Biomarkers of gastric cancer-related ischemic stroke and its underlying pathogenesis

Abstract

This study aimed to investigate the biomarkers and underlying pathogenesis of ischemic stroke in patients with gastric cancer (GC).Patients with active gastric cancer who had experienced acute ischemic stroke without conventional vascular risk factors (gastric cancer-related stroke [GCS] group) and visited The First Affiliated Hospital of Guangxi Medical University and First Affiliated Hospital of Sun Yat-sen University from January 2003 to December 2016 were retrospectively enrolled. The patients’ clinical features and laboratory findings were compared with those of age-, sex-, and disease progression-matched patients with GC without ischemic stroke (GC group) who had been admitted to the same hospital during the same period (GCS:GC ratio = 1:2).Among the 9166 patients diagnosed with GC, 70 had experienced a cerebral infarction and were enrolled in this study. Among them, 53 (75.71%) harbored multiple lesions in multiple vascular territories. Notably, patients in the GCS group exhibited significant increases in the D-dimer and cancer antigen 125 (CA125) levels and platelet-to-neutrophil ratio (PNR), compared to their counterparts in the GC group. A multiple logistic regression analysis identified all 3 factors as independent risk factors for cerebral infarction in patients with GC (D-dimer, odds ratio [OR] = 1.006 per 1 ng/mL increase, 95% confidence interval [CI], 1.004–1.009, P = .000; CA125, OR = 1.016 per 1 U/mL increase, 95% CI, 1.005–1.027, P = .005; PNR, OR = 1.025 per 1 point increase, 95% CI: 1.003–1.048, P = .023).Elevated plasma D-dimer and CA125 levels and an increased PNR might affect the occurrence of GC-related ischemic stroke and could therefore serve as potential biomarkers.

Neutrophil Lymphocyte Ratio and Cardiovascular Disease Risk: A Systematic Review and Meta-Analysis

“…Mean age of study participants ranged from 34.9 to 73.2 years. Some studies focused on patients with specific diseases including diabetic patients in 6 studies [ 14 , 16 , 23 , 30 , 43 , 44 ], gastric cancer in 1 study [ 40 ], CKD patients in 2 studies, and HIV patients in 1 study [ 47 ]. Percentages of patients having DM, HT, and DLP and smoking ranged within 0%-100%, 5.9%-80.9%, 12.4%-83.9%, and 0%-45.8%, respectively.…”

“…Among 10 studies of 58,867 participants, 2 studies [ 33 , 39 ] reported OR of high versus low NLR, 6 studies [ 35 , 37 , 38 , 40 – 42 ] reported mean differences between stroke patients and controls, and 2 studies [ 34 , 36 ] reported both. Types of stroke were ischemic stroke and TIA.…”

Platelet-to-neutrophil Ratio after Intravenous Thrombolysis Predicts Unfavorable Outcomes in Acute Ischemic Stroke

“…In addition, several studies found PNR was correlated with thrombosis [ 14 ]. For example, Long et al [ 15 ] proposed that PNR might be an indicator of blood hyperco-agulable state, and an increased PNR level may induce a gastric cancer-related ischemic stroke. However, the relationship between PNR and the prognosis of IVT patients has not been explored.…”

Clinical Characteristics and Risk Factors of Lung Cancer-Associated Acute Ischemic Stroke

“…Cancer cells can activate the body's coagulation mechanism by releasing many tissue factors, cancer-associated procoagulant, and cyokines, and cancer cells also can interact with platelets to release ADP, arachidonic acid, 5-HT, and other substances to promote blood coagulation. Eventually, the body will be hypercoagulable [23][24][25][26][27]. Bang's recent research showed circulating tumor extracellular vesicles, especially in adenocarcinoma patients, also played a vital role in cancer-associated thrombosis and tumor progression [28,29].…”