The independent risks and specific biomarker of breast cancer-related ischemic stroke

Cheng, Xue-Min; Qin, Qixiong; LiZhi, Lu; Chen, Chunyong; Wei, Yunfei; Wang, Dacheng; Li, Haihua; Li, Guohui; Liang, Hongbin; Li, Shengyu; Cheng, Daobin; Liang, Zhijian

doi:10.1080/00207454.2020.1733562

Cited by 3 publications

(8 citation statements)

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“…First, previous studies have demonstrated that cancer-related ischemia may occur after or before the diagnosis of cancer. [12][13][14] In the present study, a similar finding was also revealed in patients with ECIS, indicating that some measures should be taken to prevent ischemic stroke when the diagnosis of EC is obtained or when diagnosing the etiology of a cryptogenic ischemic stroke EC. Second, previous studies found that the clinical features of cancer-related ischemic stroke included elevated plasma DD levels and multiple ischemic lesions distributed in different cerebral arterial territories.…”

Section: Discussionsupporting

confidence: 83%

“…26 As it is also a mucinous factor that is secreted by EC cells, it was speculated that CEA may be involved in the pathogenesis of ECIS. Since increased neutrophil counts have been found to be associated with the development of cancer-related ischemic stroke, [12][13][14] it was suggested that elevated DD and CEA levels and increased neutrophils might play important roles in the development of ECIS. Compared with our previous studies, [12][13][14] ECIS and other cancer related ischemic stroke shared similar clinical features, such as ischemic stroke occurring within the first 6 months after the EC diagnosis, multiple ischemic lesions in multiple vascular areas and the pathogenesis of ischemic stroke associating with hypercoagulability.…”

Section: Discussionmentioning

confidence: 99%

“…This was a retrospective study of patients with ECIS from January 2011 to December 2020 at The First Affiliated Hospital of Guangxi Medical University, The Second Affiliated Hospital of Guangxi Medical University, The Ninth Affiliated Hospital of Guangxi Medical University, Fusui County People's Hospital, Wuzhou Red Cross Hospital, Cenxi People's Hospital and The Wuming Hospital of Guangxi Medical University. Based on a previous definition of cancer-related ischemic stroke, [12][13][14] we defined ECIS as acute ischemic stroke in patients with active EC and without conventional stroke risk factors. In the present study, we defined the conventional stroke risk factors as the presence of hypertension, diabetes, hyperlipidemia, atrial fibrillation, valvular heart disease, and cerebral artery stenosis.…”

Section: Patient Selectionmentioning

confidence: 99%

“…11 Moreover, our previous studies have found that every confirmed cancer-related ischemic stroke has its own unique clinical characteristics and risk factors, suggesting that targeting a certain type of cancer-related ischemic stroke will be more conducive to discovering the clinical characteristics and pathogenesis of cancer-related ischemic stroke. [12][13][14] For example, colorectal cancer-related ischemic stroke was associated with elevated CEA and neutrophils, 12 kidney cancerrelated stroke was associated with elevated plasma D-dimer, CA125 and CEA levels, and increased urine protein levels, 13 and breast cancer-related ischemic stroke was associated with endocrine therapy, elevated plasma D-dimer and CA153 levels. 14 Esophageal cancer (EC) is one of the most common digestive tract tumors worldwide.…”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14] For example, colorectal cancer-related ischemic stroke was associated with elevated CEA and neutrophils, 12 kidney cancerrelated stroke was associated with elevated plasma D-dimer, CA125 and CEA levels, and increased urine protein levels, 13 and breast cancer-related ischemic stroke was associated with endocrine therapy, elevated plasma D-dimer and CA153 levels. 14 Esophageal cancer (EC) is one of the most common digestive tract tumors worldwide. 15 Remarkably, the incidence of ischemic stroke in patients with EC is 1.5 times that in the normal population, 1 suggesting that the occurrence of ischemic stroke in some patients was related to EC, and ischemic stroke related to EC is called EC-related ischemic stroke (ECIS).…”

Section: Introductionmentioning

confidence: 99%

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The Index of Esophageal Cancer Related Ischemic Stroke: A Retrospective Patient Control Study

Liu¹,

LiZhi²,

Cheng³

et al. 2022

NDT

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To investigate independent risk factors for esophageal cancer-related ischemic stroke (ECIS) and to use them to develop an index of ECIS to help clinicians identify patients at high risk for ECIS or to identify ECIS from other types of ischemic stroke. Methods: We retrospectively enrolled active esophageal cancer (EC) patients with acute ischemic stroke (ECIS group) and patients with active EC without ischemic stroke (EC group), age-and sex-matched with ECIS patients, at seven centers from January 2011 to December 2020. Clinical data and laboratory and imaging findings were collected. Univariate and multivariate analyses were performed to analyze the independent risk factors for ECIS. Optimal cutoffs for sensitivities and specificities were obtained by Youden's J statistic following a receiver operator characteristic (ROC) analysis of each risk factor and the product of the risk factors. Results: A total of 91 ECIS patients and 91 EC patients were included. Elevated levels of carcinoembryonic antigen (CEA) [odds ratio (OR) = 0.105, 95% confidence interval (CI): 1.051-1.174, P < 0.001], D-dimer (DD) (OR = 0.003, 95% CI: 1.002-1.004, P < 0.001), and neutrophil count (OR = 0.857, 95% CI: 1.628-3.407, P < 0.001) were independent risk factors for ECIS. The area under the curve (AUC) of each independent risk factor and the product of the three independent risk factors were calculated by a receiver operator characteristic (ROC) curve, and the cutoff value from the largest AUC was called the ECIS index. Conclusion: It was suggested that elevated plasma DD and CEA levels and increased neutrophils in EC patients may altogether contribute to the development of ECIS. The index of ECIS may facilitate clinicians to identify patients at high risk for ECIS or to identify ECIS from other etiologic types of ischemic stroke.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The Index of Esophageal Cancer Related Ischemic Stroke: A Retrospective Patient Control Study

