Concomitant and antecedent deep venous thrombosis and cancer survival in male US veterans

Abstract

Survival is reportedly worse in patients with cancer concurrently diagnosed with deep venous thrombosis. However, information on specific malignancies is limited. From a cohort study of male US veterans we identified incident cancer cases (n = 412,008) and compared survival patterns among those with versus without a history of deep venous thrombosis. Using Cox proportional hazard models, we estimated hazard ratios (HRs) and 95% confidence intervals as measures of the relative risk of dying. Individuals with (versus without) a concomitant deep venous thrombosis and cancer diagnosis had a higher risk of dying (HR = 1.38; 1.28-1.49). The most prominent excess mortality (HR = 1.29-2.55) was observed among patients diagnosed with deep venous thrombosis at the time of diagnosis of lung, gastric, prostate, bladder, or kidney cancer. Increased risk of dying was also found among cancer patients diagnosed with deep venous thrombosis 1 year (HR = 1.14; 1.07-1.22), 1-5 years (HR = 1.14; 1.10-1.19), and >5 years (HR = 1.27; 1.23-1.31) before cancer; this was true for most cancer sites (HR = 1.17-1.64). In summary, antecedent deep venous thrombosis confers a worse prognosis upon cancer patients. Advanced stage at diagnosis, treatment effects, lifestyle factors, and comorbidity could explain differences by cancer site and time frame between a prior deep venous thrombosis diagnosis and cancer outcome.

Figure 1

A: Survival curves for all cancer patients with and without a history of deep venous thrombosis of the lower extremities (DVT). Adjusted survival curves are presented. The solid line represents cancer patients with no history of DVT. The dashed lines represent cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (). The lines for DVT 1–5 years before cancer diagnosis and DVT 1 year before cancer diagnosis are superimposed. P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001. B: Survival curves for lung cancer patients with, and without, a history of deep venous thrombosis (DVT). Adjusted survival curves are presented. The solid line represents lung cancer patients with no history of DVT. The dashed lines represent lung cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (). P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001. C: Survival curves for colorectal cancer patients with, and without, a history of deep venous thrombosis (DVT). Adjusted survival curves are presented. The solid line represents colorectal cancer patients with no history of DVT. The dashed lines represent colorectal cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (). P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001. D: Survival curves for prostate cancer patients with, and without, a history of deep venous thrombosis (DVT). Adjusted survival curves are presented. The solid line represents prostate cancer patients with no family of DVT. The dashed lines represent prostate cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001.

Figure 1

A: Survival curves for all cancer patients with and without a history of deep venous thrombosis of the lower extremities (DVT). Adjusted survival curves are presented. The solid line represents cancer patients with no history of DVT. The dashed lines represent cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (). The lines for DVT 1–5 years before cancer diagnosis and DVT 1 year before cancer diagnosis are superimposed. P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001. B: Survival curves for lung cancer patients with, and without, a history of deep venous thrombosis (DVT). Adjusted survival curves are presented. The solid line represents lung cancer patients with no history of DVT. The dashed lines represent lung cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (). P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001. C: Survival curves for colorectal cancer patients with, and without, a history of deep venous thrombosis (DVT). Adjusted survival curves are presented. The solid line represents colorectal cancer patients with no history of DVT. The dashed lines represent colorectal cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (). P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001. D: Survival curves for prostate cancer patients with, and without, a history of deep venous thrombosis (DVT). Adjusted survival curves are presented. The solid line represents prostate cancer patients with no family of DVT. The dashed lines represent prostate cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001.

Figure 1

A: Survival curves for all cancer patients with and without a history of deep venous thrombosis of the lower extremities (DVT). Adjusted survival curves are presented. The solid line represents cancer patients with no history of DVT. The dashed lines represent cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (). The lines for DVT 1–5 years before cancer diagnosis and DVT 1 year before cancer diagnosis are superimposed. P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001. B: Survival curves for lung cancer patients with, and without, a history of deep venous thrombosis (DVT). Adjusted survival curves are presented. The solid line represents lung cancer patients with no history of DVT. The dashed lines represent lung cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (). P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001. C: Survival curves for colorectal cancer patients with, and without, a history of deep venous thrombosis (DVT). Adjusted survival curves are presented. The solid line represents colorectal cancer patients with no history of DVT. The dashed lines represent colorectal cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (). P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001. D: Survival curves for prostate cancer patients with, and without, a history of deep venous thrombosis (DVT). Adjusted survival curves are presented. The solid line represents prostate cancer patients with no family of DVT. The dashed lines represent prostate cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001.

Figure 1

A: Survival curves for all cancer patients with and without a history of deep venous thrombosis of the lower extremities (DVT). Adjusted survival curves are presented. The solid line represents cancer patients with no history of DVT. The dashed lines represent cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (). The lines for DVT 1–5 years before cancer diagnosis and DVT 1 year before cancer diagnosis are superimposed. P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001. B: Survival curves for lung cancer patients with, and without, a history of deep venous thrombosis (DVT). Adjusted survival curves are presented. The solid line represents lung cancer patients with no history of DVT. The dashed lines represent lung cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (). P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001. C: Survival curves for colorectal cancer patients with, and without, a history of deep venous thrombosis (DVT). Adjusted survival curves are presented. The solid line represents colorectal cancer patients with no history of DVT. The dashed lines represent colorectal cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (). P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001. D: Survival curves for prostate cancer patients with, and without, a history of deep venous thrombosis (DVT). Adjusted survival curves are presented. The solid line represents prostate cancer patients with no family of DVT. The dashed lines represent prostate cancer patients with: DVT more than 5 years prior to cancer diagnosis (), DVT 1–5 years before cancer diagnosis (), DVT 1 year before cancer diagnosis () and DVT at cancer diagnosis (P-value (likelihood ratio test) for difference in survival according to pre-existing DVT status: P<0.0001.