Incident Cancer in a Cohort of 3,247 Cancer Diagnosis Free Ischemic Stroke Patients

Qureshi, Adnan I.; Malik, Ahmed; Saeed, Omar; Adil, Malik M; Rodríguez, Gustavo J.; Suri, M. Fareed K.

doi:10.1159/000375154

Cited by 49 publications

(49 citation statements)

References 40 publications

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“…On longer term it may be due to both recurrent cardiovascular events, and to comorbidity, which may be more prevalent and more severe in patients with severe stroke. Both cancer and cardiac failure have been associated with an increased long‐term mortality after stroke.…”

Section: Discussionmentioning

confidence: 99%

Non-cardioembolic TIA and ischemic stroke: Implications of severity

Åsberg

Farahmand²,

Hasvold

et al. 2018

Acta Neurol Scand

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Section: Discussionmentioning

confidence: 99%

Non-cardioembolic TIA and ischemic stroke: Implications of severity

Åsberg

Farahmand²,

Hasvold

et al. 2018

Acta Neurol Scand

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“…Being affected by both stroke and cancer can be devastating, leading to significantly increased risk of mortality and poor functional outcome [2-4]. Up to 15% of cancer patients experience ischaemic strokes [5], whereas approximately 20% of patients with stroke of undetermined cause (cryptogenic stroke) may have an occult malignancy at the time of stroke [6].…”

Section: Introductionmentioning

confidence: 99%

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 very important to explore which microenvironment as metastatic core for BM in NSCLC due to its significant mortality. It' s a remarkable that the rate of cancer incidence is higher among ischemic stroke patients than the general population 9,13,21,22,25) , and cancer itself may increase a risk of CI occurrence 10,11,16,30) . Once CI occurs in patients with cancer, neurological outcomes significantly worsen, and prognosis tends to be poor in addition to stroke-associated morbidity/mortality 5,15,19) .…”

Section: Discussionmentioning

confidence: 99%

Role of Cancer Emboli as a Metastatic Core on the Growth of Brain Metastasis in Patients with Non-Small Cell Lung Cancer

Kim

Gyu-Seo

Hoon-Gi

et al. 2020

J Neurointensive Care

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Brain metastasis (BM) was a common complication of patient with non-small cell lung cancer (NSCLC) and associated with a poor prognosis. The study was to evaluate the effect of cerebral infarction (CI) which was originated from cancer emboli on the risk of BM in NSCLC for preventive therapy strategy. Methods Three hundred seven patients with newly diagnosed NSCLC in our institute from July 2013 to July 2018 were retrospectively analyzed. The diagnostic criteria of CI refereed to Updated Criteria for Population-Based Stroke and Transient Ischemic Attack Incidence Studies for the 21st Century. Depending on magnetic resonance imaging (MRI), the patients were divided into the BM group and control group (without BM). Then, the prevalence of CI and baseline clinicopathological parameters were evaluated and compared between the two groups. Results Of the 307 patients, 204 patients (66.4%) had CI and 52 patients (16.9%) had BM. Especially, the prevalence of CI in the NSCLC patients with BM was 84.6%, which was significantly higher than that of 62.7% in the NSCLC patients without BM (p = 0.002). Following univariate logistic regression analysis and the multivariate model, the results demonstrated that CI was a significant independent risk factor for BM in NSCLC (odds rate, 3.303; 95% confidence interval, 1.437-7.593; p = 0.005). What's more, CI contributed to a worse prognosis in NSCLC patients with BM. Dynamical trace confirmed CI could promote BM in NSCLC patient. Conclusions CI could be associated with a metastatic tropism to the brain and then with an increased risk of BM in NSCLC patient. Therefore, targeted intervention of the metastatic core of CI could offer promising approach for the prevention, prognostic evaluation, and therapy of BM in NSCLC patients for better clinical outcome.

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Incident Cancer in a Cohort of 3,247 Cancer Diagnosis Free Ischemic Stroke Patients

Cited by 49 publications

References 40 publications

Non-cardioembolic TIA and ischemic stroke: Implications of severity

Non-cardioembolic TIA and ischemic stroke: Implications of severity

When to Screen Ischaemic Stroke Patients for Cancer

Role of Cancer Emboli as a Metastatic Core on the Growth of Brain Metastasis in Patients with Non-Small Cell Lung Cancer

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