Risk of Venous Thromboembolism by Cancer Type: A Network Meta-Analysis

 

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Abstract

Patients with cancer have an increased risk of venous thromboembolism (VTE). Comparing tumor-specific VTE risk is complicated by factors such as surgery, disease stage, and chemotherapy. Network meta-analysis (NMA) using cancer types as network nodes enabled us to estimate VTE rates by leveraging comparisons across cancer types while adjusting for baseline VTE risk in individual studies. This study was conducted to estimate the risk of VTE by cancer type and factors influencing VTE risk. The Embase, MEDLINE, and Cochrane Library repositories were systematically searched to identify clinical trials and observational studies published from 2005 to 2022 that assessed the risk of primary cancer-related VTE among two or more distinct cancer types. Studies with similar cancer populations and study methods reporting VTE occurring within 1 year of diagnosis were included in the NMA. Relative VTE rates across cancer types were estimated with random-effects Bayesian NMAs. Absolute VTE rates were calculated from these estimates using the average VTE incidence in lung cancer (the most frequently reported type) as the “anchor.” From 2,603 records reviewed, 30 studies were included in this NMA. The general network described 3,948,752 patients and 18 cancer types: 3.1% experienced VTE within 1 year of diagnosis, with cancer-specific rates ranging from 0.7 to 7.4%. Consistent with existing VTE risk prediction tools, pancreatic cancer was associated with higher-than-average VTE risk. Other cancer types with high VTE risk were brain and ovarian cancers. The relative rankings of VTE risk for certain cancers changed based on disease stage and/or receipt of chemotherapy or surgery.

Ethical Standards

This study followed the methodology of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).[29]

Data Availability Statement

The a priori–developed study protocol and statistical analysis plan are available from the corresponding author. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Authors' Contributions

Concept and design: M.B., X.L., D.R.J., K.F., A.D.D.

Data acquisition, analysis interpretation, and visualization: M.B., D.R.J., K.F., B.N., S.R.

Statistical analysis: K.F., B.N.

Drafting of the manuscript: M.B., D.R.J., S.R.

Project administration: X.L., D.R.J.

Critical revision of manuscript for important intellectual content: All authors.

Publication History

Article published online:
23 February 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
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