Prognostication of Asymptomatic Penetrating Aortic Ulcers: A Modern Approach

Circulation ◽  
2021 ◽  
Author(s):  
Charles DeCarlo ◽  
Christopher A. Latz ◽  
Laura T. Boitano ◽  
Young Kim ◽  
Adam Tanious ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Radiographic Progression ◽  
Intramural Hematoma ◽  
Rate Of Change ◽  
Change Over Time ◽  
Modern Approach ◽  
Ulcer Size ◽  
Risk Of Death ◽  
Over Time

Background: Literature detailing the natural history of asymptomatic penetrating aortic ulcers (PAU) is sparse and lacks long-term follow-up. This study sought to determine the rate of asymptomatic PAU growth over time and adverse events from asymptomatic PAU. Methods: A cohort of patients with asymptomatic PAU from 2005-2020 was followed. One ulcer was followed per patient. Primary endpoints were change in size over time and the composite of symptoms, radiographic progression, rupture, and intervention; cumulative incidence function estimated the incidence of the composite outcome. Ulcer size and rate of change were modeled using a linear mixed effects model. Patient and anatomic factors were evaluated as potential predictors of the outcomes. Results: There were 273 patients identified. Mean age was 75.5±9.6 years; 66.4% were male. The majority of ulcers were in the descending thoracic aorta (53.9%), followed by abdominal aorta (41.4%), and aortic arch (4.8%). Fusiform aneurysmal disease was present in 21.6% of patients at a separate location; 2.6% had an associated intramural hematoma; 23.6% had at least one other PAU. Symptoms developed in one patient who ruptured; 8 patients (2.9%) underwent an intervention for PAU (one for rupture, 2 for radiographic progression, 5 for size/growth) at a median of 3.1 years (IQR:1.0-6.5) after diagnosis. Five and 10-year cumulative incidence of the primary outcome, adjusted for competing risk of death, was 3.6% (95% CI: 1.6-6.9%) and 6.5% (95% CI: 3.1-11.4%), respectively. For 191 patients with multiple CT scans (760 total CT's) with median radiographic follow-up of 3.50 years (IQR:1.20-6.63 years), mean initial ulcer width, ulcer depth, and total diameter in millimeters (mm) was 13.6, 8.5, and 31.4, respectively. Small, but statistically significant change over time was observed for ulcer width (0.23 mm/year) and total diameter (0.24 mm/year); ulcer depth did not significantly change over time. Hypertension, hyperlipidemia, diabetes, initial ulcer width>20 mm, thrombosed PAU, and associated saccular aneurysm were associated with larger changes in ulcer size over time, however the magnitude of difference was small, ranging from 0.4-1.9 mm/year. Conclusions: Asymptomatic PAU displayed minimal growth and infrequent complications including rupture. Asymptomatic PAU may be conservatively managed with serial imaging and risk-factor modification.

Abstract W P368: Longitudinal Change in fMRI Blood Oxygen Level Dependent Signal in Cerebral Amyloid Angiopathy

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Aaron R Switzer ◽  
Cheryl R McCreary ◽  
Richard Frayne ◽  
Bradley G Goodyear ◽  
Eric E Smith
Keyword(s):  
Blood Oxygen Level Dependent ◽  
Rate Of Change ◽  
Amyloid Angiopathy ◽  
Blood Oxygen ◽  
Bold Signal ◽  
Blood Oxygen Level ◽  
Change Over Time ◽  
The Difference ◽  
Over Time

