Clinical features and biological markers of lung cancer-associated stroke

Abstract

ObjectiveTo identify the unique clinical features and biological markers of lung cancer-associated stroke.MethodsWe recruited 102 patients with lung cancer plus stroke, 102 with lung cancer, and 102 with stroke. Detailed information was analysed and compared among groups.ResultsThe groups were age-matched. Patients with lung cancer plus stroke showed multiple lesions involving multiple cerebral artery territories on magnetic resonance imaging, compared with stroke-alone patients. These patients also had a poorer modified Rankin Scale score at 30 days, and high mortality (18.6%). Patients with lung cancer plus stroke had a higher incidence of metastasis, and higher blood levels of D-dimer, CA125 and CA199 compared with patients with lung cancer alone. Multivariate logistic regression analysis showed that levels of D-dimer, CA125 and CA199 were independently related to lung cancer-associated stroke.ConclusionElevated plasma D-dimer, CA125 and CA199 may be independent risk factors for and biomarkers of lung cancer-associated stroke.

Cancer-associated stroke: Pathophysiology, detection and management (Review)

“…In a 2014 study, patients with active cancer and ischemic stroke tended to demonstrate higher CRP and D-dimers, more frequent cryptogenic strokes and patterns of multiple lesions, and among those patients, higher CRP and D-dimer levels were associated with a cryptogenic mechanism and multiple lesion patterns (17). In agreement with that study, Xie et al analyzed data from patients with lung cancer and came to the conclusion that high D-Dimers, alongside CA125 and CA199, were independent risk factors for lung-cancer-associated stroke (146). In a different study, lung cancer was also associated with high CRP levels (7).…”

“…Karlińska et al (2015) also noted that patients with stroke with an active cancer tended to present lower hematocrit levels, higher serum CRP levels, and a higher erythrocyte sedimentation rate when compared to cancer-free stroke patients (27). Several other studies have also reported elevated D-Dimers levels in cancer patients (7,19,146,147). Taking into consideration the significance D-Dimers seem to have in the diagnosis of cancer-related stroke, Guo et al (2014) used D-Dimers of ≥0.55 mg/l, and multiple territory infarctions, as criteria for the development of a clinically meaningful test for cancer-associated stroke.…”

“…Selvik et al (2015) claimed that routine investigation for cancer was not justified in acute ischemic stroke (7). However, a number of studies have corroborate that systemic cancer workup should be considered in patients in whom stroke origin is unclear, who have an early vascular recurrence, predisposing factors for cancer, such as smoking, high D-Dimers, fibrinogen and CRP levels (7,28,146). Xie et al suggested that patients with cryptogenic stroke and high plasma levels of CA125 and CA199 should also be investigated to rule out lung cancer (146).…”

“…However, a number of studies have corroborate that systemic cancer workup should be considered in patients in whom stroke origin is unclear, who have an early vascular recurrence, predisposing factors for cancer, such as smoking, high D-Dimers, fibrinogen and CRP levels (7,28,146). Xie et al suggested that patients with cryptogenic stroke and high plasma levels of CA125 and CA199 should also be investigated to rule out lung cancer (146). Regardless, stroke as the first manifestation of an underlying malignancy is mostly secondary to specific cancer-related causes (5).…”

Independent risk factors and the potential predictors of bladder cancer-related ischemic stroke

“…Some serum markers, such as elevated serum D-dimer, CA125, and fibrinogen levels were found to be associated with hypercoagulability and are independent risk factors for CRIS. 5,6,8 In the present study, we found that elevated serum D-dimer and CEA levels and an increased PLT count were independent risk factors for BCRIS. There is an increasing amount of evidence for elevated serum D-dimer levels in stroke patients with active cancer.…”