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Yoshimoto T, Toyoda K, Yoshimura S, Wada S, Ihara M, Miyazaki J, Miwa K, Yoshie T, Miyamoto Y, Kobayashi S, Minematsu K, Koga M. Outcomes in ischemic and hemorrhagic stroke patients with cancer: The Japan Stroke Data Bank. J Neurol Sci 2024; 466:123234. [PMID: 39288721 DOI: 10.1016/j.jns.2024.123234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 09/07/2024] [Accepted: 09/09/2024] [Indexed: 09/19/2024]
Abstract
INTRODUCTION Data on the impact of malignancy on outcomes in patients with stroke, especially hemorrhagic stroke, are limited. We aimed to clarify the association between cancer and outcomes for each stroke type (ischemic/hemorrhagic) using a hospital-based multicenter stroke registration database. PATIENTS AND METHODS Study participants were adult patients within 7 days of the onset of ischemic stroke (IS) or hemorrhagic stroke (HS) between 2000 and 2020 in the Japan Stroke Data Bank (JSDB). The patients were categorized into two groups according to whether they had a history of cancer. Outcomes included good functional outcomes, representing a modified Rankin Scale score of 0-2 at discharge and in-hospital mortality. RESULTS Of the 203,983 patients analyzed in this substudy, 152,591 (women, 39.9 %; median age, 75 years) had IS, and 51,392 (48.6 %; 69 years) had HS. Of these, 6409 IS (4.2 %) and 1560 HS (3.0 %) patients had any cancer. IS patients with cancer had a lower frequency of good functional outcomes (47.5 % vs. 56.3 %; adjusted odds ratio [aOR] 0.85, 95 % confidence interval [CI] 0.79-0.91) and a higher incidence of in-hospital mortality (6.7 % vs. 4.5 %; aOR 1.59, 95 % CI 1.41-1.80) than those without cancer. HS patients with cancer showed a lower frequency of good functional outcome (24.9 % vs. 35.7 %; aOR 0.88, 95 % CI 0.78-0.99) and higher incidence of in-hospital mortality (20.1 % vs. 16.0 %; aOR 1.26, 95 % CI 1.04-1.52) than those without cancer. CONCLUSIONS Both IS and HS patients with cancer had significantly lower good functional outcomes and more in-hospital mortality.
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Affiliation(s)
- Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan.
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Shinichi Wada
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Junji Miyazaki
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan; Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Tomohide Yoshie
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Shotai Kobayashi
- Shimane University School of Medicine, 89-1 Enya-cho Izumo, Shimane 693-8501, Japan
| | - Kazuo Minematsu
- Medical Corporation ISEIKAI, 4-11-23 Nishitenma, Kita-ku, Osaka, Osaka 530-0047, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
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Costamagna G, Hottinger AF, Milionis H, Salerno A, Strambo D, Livio F, Navi BB, Michel P. Acute ischaemic stroke in active cancer versus non-cancer patients: stroke characteristics, mechanisms and clinical outcomes. Eur J Neurol 2024; 31:e16200. [PMID: 38235924 PMCID: PMC11235609 DOI: 10.1111/ene.16200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND AND PURPOSE Demographics, clinical characteristics, stroke mechanisms and long-term outcomes were compared between acute ischaemic stroke (AIS) patients with active cancer (AC) versus non-cancer patients. METHODS Using data from 2003 to 2021 in the Acute STroke Registry and Analysis of Lausanne, a retrospective cohort study was performed comparing patients with AC, including previously known and newly diagnosed cancers, with non-cancer patients. Patients with inactive cancer were excluded. Outcomes were the modified Rankin Scale (mRS) score at 3 months, death and cerebrovascular recurrences at 12 months before and after propensity score matching. RESULTS Amongst 6686 patients with AIS, 1065 (15.9%) had a history of cancer. After excluding 700 (10.4%) patients with inactive cancer, there were 365 (5.5%) patients with AC and 5621 (84%) non-cancer AIS patients. Amongst AC patients, 154 (42.2%) strokes were classified as cancer related. In multivariable analysis, patients with AC were older (adjusted odds ratio [aOR] 1.02, 95% confidence interval [CI] 1.00-1.03), had fewer vascular risk factors and were 48% less likely to receive reperfusion therapies (aOR 0.52, 95% CI 0.35-0.76). Three-month mRS scores were not different in AC patients (aOR 2.18, 95% CI 0.96-5.00). At 12 months, death (adjusted hazard ratio 1.91, 95% CI 1.50-2.43) and risk of cerebrovascular recurrence (sub-distribution hazard ratio 1.68, 95% CI 1.22-2.31) before and after propensity score matching were higher in AC patients. CONCLUSIONS In a large institutional registry spanning nearly two decades, AIS patients with AC had less past cerebrovascular disease but a higher 1-year risk of subsequent death and cerebrovascular recurrence compared to non-cancer patients. Antithrombotic medications at discharge may reduce this risk in AC patients.