Introduction: Previous cross-sectional studies show that cerebral amyloid angiopathy (CAA) is associated with reduced blood oxygen level dependent (BOLD) signal change in response to a visual task, and that this reduction is due to impaired vascular reactivity. However, there are no data on the rate at which the BOLD signal changes over time in CAA. We hypothesized that fMRI activation would decline in CAA, representing progressively impaired vasoreactivity, and this decline would be associated with increased white matter hyperintensity (WMH) volume. Methods: fMRI BOLD amplitude was measured in response to a visual task (alternating checkerboard pattern) at study entry and 1-year follow-up for 18 patients with probable CAA by Boston criteria, and 15 healthy controls. fMRI data were matched to a canonical BOLD signal using a general linear model resulting in z-statistic images with a significance threshold of p<0.05 using FSL. The amplitude of the BOLD signal percent change from baseline was measured in the 200 most active voxels in the primary visual cortex. WMH were identified on fluid attenuated inversion recovery (FLAIR) images and the volume was measured using Quantomo software (Cybertrials Inc, Canada). Results: BOLD amplitude was lower at follow-up than baseline in CAA, but the difference was not significant (mean change -0.14±0.55, p=0.30). Mean BOLD amplitude was similar at baseline and follow-up in controls (mean change 0.20±0.49, p=0.14). The difference in rate of change over time between CAA and controls was borderline significant (p=0.04). fMRI was lower at follow-up than baseline in 11/18 CAA compared to 4/15 controls (p=0.08). In CAA patients, WMH increased over time (median 1.44 mL interquartile range -0.22 to 9.70mL, p=0.01). However, BOLD amplitude change and WMH change were not related (r=-0.01, p=0.96). Discussion: Although we did not see significant fMRI BOLD signal reduction from baseline to 1 year in CAA, we did see a difference in change over time between CAA and controls, consistent with our hypothesis that impaired vasoreactivity is a feature of CAA. Studies with larger numbers of patients, or longer duration of follow-up, are needed to more precisely determine the rate of change over time in reduction of fMRI BOLD amplitude in CAA.

scholarly journals Changing Incidence of Major Cardiovascular Events in Multiple Myeloma Patients over Time

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3598-3598
Author(s):  
Aaron Seth Rosenberg ◽  
Qian Li ◽  
Ann M Brunson ◽  
Joseph Tuscano ◽  
Ted Wun ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Cumulative Incidence ◽  
Older Patients ◽  
Stem Cell Transplant ◽  
Incidence Rates ◽  
Cell Transplant ◽  
Risk Of Death ◽  
Increased Risk ◽  
Over Time

Abstract Background: While multiple myeloma (MM) comprises only 2% of all cancer diagnoses, the prevalence of the disease in the US has markedly increased from 46,865 patients in 2000 to 124,733 in 2015. New therapeutic classes have led to longer survival, and allowed older patients to undergo life-prolonging therapy. Survivorship issues are now becoming relevant for this population, as ongoing therapy may have as yet unappreciated long term sequelae. MM is a disease of older patients, with a median diagnosis age of 69, and the incidence is greatest among African Americans (AA), populations at higher risk of cardiovascular disease (CVD). We therefore designed a retrospective study to quantify the incidence of new CVD in this population, as well as changes in incidence over time, hypothesizing that CVD incidence would increase due to both longer survival times, and increased utilization of potentially cardiotoxic drugs. Methods: Using the California Cancer Registry linked to the California Patient Discharge Database, we identified 15,404 patients diagnosed with MM between 1991-2012 with follow-up through 2014. CVD was defined as a hospital admission for coronary artery disease (CAD), congestive heart failure (CHF), or stroke (CVA) using ICD9 codes or if the cause of death due to CVD was the first report of CVD. Patients with prior CVD or in whom CVD was diagnosed within 60 days of MM diagnosis were excluded. All patients had a minimum of 60 days of follow up. Changes in CVD rates were assessed by era: 1991-97 (era 1), 1998-2002 (era 2), 2003-07 (era 3) and 2008-12 (era 4). The cumulative incidence of CVD was estimated from date of MM diagnosis to first CVD event, accounting for the competing risk of death. Adjusted hazard ratios (aHR) for developing CVD were estimated accounting for the competing risk of death per the methods by Fine and Grey. Results: Of the 15,404 patients, 8,056 (52%) were male, 9154 (59%) were non-Hispanic white (NHW), 1890 (12%) were African American, 2839 (18%) were Hispanic, and 1360 (9%) were Asian. Median age at diagnosis was 65, with 12% of patients <50 and11%>80. Stem cell transplant was utilized by 2989 (19%) patients. The most common insurers were private/military (42%), followed by Medicare (31%), Medicaid/other public (7%), and unknown (19%) insurance. The median age of patients who developed CVD was 68 vs 63 who were never admitted for CVD (p<0.001). The 2 and 5 year cumulative incidence of developing CVD was 15.8% (95% confidence interval (CI): 15.2% - 16.3%) and 26.3% (CI: 25.6% - 27.0%). This was significantly less in era 4 (2008-12): 12.6% (11.6% - 13.7%) and 22.3% (20.9% - 23.8%) (p<0.001) (Figure). When examining types of CVD, CVA was less common in era 1 (1991-97) compared to eras 2-4 (5 year cumulative incidence rates in eras 1-4 respectively: 3.9% [3.4% - 4.5%], 4.6% [4.0% - 5.4%], 5.0% [4.3% - 5.7%], 4.6% [3.9% - 5.4%]) (p=0.002). CAD was less common in era 4 (5 year cumulative incidence rates in ears 1-4 respectively: 10.3% [9.4% - 11.2%], 11.5% [10.5% - 12.7%], 10.8% [9.9% - 11.9%], 9.4% [8.5% - 10.5%]) (p = 0.003). CHF was less common in era 4 (5 year cumulative incidence rates in eras 1-4 respectively: 17.9% [16.7% - 19.1%], 18.6% [17.3% - 20.0%], 17.7% [16.5% - 19.0%], 13.8% [12.6% - 15.0%]. In multivariable analysis, increased age, male sex, AA race/ethnicity, increased Elixhauser comorbidity score were associated with increased risk of CVD. Surprisingly, after accounting for age Medicare insurance was associated with increased risk of CVD, while socioeconomic status was not. Use of stem cell transplant was associated with decreased risk, likely due to pre-transplant screening for CVD. Diagnosis during era 4 (2008 - 12) was associated with decreased risk of new CVD (adjusted hazard ratio 0.70 [CI: 0.63, 0.77]). Conclusion: CVD is a common complication in MM patients: within 5 years of a MM diagnosis, over 25% develop CVD requiring hospitalization. Contrary to our hypothesis, we did not find increased CVD admissions in the most recent era. Decreased admissions due to CHF and CAD in the most recent era of diagnosis may indicate a greater awareness of this issue, routine thromboprophylaxis with anti-platelet agents in patients being treated with immunomodulatory agents, or changes in secular trends in the diagnosis and treatment of CVD. CVD is an ongoing source of morbidity for MM patients requiring further study and the vigilance of clinicians. Figure. Figure. Disclosures Rosenberg: Amgen: Research Funding, Speakers Bureau.

