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Meta-Analysis
. 2017 Nov 10;17(1):747.
doi: 10.1186/s12885-017-3719-1.

Venous thromboembolism and mortality in breast cancer: cohort study with systematic review and meta-analysis

Umair T Khan  1   2 , Alex J Walker  1   3 , Sadaf Baig  1 , Tim R Card  1 , Cliona C Kirwan  4 , Matthew J Grainge  5
Affiliations
Meta-Analysis

Venous thromboembolism and mortality in breast cancer: cohort study with systematic review and meta-analysis

Umair T Khan et al. BMC Cancer. .

Abstract

Background: Breast cancer patients are at an increased risk of venous thromboembolism (VTE). However, current evidence as to whether VTE increases the risk of mortality in breast cancer patients is conflicting. We present data from a large cohort of patients from the UK and pool these with previous data from a systematic review.

Methods: Using the Clinical Practice Research Datalink (CPRD) dataset, we identified a cohort of 13,202 breast cancer patients, of whom 611 were diagnosed with VTE between 1997 and 2006 and 12,591 did not develop VTE. Hazard ratios (HR) were used to compare mortality between the two groups. These were then pooled with existing data on this topic identified via a search of the MEDLINE and EMBASE databases (until January 2015) using a random-effects meta-analysis.

Results: Within the CPRD, VTE was associated with increased mortality when treated as a time-varying covariate (HR = 2.42; 95% CI, 2.13-2.75), however, when patients were permanently classed as having VTE based on presence of a VTE event within 6 months of cancer diagnosis, no increased risk was observed (HR = 1.22; 0.93-1.60). The pooled HR from seven studies using the second approach was 1.69 (1.12-2.55), with no effect seen when restricted to studies which adjusted for key covariates.

Conclusion: A large HR for VTE in the time-varying covariate analysis reflects the known short-term mortality following a VTE. When breast cancer patients are fortunate to survive the initial VTE, the influence on longer-term mortality is less certain.

Keywords: Breast cancer; Cohort study; Deep vein thrombosis; Meta-analysis; Mortality; Prognosis; Pulmonary embolism; Systematic review; Venous thromboembolism.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the CPRD Independent Scientific Advisory Committee, protocol number- 10_091.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Summary of search results and breakdown at each stage. CA conference abstracts
Fig. 2
Fig. 2
Forest plot of the hazard ratios by type of analysis, time-varying covariate compared to non-time-varying
Fig. 3
Fig. 3
Forest plot of the hazard ratios of nTVA studies comparing adjusted to non-adjusted studies
Fig. 4
Fig. 4
Forest plot of the hazard ratios of nTVA studies comparing ‘VTE before cancer diagnosis’ with ‘VTE after cancer diagnosis’
See this image and copyright information in PMC

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