal operation (HR = 0.4; 95% CI, 0.3 to 0.4). In risk-adjusted models, VTE was a significant predictor of death within 1 year of cancer diagnosis among patients with local- (HR = 1.8; 95% CI, 1.4 to 2.3) or regional-stage disease (HR = 1.5; 95% CI, 1.3 to 1.8) but not among patients with metastatic disease (HR = 1.1; 95% CI, 1.0 to 1.2). Conclusion: The incidence of VTE among colorectal cancer patients was highest in the first 6 months after diagnosis and decreased rapidly thereafter. Metastatic disease and the number of medical comorbidities were the strongest predictors of VTE. Incident VTE reduced survival among patients with local or regional disease, suggesting that, in these patients, VTE may reflect the presence of a biologically more aggressive cancer.

AB - Purpose: To describe the incidence and outcomes associated with venous thromboembolism (VTE) among patients with colorectal cancer. Methods: This was a retrospective analysis of all colorectal cancer patients diagnosed in California between 1993 and 1995 and 1997 to 1999. Principal outcomes were incident symptomatic VTE events and death. Associations between specific risk factors and principal outcomes were analyzed using Cox proportional hazards models. Results: Among 68, 142 colorectal cancer patients, 50% were women, mean age was 70 ± 15 years, and approximately 70% underwent a major operation. The 2-year cumulative incidence of VTE was 2,100 patients (3.1%), with an incidence rate that decreased significantly over time from 5.0% (events/100 patient-years) in months 0 to 6 to 1.4% during months 7 to 12 to 0.6% during the second year. Significant predictors of VTE included metastatic stage (hazard ratio [HR] = 3.2; 95% CI, 2.8 to 3.8) and three or more comorbid conditions (HR = 2.0; 95% CI, 1.7 to 2.3). The risk of VTE was significantly reduced among Asians/Pacific Islanders (HR = 0.4; 95% CI, 0.3 to 0.5.) and patients who underwent an abdominal operation (HR = 0.4; 95% CI, 0.3 to 0.4). In risk-adjusted models, VTE was a significant predictor of death within 1 year of cancer diagnosis among patients with local- (HR = 1.8; 95% CI, 1.4 to 2.3) or regional-stage disease (HR = 1.5; 95% CI, 1.3 to 1.8) but not among patients with metastatic disease (HR = 1.1; 95% CI, 1.0 to 1.2). Conclusion: The incidence of VTE among colorectal cancer patients was highest in the first 6 months after diagnosis and decreased rapidly thereafter. Metastatic disease and the number of medical comorbidities were the strongest predictors of VTE. Incident VTE reduced survival among patients with local or regional disease, suggesting that, in these patients, VTE may reflect the presence of a biologically more aggressive cancer.

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