scholarly journals Radiolucent lines are decreased at 3 years following total knee arthroplasty using trabecular metal tibial components

2018 ◽  
Vol 46 (5) ◽  
pp. 1919-1927 ◽  
Author(s):  
Hirotaka Mutsuzaki ◽  
Arata Watanabe ◽  
Tomonori Kinugasa ◽  
Kotaro Ikeda
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
X Rays ◽  
Trabecular Metal ◽  
Change Over Time ◽  
Radiolucent Lines ◽  
Total Knee ◽  
Over Time

Objective To analyse location and frequency, and change over time, of radiolucent lines (RLLs) around trabecular metal tibial components in total knee arthroplasty (TKA). Methods Osteoarthritic knees in patients who had undergone TKA were retrospectively evaluated via analysis of RLLs on anteroposterior and lateral X-rays obtained at 2 and 6 months, and 1, 2 and 3 years following TKA. Results In 125 osteoarthritic knees from 90 patients (mean age, 75.0 ± 6.2; 21 male/69 female), frequency of RLLs around trabecular metal tibial components was generally highest at 2 and 6 months, and 1 year following TKA, then gradually decreased over the 3-year follow-up. Frequency of RLLs around trabecular metal tibial components was greater at the tip of the two pegs, particularly the medial peg, and around the pegs, versus other zones. No postoperative revisions were performed for loosening. Conclusions Over 3 years following TKA, RLLs were most frequently observed up to 1 year, then gradually decreased. RLLs were significantly more frequent in the medial peg zone and zones close to the medial peg than in other zones.

Mortality in adult-onset and elderly-onset IBD: a nationwide register-based cohort study 1964–2014

Gut ◽  
2019 ◽  
Vol 69 (3) ◽  
pp. 453-461 ◽  
Author(s):  
Ola Olén ◽  
Johan Askling ◽  
Michael C Sachs ◽  
Martin Neovius ◽  
Karin E Smedby ◽  
...  
Keyword(s):  
Cohort Study ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Adult Onset ◽  
Risk Of Death ◽  
Increased Risk ◽  
Elderly Onset ◽  
Incident Cases ◽  
Over Time