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Affiliation(s)
- Gianluca Costamagna
- Stroke Center, Neurology Service, Department of Clinical NeurosciencesLausanne University Hospital and University of LausanneLausanneSwitzerland
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT)University of MilanMilanItaly
| | - Andreas F. Hottinger
- Lundin and Family Brain Tumor Research Center, Services of Neurology and OncologyLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Haralampos Milionis
- First Department of Internal Medicine, Medical SchoolUniversity of IoanninaIoanninaGreece
| | - Alexander Salerno
- Stroke Center, Neurology Service, Department of Clinical NeurosciencesLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Davide Strambo
- Stroke Center, Neurology Service, Department of Clinical NeurosciencesLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Francoise Livio
- Service of Clinical PharmacologyLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Babak B. Navi
- Feil Family Brain and Mind Research Institute and Department of NeurologyWeill Cornell MedicineNew York CityNew YorkUSA
- Department of NeurologyMemorial Sloan Kettering Cancer CenterNew York CityNew YorkUSA
| | - Patrik Michel
- Stroke Center, Neurology Service, Department of Clinical NeurosciencesLausanne University Hospital and University of LausanneLausanneSwitzerland
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Włodarczyk E, Wrona P, Homa T, Sobolewska M, Wróbel D, Rolkiewicz D, Popiela T, Słowik A, Sawczyńska K. Long-term outcomes of mechanical thrombectomy in acute ischaemic stroke patients with concomitant malignancy. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2024; 20:95-102. [PMID: 38616929 PMCID: PMC11008522 DOI: 10.5114/aic.2024.137433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Patients with cancer (CP) need a different approach to acute ischaemic stroke (AIS) treatment as intravenous thrombolysis (IVT) may be contraindicated. Mechanical thrombectomy (MT) is a treatment of choice for otherwise eligible patients, although the literature on its long-term outcomes in CP is limited. Aim Assessing outcomes of MT-treated AIS patients with concomitant malignancy in a year-long follow-up. Material and methods The study included 593 MT-treated AIS patients admitted in 2019-2021. The group was divided into CP (defined as a diagnosis of malignancy and undergoing/qualified for cancer treatment within previous 5 years) and a control group. The profile of cardiovascular risk factors, stroke severity and discharge, 90-day and 365-day outcomes were compared between the groups. Results CP and controls had a similar profile of cardiovascular risk factors and comparable stroke severity. CP were less frequently treated with IVT (25.7% vs. 59.1%, p < 0.001). There were no differences between the groups in the successful reperfusion rate and occurrence of haemorrhagic complications. Discharge and 90-day outcomes were similar. CP had higher 365-day mortality (48.6% vs. 29.9%, p = 0.024) but the percentage of patients achieving good functional outcome in a year-long observation was comparable. Conclusions Treatment with MT seems beneficial for AIS patients with concomitant malignancy both in short- and long-term observation.
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Affiliation(s)
- Ewa Włodarczyk
- Department of Neurology, University Hospital, Krakow, Poland
| | - Paweł Wrona
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Homa
- Department of Neurology, University Hospital, Krakow, Poland
| | - Maria Sobolewska
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Dominik Wróbel
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Dawid Rolkiewicz
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Tadeusz Popiela
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Sawczyńska
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
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