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Venous Thromboembolism in Patients With Colorectal Cancer: Incidence and Effect on Survival

From the Division of Hematology and Oncology, Department of Internal Medicine; Division of Surgical Oncology, Department of Surgery; Division of General Internal Medicine, Department of Internal Medicine; Department of Medicine and Statistics; and Department of Public Health Sciences, University of California, Davis; and Section of Hematology and Oncology, Veterans’ Affairs Northern California Health Care System, Sacramento, CA

Address reprint requests to Richard H. White, MD, Division of General Medicine, University of California, Davis, Ste 2400, 4150 V St, Sacramento, CA 95817; e-mail: rhwhite{at}ucdavis.edu

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.

Supported in part by National Institutes of Health Grant No. 1-RO3- CA99527-01.

Presented in part at the 20th Congress of the International Society of Thrombosis and Haemostasis, Sydney, Australia, August 6-12, 2005.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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