ObjectivesTo examine all-cause and cause-specific mortality in adult-onset and elderly-onset IBD and to describe time trends in mortality over the past 50 years.DesignSwedish nationwide register-based cohort study 1964–2014, comparing mortality in 82 718 incident IBD cases (inpatient and non-primary outpatient care) with 10 times as many matched general population reference individuals (n=801 180) using multivariable Cox regression to estimate HRs. Among patients with IBD, the number of participants with elderly-onset (≥60 years) IBD was 17 873.ResultsDuring 984 330 person-years of follow-up, 15 698/82 718 (19%) of all patients with IBD died (15.9/1000 person-years) compared with 121 095/801 180 (15.1%) of reference individuals, corresponding to an HR of 1.5 for IBD (95% CI=1.5 to 1.5 (HR=1.5; 95% CI=1.5 to 1.5 in elderly-onset IBD)) or one extra death each year per 263 patients. Mortality was increased specifically for UC (HR=1.4; 95% CI=1.4 to 1.5), Crohn’s disease (HR=1.6; 95% CI=1.6 to 1.7) and IBD-unclasssified (HR=1.6; 95% CI=1.5 to 1.8). IBD was linked to increased rates of multiple causes of death, including cardiovascular disease (HR=1.3; 1.3 to 1.3), malignancy (HR=1.4; 1.4 to 1.5) and digestive disease (HR=5.2; 95% CI=4.9 to 5.5). Relative mortality during the first 5 years of follow-up decreased significantly over time. Incident cases of 2002–2014 had 2.3 years shorter mean estimated life span than matched comparators.ConclusionsAdult-onset and elderly-onset patients with UC, Crohn’s disease and IBD-unclassified were all at increased risk of death. The increased mortality remained also after the introduction of biological therapies but has decreased over time.

scholarly journals Exploring Changes in Activity Patterns in Individuals with Chronic Pain

2020 ◽  
Vol 17 (10) ◽  
pp. 3560
Author(s):  
Elena Rocío Serrano-Ibáñez ◽  
Rebecca Bendayan ◽  
Carmen Ramírez-Maestre ◽  
Alicia Eva López-Martínez ◽  
Gema Teresa Ruíz-Párraga ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Specific Activity ◽  
Activity Patterns ◽  
Positive Association ◽  
Random Coefficients ◽  
Rate Of Change ◽  
Linear Change ◽  
Change Over Time ◽  
Pain Duration ◽  
Over Time

This longitudinal study explored whether activity patterns change over time in a sample of 56 individuals with chronic musculoskeletal pain over a 15-day period. Once a day, the participants recorded their level of pain intensity and the degree to which they had engaged in several specific activity patterns. Linear mixed models with random coefficients were used to investigate the rate of change in the activity patterns. Age, sex, pain intensity, and pain duration were controlled. The results show that excessive persistence was the only self-reported activity pattern to show a linear change over the 15-day period. There was a decrease in excessive persistence, and this decrease was slower with higher levels of activity avoidance. However, no significant association was found between sex, age, pain intensity, and pain duration and excessive persistence at baseline or change over time. At baseline, a positive association was found between excessive persistence and pain avoidance, pain-related persistence, and pacing to reduce pain, and a negative association was found between excessive persistence and pacing to save energy for valued activities. This result suggests a profile characterized by alternate periods of high and low activity that, in this study, were unrelated to longitudinal changes in pain intensity.

Second Malignancies After Autologous Hematopoietic Cell Transplantation (AHCT) for Multiple Myeloma (MM): A Center for International Blood and Marrow Transplant Research (CIBMTR) Analysis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 591-591
Author(s):  
Girindra Raval ◽  
Anuj Mahindra ◽  
Xiaobo Zhong ◽  
Ruta Brazauskas ◽  
Robert Peter Gale ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Multivariate Analysis ◽  
General Population ◽  
Cumulative Incidence ◽  
Incidence Rates ◽  
High Dose ◽  
Risk Of Death ◽  
Age And Sex

