Diana Hedevang Christensen1, Erzsébet Horváth-Puhó2, Reimar Wernich Thomsen2, Søren Tang Knudsen3, Olaf Dekkers4, Paolo Prandoni5, Henrik Toft Sørensen2. 1. Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Norrebrogade 44, 8000 Aarhus C, Denmark. Electronic address: dhcr@clin.au.dk. 2. Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark. 3. Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Norrebrogade 44, 8000 Aarhus C, Denmark. 4. Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark; Department of Clinical Epidemiology and Metabolism, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands. 5. Department of Cardiothoracic and Vascular Science, Thromboembolism Unit, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
Abstract
AIM: Venous thromboembolism (VTE) has long been regarded as a marker of underlying malignancy in the general population. Patients with diabetes mellitus are at increased risk of developing VTE, but it is unclear whether VTE in diabetes patients is also a harbinger of occult cancer. METHODS: From Danish medical health databases, we identified all diabetes patients (N=8783) with a first-time diagnosis of VTE during 1978-2011. We followed the patients until a first-time diagnosis of cancer, emigration, death, or study end, whichever came first. We calculated one-year absolute cancer risk and overall and site-specific standardized incidence ratios (SIRs) for cancer based on national cancer incidence. RESULTS: During the total study period 878 cancers were observed. The one-year absolute cancer risk was 4.1% and the corresponding SIR was 3.28 (95% confidence interval [CI]: 2.94-3.64). The highest SIRs were observed for cancers of the gallbladder and biliary tract (SIR 13.59; 6.77-24.31), the pancreas (SIR 10.16; 6.85-14.50), the ovary (SIR 9.85; 5.63-16.00), and the liver (SIR 9.39; 4.30-17.84). After the first year of follow-up, the overall cancer SIR associated with VTE and diabetes decreased to 1.05 (95% CI: 0.97-1.15). CONCLUSIONS: VTE may be a marker of underlying cancer in patients with diabetes mellitus.
AIM: Venous thromboembolism (VTE) has long been regarded as a marker of underlying malignancy in the general population. Patients with diabetes mellitus are at increased risk of developing VTE, but it is unclear whether VTE in diabetespatients is also a harbinger of occult cancer. METHODS: From Danish medical health databases, we identified all diabetespatients (N=8783) with a first-time diagnosis of VTE during 1978-2011. We followed the patients until a first-time diagnosis of cancer, emigration, death, or study end, whichever came first. We calculated one-year absolute cancer risk and overall and site-specific standardized incidence ratios (SIRs) for cancer based on national cancer incidence. RESULTS: During the total study period 878 cancers were observed. The one-year absolute cancer risk was 4.1% and the corresponding SIR was 3.28 (95% confidence interval [CI]: 2.94-3.64). The highest SIRs were observed for cancers of the gallbladder and biliary tract (SIR 13.59; 6.77-24.31), the pancreas (SIR 10.16; 6.85-14.50), the ovary (SIR 9.85; 5.63-16.00), and the liver (SIR 9.39; 4.30-17.84). After the first year of follow-up, the overall cancer SIR associated with VTE and diabetes decreased to 1.05 (95% CI: 0.97-1.15). CONCLUSIONS:VTE may be a marker of underlying cancer in patients with diabetes mellitus.
Authors: Fiorella Guadagni; Silvia Riondino; Vincenzo Formica; Girolamo Del Monte; Anna Maria Morelli; Jessica Lucchetti; Antonella Spila; Roberta D'Alessandro; David Della-Morte; Patrizia Ferroni; Mario Roselli Journal: World J Gastroenterol Date: 2017-07-28 Impact factor: 5.742