Cancer in Young Adults With Ischemic Stroke

Abstract

Background and Purpose— Cancer is a risk factor for ischemic stroke. Little is known about cancer among young adults with ischemic stroke. We studied the frequency of cancer and its association with long-term risk of death among young patients with first-ever ischemic stroke. Methods— 1002 patients aged 15 to 49 years, registered in the Helsinki Young Stroke Registry, and with a median follow-up of 10.0 years (interquartile range 6.5–13.8) after stroke were included. Historical and follow-up data were derived from the Finnish Care Register and Statistics Finland. Survival between groups was compared with the Kaplan–Meier life-table method, and Cox proportional hazard models were used to identify factors associated with mortality. Results— One or more cancer diagnosis was made in 77 (7.7%) patients, of whom 39 (3.9%) had cancer diagnosed prestroke. During the poststroke follow-up, 41 (53.2%) of the cancer patients died. Median time from prestroke cancer to stroke was 4.9 (1.0–9.5) years and from stroke to poststroke cancer was 6.7 (2.7–10.9) years. Poststroke cancer was associated with age >40 years, heavy drinking, and cigarette smoking. The cumulative mortality was significantly higher among the cancer patients (68.6%, 95% confidence interval 52.0%–85.3%) compared with patients without cancer (19.7%, 95% confidence interval 16.3%–23.2%). Active cancer at index stroke, melanoma, and lung/respiratory tract cancer had the strongest independent association with death during the follow-up when adjusted for known poststroke mortality prognosticators. Conclusions— Cancer, and especially active cancer and no other apparent cause for stroke, is associated with unfavorable survival among young stroke patients.

Prior Cancer in Patients with Ischemic Stroke: The Bergen NORSTROKE Study

“…218 Although it did not reach statistical significance, the young stroke patients had a higher rate or cardioembolic strokes, also after adjusting for patent foramen ovale (PFO). 218 Furthermore, Finelli et al portrayed DWI-findings in patients with stroke and cancer, where 75 % of the patients with embolic appearing infarctions actually had emboli of no detected source. 219 Clinically, if patients have embolic appearing strokes and report symptoms that indicate a possible AF such as palpitations, even without ECG findings, they might be classified as cardioembolic.…”

“…Given the strong association between cancer-related stroke and poor clinical outcome, it is not surprising that the same patients also have an increased mortality. 105,218 In paper I we found that stroke patients with prior cancer had a double risk of death compared to other stroke patients. In paper III we did not study the mortality of the patients, but we saw that the patients with active cancer had a lower mean cholesterol level.…”

“…In fact, Aarnio et al, found that for stroke in the young, the cancer-associated strokes were especially not of undetermined cause. 218 Aarnio's young stroke patients with cancer had determined etiologies distributed similarly to the stroke patients with no cancer in the control group. 218 Although it did not reach statistical significance, the young stroke patients had a higher rate or cardioembolic strokes, also after adjusting for patent foramen ovale (PFO).…”

“…218 Aarnio's young stroke patients with cancer had determined etiologies distributed similarly to the stroke patients with no cancer in the control group. 218 Although it did not reach statistical significance, the young stroke patients had a higher rate or cardioembolic strokes, also after adjusting for patent foramen ovale (PFO). 218 Furthermore, Finelli et al portrayed DWI-findings in patients with stroke and cancer, where 75 % of the patients with embolic appearing infarctions actually had emboli of no detected source.…”

Increased Risk of Intracranial Hemorrhage and Mortality Following Thrombolysis in Patients with Stroke and Active Cancer

“…Although the two studies were based on the long-term follow up results, patients comorbid with cancer were associated with higher mortality among the ischemic stroke patients. 19,20 In active cancer patients, the risk of HT, sICH and mortality were all increased with the use of rt-PA, not by endovascular therapy. Analyzing the patients who received IV thrombolysis only, not only the mortality rate in patients with active cancer, the proportion of cerebral hemorrhage were also higher than the patients without cancer.…”