Abstract Abstract 591 Background: Survival of patients with MM has improved over the past two decades, in part due to the use of AHCT. Increasingly, second primary malignancies (SPMs) are observed in MM survivors. Determining the baseline incidence and risk factors associated with SPMs after AHCT is important to assess risk and to evaluate the risk-benefit ratio of newer therapies. Methods: We analyzed the incidence of SPMs in 3784 MM patients receiving (“upfront”) AHCT for MM within 18 months of diagnosis between 1990 and 2010 and reported to the CIBMTR. Cumulative incidence rates of SPMs were estimated taking into account the competing risk of death. For each transplant recipient, the number of person-years at risk was calculated from the date of transplantation until date of last contact, death, or diagnosis of SPM, whichever occurred first. Incidence rates for all invasive cancers in the general population were obtained from the SEER database. Age-, sex-, and race- specific incidence rates for overall SPMs and particular anatomical sites were applied to the appropriate person-years at risk to compute the expected numbers of cancers. Observed–to –expected (O/E) ratios were calculated, and Poisson distribution 99% confidence intervals (CIs) were generated. Poisson regression model was used to analyze risk factors for overall SPMs and AML/MDS. Results: Pre-transplant therapy included novel agents in 56% including thalidomide (35%), lenalidomide (9%), bortezomib (16%) or their combinations (11%). Majority (80%) received high dose melphalan conditioning. Post-transplant maintenance therapy included thalidomide (16%), lenalidomide (8%), bortezomib (9%) and interferon (6%). Median follow-up of survivors was 52 months (range 3 to 192 months).With 12707 person years of follow up, 153 new malignancies were reported with a crude rate of 1.2 SPM per 100 person years of follow up. Observed/Expected [O/E] ratio for all SPMs was 0.99 (99% CI, 0.80–1.22). Cumulative incidence of SPM overall was 2.48% (95% CI, 1.96–3.05) at 3 years and 6.0% (95% CI, 4.96–7.10) at 7 years [Figure 1]. Individual SPMs observed significantly more frequently than expected are summarized in Table 1. The cumulative incidence of MDS/AML was 0.5% (95% CI, 0.28–0.78) at 3 years and 1.3 (95% CI, 0.85– 1.9%) at 7 years. Majority had MM progression prior to diagnosis of SPM (65 of 102 patients overall and 15 of 23 patients for MDS/AML). In multivariate analysis, significant risk factors for development of SPMs included: obesity [Hazard ratio = HR 1.89(95%CI, 1.21–2.93), p=0.0047 for BMI>30 vs. BMI<25], older age: [HR10.53 (95%CI, 1.46–75.82), p=0.0195] for 60–69 year olds and HR14.4 (95%CI, 1.89–109.75), p=0.01 for 70+ year olds compared to the 18–39 year old group. Specific conditioning regimens did not correlate with the risk of SPM. The low number of MDS/AML (33 events out of 3784 cases) limited the power of multivariate analysis. Increasing age was significantly associated with development of MDS (HR10.77, (95%CI,92.09–55.51), p=0.004 for 70+ year old vs. 40–49 year olds). Conclusion: In this large cohort of AHCT recipients for MM, the incidence of MDS/AML, melanoma and other skin cancers was significantly higher compared to age and sex matched general population. However the overall risk of SPM was similar to that expected for age and sex matched population. It was also similar to the placebo arms of recent reports by McCarthy Pl et al and Attal M et al (N Engl J Med. 10; 366(19):1770–91). Lenalidomide (8%) or thalidomide maintenance (16%) used in a small subset of patients with comparatively short follow up, was not associated with risk of SPM in the analysis of the overall cohort. Disclosures: Gale: Celgene: Employment. Brandenburg:Celgene: Employment, Equity Ownership. Lonial:Millennium, Celgene, Novartis, BMS, Onyx, Merck all Consultancy. Krishnan:Celgene and Millennium: Consultancy, Speakers Bureau. Dispenzieri:Celgene and Millennium: Research Funding. Hari:Celgene: Consultancy, Honoraria.

Risk of skeletal-related events (SREs) in patients with prostate cancer (PC) and newly diagnosed metastases to bone.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15197-e15197
Author(s):  
Andrew Glass ◽  
Lois Lamerato ◽  
John Edelsberg ◽  
Kathryn E. Richert-Boe ◽  
Charu Taneja ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cumulative Incidence ◽  
Randomized Clinical Trials ◽  
Pathologic Fracture ◽  
Cord Compression ◽  
Routine Clinical Practice ◽  
Initial Diagnosis ◽  
Newly Diagnosed ◽  
Risk Of Death

e15197 Background: Bone is a common site of metastatic involvement in patients (pts) with PC. Bony metastases (mets) are often associated with SREs (spinal cord compression [SCC], pathologic fracture [PF], surgery to bone [SB], radiotherapy to bone [RT]). Skeletal complications cause significant morbidity and mortality. Current estimates of SRE risk come principally from randomized clinical trials. Information from routine clinical practice is limited. Methods: Using the tumor registry and electronic data stores at a large U.S. Midwest healthcare system that serves approximately 800,000 persons, we retrospectively identified all pts aged ≥18 yrs with primary PC and newly diagnosed bone mets between 1/1/95 and 12/31/09. Electronic medical records were reviewed by trained abstractors for evidence of SREs between date of bone mets diagnosis and death, loss to follow-up, or end of study for evidence of first SRE. Cumulative incidence of SREs was estimated in the presence of competing risk of death. Results: We identified a total of 420 men with primary PC and newly diagnosed bone mets; 42 pts had evidence of SREs at initial diagnosis of bone mets and were excluded from the analyses. Among the remaining 378 pts, mean (SD) age was 72.7 yrs (9.8 yrs); 38% were Caucasian and 58% were African-American. Median duration of follow-up after diagnosis of bone mets was 17.1 months (mos). At 12 mos, cumulative incidence of SREs was 31.6% (SCC, 6.1%; PF, 15.0%; SCC and/or PF, 19.1%; SB, 3.9%; RT, 24.4%) (Table). Corresponding figures at 24 mos were 45.3% (SCC, 12.5%; PF, 22.2%; SCC and/or PF, 30.2%; SB, 6.2%; RT, 34.9%). Relatively few pts (14.6%) received intravenous bisphosphonates prior to SRE. Conclusions: Pts with PC in routine clinical practice are at high risk of SREs following initial diagnosis of bone mets. [Table: see text]

