Immediate and Long-Term Outcomes of Reperfusion Therapy in Patients With Cancer

Abstract

Background and Purpose: Patients with acute stroke are often accompanied by comorbidities, such as active cancer. However, adequate treatment guidelines are not available for these patients. The purpose of this study was to evaluate the association between cancer and the outcomes of reperfusion therapy in patients with stroke. Methods: We compared treatment outcomes in patients who underwent reperfusion therapy, using a nationwide reperfusion therapy registry. We divided the patients into 3 groups according to cancer activity: active cancer, nonactive cancer, and without a history of cancer. We investigated reperfusion processes, 24-hour neurological improvement, adverse events, 3-month functional outcome, and 6-month survival and related factors after reperfusion therapy. Results: Among 1338 patients who underwent reperfusion therapy, 62 patients (4.6%) had active cancer, 78 patients (5.8%) had nonactive cancer, and 1198 patients (89.5%) had no history of cancer. Of the enrolled patients, 969 patients received intravenous thrombolysis and 685 patients underwent endovascular treatment (316 patients received combined therapy). Patients with active cancer had more comorbidities and experienced more severe strokes; however, they showed similar 24-hour neurological improvement and adverse events, including cerebral hemorrhage, compared with the other groups. Although the functional outcome at 3 months was poorer than the other groups, 36.4% of patients with active cancer showed functional independence. Additionally, 52.9% of the patients with determined stroke etiology showed functional independence despite active cancer. During the 6-month follow-up, 46.6% of patients with active cancer died, and active cancer was independently associated with poor survival (hazard ratio, 3.973 [95% CI, 2.528–6.245]). Conclusions: In patients with active cancer, reperfusion therapy showed similar adverse events and short-term outcomes to that of other groups. While long-term prognosis was worse in the active cancer group than the nonactive cancer groups, not negligible number of patients had good functional outcomes, especially those with determined stroke mechanisms.

Mechanical Thrombectomy for Acute Ischemic Stroke in Patients with Malignancy: A Systematic Review

“…All of the included studies were retrospective analyses of either files/databases of patients that received acute treatment for AIS [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ], or analyses of hospital records with the use of diagnostic codes, e.g., ICD codes for AIS and malignancy [ 20 , 21 , 22 ]. One study was a retrospective analysis of cancer patients from the MR CLEAN thrombectomy study registry [ 23 ].…”

“…There was a certain amount of discrepancy regarding the patients included in the studies. Most studies included patients with AIS and an active malignancy (AM), defined as patients with a diagnosis of current or metastatic cancer, those undergoing treatment for cancer, or who refused the treatment [ 6 , 7 , 10 , 11 , 13 , 14 , 15 , 16 , 18 , 24 ], and at times patients with a diagnosis made during or after the AIS-hospitalization [ 10 , 14 , 15 ]. This definition was occasionally restricted to a diagnosis within a year or 6months, or cancer treatment within 1–6 months of the ischemic event [ 7 , 11 , 18 , 23 ].…”

“…Most studies included patients with AIS and an active malignancy (AM), defined as patients with a diagnosis of current or metastatic cancer, those undergoing treatment for cancer, or who refused the treatment [ 6 , 7 , 10 , 11 , 13 , 14 , 15 , 16 , 18 , 24 ], and at times patients with a diagnosis made during or after the AIS-hospitalization [ 10 , 14 , 15 ]. This definition was occasionally restricted to a diagnosis within a year or 6months, or cancer treatment within 1–6 months of the ischemic event [ 7 , 11 , 18 , 23 ]. Others utilized ICD codes pertaining to active and metastatic malignancies [ 20 , 21 , 22 ], while certain studies analyzed all patients with any history of cancer [ 9 ], or did not provide a solid definition of active/underlying cancer [ 17 ].…”

“…Regarding baseline characteristics ( Table 2 ), patients allocated in the malignancy groups were often found to be younger [ 13 , 18 ] and with lower rates of common stroke risk factors, such as atrial fibrillation, hyperlipidemia, and diabetes [ 7 , 10 , 11 , 12 , 13 , 14 , 16 , 18 , 20 , 21 , 23 , 25 ]. No study reported higher comorbidity rates in CPs; only one reported higher smoking rates in CPs [ 23 ], though smoking is also considered a major malignancy risk factor.…”

“…Cancer patients were also more often found to have increased pre-stroke disability (modified Rankin Scale-mRS score ≥2) [ 23 ]. A few studies compared baseline values of biochemical markers commonly associated with cancer and cancer-related stroke [ 2 ], and found higher mean CRP [ 13 , 14 ] and D-dimer values [ 18 ], higher leukocyte counts [ 14 ], lower hemoglobin [ 14 , 18 ], and lower platelet counts [ 14 , 15 ]. Higher D-dimer values also correlated with unfavorable outcomes [ 14 ].…”