title: Impact of anatomical location of lower limb venous thrombus on the risk of subsequent cancer.
abstract: After a proximal deep-vein thrombosis (P-DVT), the risk of diagnosis of a previously unsuspected cancer is high. Isolated distal DVT (iD-DVT; i.e. infra-popliteal DVT without pulmonary embolism [PE]) and isolated superficial-vein thrombosis (iSVT; i.e. without concomitant DVT and PE) are at least as frequent as P-DVT but their association with subsequent cancer is uncertain. We exploited data from the OPTIMEV prospective, observational, multicentre study to i) compare the risk of subsequent cancer three years after a first objectively confirmed iSVT, iD-DVT and iP-DVT in patients without a prior history of cancer or of venous thromboembolism, ii) assess predictors of subsequent cancer in cases of iD-DVT. The overall cumulative rates of cancer among the 304 patients with iSVT, 536 patients with iD-DVT, and 327 patients with iP-DVT were similar (3.4% 95% confidence interval [1.8-6.2], 3.9% [2.5-5.9] and 3.9% [2.3-6.8], respectively), regardless of whether the index venous thromboembolic event was unprovoked or associated with a major transient risk factor. Neither anatomical (muscular vs deep-calf DVT) nor ultrasound scan characteristics (number of thrombosed veins, clot diameter under compression) seemed strongly associated with the risk of cancer in cases of iD-DVT. In patients managed in routine practice, all the different clinical expressions of lower limb venous thromboembolism are associated with a similar risk of subsequent cancer. From a clinical practice point of view, this suggests that cancer screening, without discussing the necessity, or not, of such screening, should not differ between a deep-proximal, deep-distal or superficial location of thrombosis.
authors.affiliation: Jean-Philippe Galanaud, MD, PhD, Centre d'Investigations Cliniques et, Service de Médecine Interne et Maladies Vasculaires, Hôpital Saint Eloi, Centre Hospitalier Universitaire de Montpellier, 80, avenue Augustin Fliche, 34295 Montpellier Cedex 05, France, Tel.: +33 467 33 70 24, Fax: +33 467 33 70 23, E-mail: jp-galanaud@chu-montpellier.fr.
authors.forename: J-P
authors.initials: JP
authors.lastname: Galanaud
authors.forename: A C
authors.initials: AC
authors.lastname: Arnoult
authors.forename: M-A
authors.initials: MA
authors.lastname: Sevestre
authors.forename: C
authors.initials: C
authors.lastname: Genty
authors.forename: M
authors.initials: M
authors.lastname: Bonaldi
authors.forename: A
authors.initials: A
authors.lastname: Guyard
authors.forename: P
authors.initials: P
authors.lastname: Giordana
authors.forename: O
authors.initials: O
authors.lastname: Pichot
authors.forename: M
authors.initials: M
authors.lastname: Colonna
authors.forename: I
authors.initials: I
authors.lastname: Quéré
authors.forename: J-L
authors.initials: JL
authors.lastname: Bosson
mesh_terms: D000368:Aged; D002423:Cause of Death; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy
keywords: Epidemiological studies; cancer; risk factors; ultrasound analysis; venous thrombosis