scholarly journals PATTERNS OF CHANGE DURING THE DERMOSCOPIC FOLLOW-UP OF MELANOCYTIC LESIONS IN HIGH RISK PATIENTS

2015 ◽  
Vol 88 (1) ◽  
pp. 38-43 ◽  
Author(s):  
Loredana Ungureanu ◽  
Alina Letcă ◽  
Simona Corina Șenilă ◽  
Ana Sorina Dănescu ◽  
Rodica Cosgarea
Keyword(s):  
High Risk ◽  
Retrospective Analysis ◽  
High Specificity ◽  
Change Over Time ◽  
Melanocytic Nevi ◽  
Melanocytic Lesions ◽  
Risk Patients ◽  
Asymmetric Growth ◽  
Over Time

Background. Melanomas and melanocytic nevi that change over time display different change patterns, correlated with histopathological features.Methods. We performed a retrospective analysis of the dermoscopic images corresponding to 86 lesions excised due to the changes occurred during the follow-up period in patients at high risk for melanoma, and we drew a comparison between the changes occurring in melanomas and those occurring in melanocytic nevi.Results. There were significant differences between the models of dermoscopic change characteristic to melanoma and those characteristic to melanocytic nevi. We observed changes with high specificity for the diagnosis of melanoma – asymmetric growth (Sp=90%), new structureless grey-blue areas (Sp=97.5%) or new grey-blue network (Sp=96.25%), new pseudopods or radial streaks (Sp=95%).Conclusion. Our study highlights highly specific changes whose presence should raise the suspicion of melanoma and lead to the excision of the lesion.

scholarly journals The Incidence of Cancer Associated Thrombosis is Increasing Over Time

2021 ◽  
Author(s):  
Anjlee Mahajan ◽  
Ann Brunson ◽  
Oyebimpe Adesina ◽  
Theresa HM Keegan ◽  
Ted Wun
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
Temporal Trends ◽  
Individual Risk ◽  
Cancer Type ◽  
Tumor Type ◽  
Risk Of Death ◽  
Breast And Prostate Cancer ◽  
Cancer Associated Thrombosis ◽  
Over Time

Cancer associated thrombosis (CAT) is an important cause of morbidity and mortality for patients with malignancy and varies by primary cancer type, stage and therapy. We aimed to characterize the incidence, risk factors, temporal trends and the effect on mortality of CAT. The California Cancer Registry was linked to the statewide hospitalization database to identify individuals with the 13 most common malignancies diagnosed 2005 -2017 and determine the 6 and 12-month cumulative incidence of CAT by venous thromboembolism (VTE) location, tumor type and stage after adjusting for competing risk of death. Cox proportional hazard regression models were used to determine risk factors associated with CAT and the effect of CAT on all-cause mortality. 942,019 patients with cancer were identified; 62,003 (6.6%) had an incident diagnosis of CAT. Patients with pancreatic, brain, ovarian, and lung cancer had the highest and patients with breast and prostate cancer had the lowest 12-month cumulative incidence of CAT. For most malignancies, men, those with metastatic disease and more co-morbidities, and African-Americans (vs. non-Hispanic Whites) were at highest risk for CAT. Patients diagnosed with cancer 2014-2017 had higher risk of CAT compared to those diagnosed 2005-2007. CAT was associated with increased overall mortality for all malignancies (HR ranges 1.89 - 4.79). The incidence of CAT increased over time and was driven by an increase in PE±DVT. CAT incidence varies based on tumor type and stage, and on individual risk factors including gender, race/ethnicity, and co-morbidities. For all tumor types CAT is associated with an increased mortality.

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