The Activity of Malignancy May Determine Stroke Pattern in Cancer Patients

Karlińska, A; Gromadzka, Grażyna; Karliñski, Michał; Członkowska, Anna

doi:10.1016/j.jstrokecerebrovasdis.2014.11.003

Cited by 34 publications

(34 citation statements)

References 24 publications

(49 reference statements)

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“…Lung cancer and prostate cancer were the 2 most common cancer types, which is in concordance with other studies [9, 25, 26]. …”

Section: Discussionsupporting

confidence: 91%

“…This is less common than simply including diagnoses prior to stroke, but the definition varies widely in existing literature [8, 13, 26, 33, 34]. However, based on the results from our initial analyses showing no significant differences among patients diagnosed with cancer pre- and post-stroke, both groups were included as patients with “active cancer”.…”

Section: Discussionmentioning

confidence: 99%

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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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“…Lung cancer and prostate cancer were the 2 most common cancer types, which is in concordance with other studies [9, 25, 26]. …”

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

When to Screen Ischaemic Stroke Patients for Cancer

et al. 2018

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“…A recent prospective study also emphasizes the role of cancer activity in vascular profile distinction between cancer and non-cancer patients. 15 On the other hand, another recent study, The Bergen NORSTROKE Study 16 identified that patients with ischemic stroke and a previous history of cancer had a higher frequency of specific vascular risk factors (atrial fibrillation, heart disease and smoking), highlighting the fact that cancer and stroke have common risk factors. In our series of patients, there were no differences concerning vascular profile between active and non-active cancer patients, which could be explained by the limited number of patients with an active malignancy.…”

Section: Discussionmentioning

confidence: 99%

Acute Ischemic Stroke on Cancer Patients, a Distinct Etiology? A Case-Control Study

2015

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Discussion: In our case-control study two subsets of cancer patients were delineated. In a subgroup, cancer and stroke co-exist, sharing traditional vascular risk factors. In another subset of patients, stroke appears to be directly related to the presence of a malignancy, where hypercoagulopathy turns out to be a decisive mechanism. Conclusion:In clinical grounds, hypercoagulopathy as stroke etiology should prompt the physician to screen the patient for occult cancer.

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“…107,229 Yet another definition used is active cancer within 12 months before index stroke or cancer diagnosis while in the stroke unit. 230 This brings up another aspect of the active cancer definition. At what point does a cancer, solid or not, affect a patient negatively, and when could it affect coagulation?…”

Section: Defining Active Cancermentioning

confidence: 99%