Abstract

BACKGROUND:

Routine VTE prophylaxis within 30 days of radical cystectomy (RC) for urinary bladder cancer (UBC) is used to protect from venous thromboembolism (VTE). However, randomized studies and nationwide population-based studies are lacking.

OBJECTIVE:

To study VTE and risk factors for VTE in muscle-invasive UBC in a nationwide population-based series, with a focus on the association with RC with and without chemotherapy.

MATERIALS AND METHODS:

We studied all patients with clinical stage T2-T4 UBC diagnosed 1997 to 2014 in the Bladder Cancer Data Base Sweden (BladderBaSe). Previous VTE events and risk factors for VTE were registered from 1987. Cox regression analyses and Kaplan-Meier curves were performed to study risk factors for VTE and cumulative incidence of VTE.

RESULTS:

In 9720 patients (71%males) with a median age of 74 years 546 (5.6%) had VTE after diagnosis. In Cox analyses controlling for patient’s and tumour characteristics, and risk factors for VTE, VTE after diagnosis and first treatment date were associated with chemotherapy with or without RC. Cumulative incidence of VTE increased during 24 months after diagnosis and first treatment date. VTE were less common in patients with previous cardiovascular disease.

CONCLUSIONS:

VTE was commonly observed after 30 days from diagnosis and from first treatment date in patients with T2-T4 UBC, particularly after chemotherapy. The findings suggest that long-term intervention studies of benefit and possible harms of VTE prophylaxis after UBC should be undertaken.

中文翻译：

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肌层浸润性膀胱癌的血栓栓塞。基于人口的全国性研究

 抽象的

 背景：

膀胱癌 (UBC) 根治性膀胱切除术 (RC) 后 30 天内常规预防 VTE，可预防静脉血栓栓塞 (VTE)。然而，缺乏随机研究和全国范围内的人群研究。

 客观的：

在全国范围内以人群为基础的系列研究中，研究肌肉侵袭性 UBC 中的 VTE 和 VTE 的危险因素，重点是在接受或不接受化疗的情况下与 RC 的关联。

 材料和方法：

我们研究了瑞典膀胱癌数据库 (BladderBaSe) 1997 年至 2014 年诊断的所有临床分期 T2-T4 UBC 患者。自 1987 年起记录了既往 VTE 事件和 VTE 危险因素。进行 Cox 回归分析和 Kaplan-Meier 曲线来研究 VTE 危险因素和 VTE 累积发生率。

 结果：

在 9720 名中位年龄为 74 岁的患者（71% 男性）中，有 546 名患者（5.6%）在诊断后患有 VTE。在控制患者和肿瘤特征以及 VTE 危险因素的 Cox 分析中，诊断后和首次治疗日期的 VTE 与伴或不伴 RC 的化疗相关。诊断后和首次治疗日期后 24 个月内，VTE 的累积发生率有所增加。 VTE 在既往患有心血管疾病的患者中较少见。

 结论：

T2-T4 UBC 患者，尤其是化疗后，通常在诊断后和首次治疗后 30 天后观察到 VTE。研究结果表明，应该对 UBC 后 VTE 预防的益处和可能的危害进行长期干预研究。