Cancer-Associated Stroke: The Bergen NORSTROKE Study

Selvik, Henriette Aurora; Thomassen, Lars; Bjerkreim, Anna Therese; Næss, Halvor

doi:10.1159/000440730

Cited by 84 publications

(99 citation statements)

References 18 publications

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“…It is still disputed which cancer types are most likely to induce a hypercoagulable state [29, 36, 37]. Lung and prostate cancer were the 2 most common active cancer types in our study.…”

Section: Discussionmentioning

confidence: 62%

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When to Screen Ischaemic Stroke Patients for Cancer

et al. 2018

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Background and Purpose: Ischemic stroke can be the first manifestation of cancer and it is therefore important to ascertain which stroke patients should be considered for cancer-diagnostic investigations. We aimed to determine the frequency of active cancer in patients with acute ischemic stroke and to compare clinical findings in stroke patients with active cancer to ischemic stroke patients with no history of cancer. Finally, we aimed to develop a predictive and feasible score for clinical use to uncover underlying malignancy. Methods: All ischemic stroke patients admitted to the stroke unit in the Department of Neurology, Haukeland University Hospital were consecutively included in the Norwegian Stroke Research Registry (NORSTROKE). Stroke etiology was determined by the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Data on cancer diagnoses was obtained from patients’ medical records and the Cancer Registry of Norway. Active cancer was defined as cancer diagnosis, metastasis of known cancer, recurrent cancer or receiving cancer treatment, all within 12 months before or after the index stroke. Based on variables independently associated with active cancer, a predictive score was developed using the area under the receiver operating characteristic (AUC-ROC) curves. Bayes’ theorem was used to calculate post-test probabilities of active cancer. Results: Of the 1,646 ischemic stroke patients included, 82 (5.0%) had active cancer. Increased D-dimer (OR = 1.1, 95% CI: 1.1–1.2, p = <0.001), lower Hb (OR = 0.6, 95% CI: 0.5–0.7, p = <0.001), smoking (OR = 2.2, 95% CI: 1.2–4.3, p = 0.02) and suffering a stroke of undetermined etiology (OR = 1.9, 95% CI: 1.1–3.3, p = 0.03) were factors independently associated with active cancer. These were included in the final predictive score which gave an AUC of 0.73 (95% CI: 0.65–0.81) in patients younger than 75 years of age. Assuming the prevalence of cancer to be 5%, the score shows that if a patient fulfills all 3 score points, the probability of active cancer is 53%. Conclusions: Active cancer was found in 5% of our ischemic stroke patients. We found that a clinical score comprising elevated D-dimer ≥3 mg/L, lower Hb ≤12.0 g/dL and previous or current smoking is feasible for predicting active cancer in ischemic stroke patients.

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“…It is still disputed which cancer types are most likely to induce a hypercoagulable state [29, 36, 37]. Lung and prostate cancer were the 2 most common active cancer types in our study.…”

Section: Discussionmentioning

confidence: 62%

“…The proportion of stroke patients with active or occult cancer is debated and study findings reveal a value ranging from <2 to 13% [12, 27-29]. However, with increasing age of populations and thereby higher incidence of both stroke and cancer, uncovering cancer-associated strokes is becoming increasingly important.…”

Section: Discussionmentioning

confidence: 99%

When to Screen Ischaemic Stroke Patients for Cancer

et al. 2018

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“…2 7 and 17.9 per 1000 8. Our study is the first to present prevalence of occult cancer in stroke in comparison to prevalence in the background population and thus the first to present adjusted analyses of stroke patients' excess risk of having occult cancer.…”

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confidence: 82%

“…3 In the year before cancer is diagnosed when cancer is occult, the risk of stroke is almost twice that in the background population without occult cancer. [4][5][6][7][8] Comparative studies on prevalence of occult cancer in comparable background populations are missing. A prerequisite for implementation of cancer screening would be that prevalence of occult cancers in the stroke population is markedly higher than in the background population.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk of occult cancer in stroke

2019

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Objectives: Cancer is associated with higher risk of stroke. Whether this translates into higher risk of cancer in stroke of an extent calling for cancer screening in stroke is unclear. We investigated prevalence and risk of occult cancer in stroke compared to the background population without history of stroke. Materials and methods: All patients >40 years of age with incident stroke in Denmark 2003-2015 were identified through the Danish Stroke Registry (n = 85 893) and matched 1:10 on age and sex to the Danish background population without history of stroke (n = 858 740). Linking data to the Danish Cancer Registry, we determined prevalence of occult cancer in stroke defined as the event of previously unknown cancer during a 1-year follow-up in the stroke and in the background population. Cox regression models were used to study risk in comparison to the background population. Results: Prevalence (per 1000) of occult cancer in the stroke/background cohorts was 25.0/15.8 in women and 29.8/20.4 in men. Prevalence was dependent on age and sex. Highest among stroke patients aged 70-80 years (35.6 in women, 42.4 in men); lowest in patients aged 40-50 years (8.3 in women, 6.8 in men). Stroke was associated with an overall 54% higher risk of occult cancer but risk increased significantly with smoking, hazard ratio (HR) 1.47, age HR 1.27 per 10 years, male sex HR 1.25, and diabetes HR 1.25. Conclusions:Prevalence and risk of occult cancer in stroke is considerable and calls for attention when designing the stroke investigation program. K E Y W O R D Scancer, prevalence, risk, stroke

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“…In a recent US-based nationwide registry study, about 10% of all hospitalized ischemic stroke patients had comorbid cancer, with a slight rise in this rate over the last decade. 3,4 In a Swedish nationwide follow-up study, patients with cancer developed ischemic stroke 2.2 times more often than their age-and sex-matched non-cancer control population during a six months follow-up. 3,4 In addition, probability of cancer diagnosis after stroke is associated with smoking, elevated D-dimer, elevated C-reactive protein (CRP), and anemia on admission.…”

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confidence: 99%