Liu¹,

LiZhi²,

Cheng³

et al. 2022

NDT

Self Cite

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The investigation on the hypercoagulability of hepatocellular carcinoma‐related cerebral infarction with thromboelastography

et al. 2023

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Aim To investigate the hypercoagulability of hepatocellular carcinoma (HCC)‐related cerebral infarction (HCRCI) with thromboelastography (TEG). Methods A multicenter prospective study was conducted in HCRCI patients, HCC patients without cerebral infarction, and acute cerebral infarction (ACI) patients without HCC between January 2016 and December 2019. TEG parameters and laboratory and clinical data were collected and compared among the three groups. To confirm the independent risk factors of HCRCI, multivariate analyses were conducted. Receiver operating characteristic (ROC) curves were utilized to evaluate the area under the curve (AUC) plotted by each independent risk factor. Results There were 38 patients recruited in the HCRCI group, and 152 patients were recruited to the HCC group and the ACI group. The levels of plasma neutrophil count, D‐dimer, α‐fetoprotein (AFP), carcinoembryonic antigen, and maximum amplitude (MA)—a parameter of TEG—were significantly higher in the HCRCI group than HCC and ACI groups. Multivariate logistic regression analysis showed that increased neutrophile count, D‐dimer, AFP, and MA were independently associated with HCRCI. ROC curve analysis showed first that AUC of MA for HCRCI was .875, which was larger than the other risk factors, and second that the optimal cutoff value for MA was 61.35, with a sensitivity of 89.50% and specificity of 66.40%. Conclusion It was suggested that TEG disclosed that the pathogenesis of HCRIC is exactly related to the hypercoagulability. And with a cutoff value of MA equaling to 61.35, TEG facilitates clinicians to identify HCC patients at high risk of HCRIC.

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Cancer-related cryptogenic stroke involving the bilateral anterior and the posterior circulations: Diagnostic value of clinical and imaging characteristics

Zhuang²,

Xu³

2022

Front. Neurol.

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ObjectivesThis study analyzed the clinical and imaging characteristics of patients with cancer-related cryptogenic stroke (CCS) involving the bilateral anterior and the posterior circulations (three circulations) and evaluate the diagnostic value of clinical and imaging features for patients with cryptogenic stroke involving three circulations (CST).MethodsOf the 12,580 patients with acute ischemic stroke, 148 patients with CST from May 2017 to November 2021 were divided into the cancer group (n = 81) and the non-cancer group (n = 67). Cardiovascular risk factors, diffusion-weighted imaging patterns of cryptogenic stroke, blood routine, coagulation routine, and biochemical routine were compared between the two groups. Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were used to determine associations between the two groups.ResultsCompared with the non-cancer group, the cancer group exhibited higher D-dimer levels (P < 0.001), fibrin degradation product (FDP, P < 0.001), international normalized ratio (INR, P = 0.014), neutrophil to lymphocyte ratio (NLR, P < 0.001), platelets to lymphocyte ratio (PLR, P = 0.001), activated partial thromboplastin time (APTT, P = 0.039), more frequent multiple lesions in three circulations (P < 0.001) and lower lymphocytes (P < 0.001), red blood cells (P < 0.001), and thrombin time (TT, P = 0.034). Furthermore, D-dimer [area under the curve (AUC) = 0.915, P < 0.001)], FDP (AUC = 0.923, P < 0.001), INR (AUC = 0.617, P = 0.014), NLR (AUC = 0.700, P < 0.001), PLR (AUC = 0.658, P = 0.001), and multiple lesions in three circulations (AUC = 0.786, P < 0.001) had potential diagnostic value in cryptogenic stroke. When combining these 6 parameters, the predictive power was improved (AUC = 0.949, P < 0.001).ConclusionCryptogenic stroke involving three circulations with cancer has unique clinical features, and these potential diagnostic indicators could help patients identify CCS earlier.

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The independent risks and specific biomarker of breast cancer-related ischemic stroke

Cited by 3 publications

References 36 publications

The Index of Esophageal Cancer Related Ischemic Stroke: A Retrospective Patient Control Study

The Index of Esophageal Cancer Related Ischemic Stroke: A Retrospective Patient Control Study

The investigation on the hypercoagulability of hepatocellular carcinoma‐related cerebral infarction with thromboelastography

Cancer-related cryptogenic stroke involving the bilateral anterior and the posterior circulations: Diagnostic value of clinical and imaging characteristics

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