Idiopathic venous thromboembolism: a potential surrogate for occult cancer.
BACKGROUND
Several studies have indicated an association between venous thromboembolism (VTE) and a subsequent diagnosis of cancer in Western countries. However, information is scant on subsequent cancer incidence after idiopathic VTE events in Asian people. Through a nationwide cohort study, we evaluated the cancer prevalence of VTE and new cancer incidence in patients after the first episode of idiopathic VTE.


METHODS
To conduct a nationwide population cohort study on VTE, we retrieved data from the Taiwan National Health Insurance Database from 1998 to 2008, including a 2-year follow-up period extending to the end of 2010. The occurrence of cancer in the cohort was also determined by accessing the Registry for Catastrophic Illness Patient Database.


RESULTS
A total of 45,242 patients had the newly diagnosed VTE from 1998 to 2008. The incidence of VTE increased with age. Among 28,243 idiopathic VTE patients, 1944 patients (6.89%) had a subsequent cancer diagnosis within 2 years of the first idiopathic VTE episode. The three most common newly diagnosed cancers after idiopathic VTE were lung cancer, liver cancer and colorectal cancer (18.3%, 12.3% and 10.9%, respectively). Male sex and advanced age are independent risk factors of having an underlying malignant disorder among patients diagnosed with idiopathic VTE.


CONCLUSIONS
Patients with symptomatic VTE without an identifiable risk factor have a 6.89% incidence of subsequent cancer diagnosis in Taiwan. An extensive screening for an occult cancer in an idiopathic VTE patient may be warranted.
From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
W-S
WS
Chung
From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
C-L
CL
Lin
From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
W-H
WH
Hsu
From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
F-C
FC
Sung
From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
R-Y
RY
Li
From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, TaiwanFrom the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Management Office for Health Data, China Medical University Hospital, Taichung and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan d10040@mail.cmuh.org.tw.
C-H
CH
Kao
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000150:complications / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000150:complications / Q000453:epidemiology; D008175:Lung Neoplasms / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010257:Paraneoplastic Syndromes / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology*