Factors affecting post-ischemic stroke mortality in cancer patients
Background and Purpose: Determining the factors associated with post-stroke survival and prognosis in cancer patients is important for treatment selection. However, there has been no clear evidence related to markers that can predict mortality. Therefore, in this study, we analyzed the factors assoc...
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| Published in | Japanese Journal of Stroke Vol. 44; no. 3; pp. 252 - 258 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English Japanese |
| Published |
The Japan Stroke Society
2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0912-0726 1883-1923 |
| DOI | 10.3995/jstroke.10968 |
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| Abstract | Background and Purpose: Determining the factors associated with post-stroke survival and prognosis in cancer patients is important for treatment selection. However, there has been no clear evidence related to markers that can predict mortality. Therefore, in this study, we analyzed the factors associated with post-stroke mortality in patients with cancer. Methods: Specifically, this was a retrospective cohort study that included cancer patients with acute ischemic stroke hospitalized at Kawasaki Municipal Tama Hospital between January 2009 and March 2021. To evaluate the associations between clinical factors within 24 hours of initial stroke and mortality or stroke recurrence events within 6 months after stroke onset, logistic analysis was used. Further, in each study group, cutoff points for the markers of mortality were determined using receiver operating characteristic (ROC) curve analysis, and cumulative outcome rate was compared using Kaplan-Meier analysis. Results: A total of 94 cancer patients who developed acute stroke were ultimately selected for analysis, wherein 40 (42.5%) subjects died within 6 months following stroke onset. On assessment, high D-dimer levels and deep venous thrombosis (DVT) were independently associated with mortality, in which a higher death rate was significantly confirmed in the group with D-dimer levels ≥4.1 mg/dl. Conclusion: Furthermore, cancer patients with stroke, high D-dimer levels, and DVT would be associated with the risk of mortality within 6 months after stroke onset. |
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| AbstractList | Background and Purpose: Determining the factors associated with post-stroke survival and prognosis in cancer patients is important for treatment selection. However, there has been no clear evidence related to markers that can predict mortality. Therefore, in this study, we analyzed the factors associated with post-stroke mortality in patients with cancer. Methods: Specifically, this was a retrospective cohort study that included cancer patients with acute ischemic stroke hospitalized at Kawasaki Municipal Tama Hospital between January 2009 and March 2021. To evaluate the associations between clinical factors within 24 hours of initial stroke and mortality or stroke recurrence events within 6 months after stroke onset, logistic analysis was used. Further, in each study group, cutoff points for the markers of mortality were determined using receiver operating characteristic (ROC) curve analysis, and cumulative outcome rate was compared using Kaplan-Meier analysis. Results: A total of 94 cancer patients who developed acute stroke were ultimately selected for analysis, wherein 40 (42.5%) subjects died within 6 months following stroke onset. On assessment, high D-dimer levels and deep venous thrombosis (DVT) were independently associated with mortality, in which a higher death rate was significantly confirmed in the group with D-dimer levels ≥4.1 mg/dl. Conclusion: Furthermore, cancer patients with stroke, high D-dimer levels, and DVT would be associated with the risk of mortality within 6 months after stroke onset. |
| ArticleNumber | 10968 |
| Author | Hasegawa, Yasuhiro Yamauchi, Junji Tsuchihashi, Yoko Imai, Takeshi Akasu, Yukari Shimizu, Takahiro Akiyama, Hisanao Yamano, Yoshihisa |
| Author_xml | – sequence: 1 fullname: Akasu, Yukari organization: Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine – sequence: 1 fullname: Yamauchi, Junji organization: Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine – sequence: 1 fullname: Yamano, Yoshihisa organization: Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine – sequence: 1 fullname: Tsuchihashi, Yoko organization: Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine – sequence: 1 fullname: Shimizu, Takahiro organization: Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine – sequence: 1 fullname: Imai, Takeshi organization: Department of Neurology, Kawasaki Municipal Tama Hospital – sequence: 1 fullname: Akiyama, Hisanao organization: Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine – sequence: 1 fullname: Hasegawa, Yasuhiro organization: Division of Neurology, Department of Internal Medicine, Shin-Yurigaoka General Hospital |
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| Cites_doi | 10.1002/ana.24325 10.1111/j.1538-7836.2005.01174.x 10.1007/s00595-016-1308-6 10.1182/blood-2006-10-053736 10.1016/j.jstrokecerebrovasdis.2020.105365 10.5853/jos.2014.16.2.91 10.1001/archinte.166.4.458 10.1111/jth.13761 10.1212/WNL.0000000000000539 10.1253/circj.CJ-17-0445 10.1161/STR.0000000000000158 10.1007/s10238-013-0230-0 10.1038/sj.bjc.6601242 10.5853/jos.2016.00570 10.1056/NEJM200012213432504 10.1016/j.ctrv.2012.08.003 10.1159/000491436 10.1016/S0140-6736(11)61904-1 10.1212/01.WNL.0000129912.56486.2B 10.1161/STROKEAHA.112.658625 10.1373/clinchem.2011.166249 10.1200/JCO.2009.22.4584 10.1002/ana.22050 10.1186/s12959-016-0117-x 10.1038/sj.bjc.6603552 10.1016/j.critrevonc.2003.10.003 10.1016/j.thromres.2011.02.015 10.1161/STROKEAHA.118.023044 |
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| References | 10) Schwarzbach CJ, Schaefer A, Ebert A, et al.: Stroke and cancer: the importance of cancer-associated hypercoagulation as a possible stroke etiology. Stroke 43: 3029–3034, 2012 27) Asakura H, Takahashi H, Uchiyama T, et al.: Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis. Thromb J 14: 42, 2016 28) Kawasugi K, Wada H, Hatada T, et al.: Prospective evaluation of hemostatic abnormalities in overt DIC due to various underlying diseases. Thromb Res 128: 186–190, 2011 29) Watanabe J, Otani S, Sakamoto T, et al.: Prognostic indicators based on inflammatory and nutritional factors after pancreaticoduodenectomy for pancreatic cancer. Surg Today 46: 1258–1267, 2016 23) Dentali F, Pegoraro S, Barco S, et al.: Clinical course of isolated distal deep vein thrombosis in patients with active cancer: a multicenter cohort study. J Thromb Haemost 15: 1757–1763, 2017 11) Goldhaber SZ, Bounameaux H: Pulmonary embolism and deep vein thrombosis. Lancet 379: 1835–1846, 2012 16) Tripodi A: D-dimer testing in laboratory practice. Clin Chem 57: 1256–1262, 2011 25) Seok JM, Kim SG, Kim JW, et al.: Coagulopathy and embolic signal in cancer patients with ischemic stroke. Ann Neurol 68: 213–219, 2010 7) Powers WJ, Rabinstein AA, Ackerson T, et al.: 2018 Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49: e46–e110, 2018 2) Navi BB, Reiner AS, Kamel H, et al.: Association between incident cancer and subsequent stroke. Ann Neurol 77: 291–300, 2015 13) Forrest LM, McMillan DC, McArdle CS, et al.: Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer 89: 1028–1030, 2003 22) Yamashita Y, Shiomi H, Morimoto T, et al.: Asymptomatic lower extremity deep vein thrombosis - clinical characteristics, management strategies, and long-term outcomes. Circ J 81: 1936–1944, 2017 26) Fujinami J, Ohara T, Kitani-Morii F, et al.: Cancer-associated hypercoagulation increases the risk of early recurrent stroke in patients with active cancer. Cerebrovasc Dis 46: 46–51, 2018 19) Uno K, Homma S, Satoh T, et al.: Tissue factor expression as a possible determinant of thromboembolism in ovarian cancer. Br J Cancer 96: 290–295, 2007 3) Varki A: Trousseau’s syndrome: multiple definitions and multiple mechanisms. Blood 110: 1723–1729, 2007 14) Chew HK, Wun T, Harvey D, et al.: Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 166: 458–464, 2006 4) Dammacco F, Vacca A, Procaccio P, et al.: Cancer-related coagulopathy (Trousseau’s syndrome): review of the literature and experience of a single center of internal medicine. Clin Exp Med 13: 85–97, 2013 6) Navi BB, Singer S, Merkler AE, et al.: Recurrent thromboembolic events after ischemic stroke in patients with cancer. Neurology 83: 26–33, 2014 15) McMillan DC: The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer. Cancer Treat Rev 39: 534–540, 2013 17) Kim K, Lee JH: Risk factors and biomarkers of ischemic stroke in cancer patients. J Stroke 16: 91–96, 2014 18) De Cicco M: The prothrombotic state in cancer: pathogenic mechanisms. Crit Rev Oncol Hematol 50: 187–196, 2004 20) Kuderer NM, Ortel TL, Francis CW: Impact of venous thromboembolism and anticoagulation on cancer and cancer survival. J Clin Oncol 27: 4902–4911, 2009 5) Lee MJ, Chung JW, Ahn MJ, et al.: Hypercoagulability and mortality of patients with stroke and active cancer: The OASIS-CANCER study. J Stroke 19: 77–87, 2017 21) Nierodzik M, Karpatkin S: Hypercoagulability preceding cancer. Does hypercoagulability awaken dormant tumor cells in the host? J Thromb Haemost 3: 577–580, 2005 9) Lee MJ, Chung JW, Ahn MJ, et al.: Hypercoagulability snd mortality of patients with stroke and active cancer: The OASIS-CANCER Study. J Stroke 19: 77–87, 2017 24) Sørensen HT, Mellemkjaer L, Olsen JH, et al.: Prognosis of cancers associated with venous thromboembolism. N Engl J Med 343: 1846–1850, 2000 12) Yoo J, Nam HS, Kim YD, et al.: Short-term outcome of ischemic stroke patients with systemic malignancy. Stroke 50: 507–511, 2019 1) Cestari DM, Weine DM, Panageas KS, et al.: Stroke in patients with cancer: incidence and etiology. Neurology 62: 2025–2030, 2004 8) Tsuchihashi Y, Shimizu T, Akiyama H, et al.: The risk factors for death within 6 months after ischemic stroke in patients with cancer. J Stroke Cerebrovasc Dis 29: 105365, 2020 doi: 10. 1016/j.jstrokecerebrovasdis.2020.105365 22 23 24 25 26 27 28 29 10 11 12 13 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 20 21 |
| References_xml | – reference: 9) Lee MJ, Chung JW, Ahn MJ, et al.: Hypercoagulability snd mortality of patients with stroke and active cancer: The OASIS-CANCER Study. J Stroke 19: 77–87, 2017 – reference: 22) Yamashita Y, Shiomi H, Morimoto T, et al.: Asymptomatic lower extremity deep vein thrombosis - clinical characteristics, management strategies, and long-term outcomes. Circ J 81: 1936–1944, 2017 – reference: 8) Tsuchihashi Y, Shimizu T, Akiyama H, et al.: The risk factors for death within 6 months after ischemic stroke in patients with cancer. J Stroke Cerebrovasc Dis 29: 105365, 2020 doi: 10. 1016/j.jstrokecerebrovasdis.2020.105365 – reference: 3) Varki A: Trousseau’s syndrome: multiple definitions and multiple mechanisms. Blood 110: 1723–1729, 2007 – reference: 20) Kuderer NM, Ortel TL, Francis CW: Impact of venous thromboembolism and anticoagulation on cancer and cancer survival. J Clin Oncol 27: 4902–4911, 2009 – reference: 23) Dentali F, Pegoraro S, Barco S, et al.: Clinical course of isolated distal deep vein thrombosis in patients with active cancer: a multicenter cohort study. J Thromb Haemost 15: 1757–1763, 2017 – reference: 18) De Cicco M: The prothrombotic state in cancer: pathogenic mechanisms. Crit Rev Oncol Hematol 50: 187–196, 2004 – reference: 16) Tripodi A: D-dimer testing in laboratory practice. Clin Chem 57: 1256–1262, 2011 – reference: 29) Watanabe J, Otani S, Sakamoto T, et al.: Prognostic indicators based on inflammatory and nutritional factors after pancreaticoduodenectomy for pancreatic cancer. Surg Today 46: 1258–1267, 2016 – reference: 17) Kim K, Lee JH: Risk factors and biomarkers of ischemic stroke in cancer patients. J Stroke 16: 91–96, 2014 – reference: 1) Cestari DM, Weine DM, Panageas KS, et al.: Stroke in patients with cancer: incidence and etiology. Neurology 62: 2025–2030, 2004 – reference: 5) Lee MJ, Chung JW, Ahn MJ, et al.: Hypercoagulability and mortality of patients with stroke and active cancer: The OASIS-CANCER study. J Stroke 19: 77–87, 2017 – reference: 21) Nierodzik M, Karpatkin S: Hypercoagulability preceding cancer. Does hypercoagulability awaken dormant tumor cells in the host? J Thromb Haemost 3: 577–580, 2005 – reference: 10) Schwarzbach CJ, Schaefer A, Ebert A, et al.: Stroke and cancer: the importance of cancer-associated hypercoagulation as a possible stroke etiology. Stroke 43: 3029–3034, 2012 – reference: 14) Chew HK, Wun T, Harvey D, et al.: Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 166: 458–464, 2006 – reference: 11) Goldhaber SZ, Bounameaux H: Pulmonary embolism and deep vein thrombosis. Lancet 379: 1835–1846, 2012 – reference: 4) Dammacco F, Vacca A, Procaccio P, et al.: Cancer-related coagulopathy (Trousseau’s syndrome): review of the literature and experience of a single center of internal medicine. Clin Exp Med 13: 85–97, 2013 – reference: 2) Navi BB, Reiner AS, Kamel H, et al.: Association between incident cancer and subsequent stroke. Ann Neurol 77: 291–300, 2015 – reference: 28) Kawasugi K, Wada H, Hatada T, et al.: Prospective evaluation of hemostatic abnormalities in overt DIC due to various underlying diseases. Thromb Res 128: 186–190, 2011 – reference: 7) Powers WJ, Rabinstein AA, Ackerson T, et al.: 2018 Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49: e46–e110, 2018 – reference: 12) Yoo J, Nam HS, Kim YD, et al.: Short-term outcome of ischemic stroke patients with systemic malignancy. Stroke 50: 507–511, 2019 – reference: 25) Seok JM, Kim SG, Kim JW, et al.: Coagulopathy and embolic signal in cancer patients with ischemic stroke. Ann Neurol 68: 213–219, 2010 – reference: 13) Forrest LM, McMillan DC, McArdle CS, et al.: Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer 89: 1028–1030, 2003 – reference: 24) Sørensen HT, Mellemkjaer L, Olsen JH, et al.: Prognosis of cancers associated with venous thromboembolism. N Engl J Med 343: 1846–1850, 2000 – reference: 26) Fujinami J, Ohara T, Kitani-Morii F, et al.: Cancer-associated hypercoagulation increases the risk of early recurrent stroke in patients with active cancer. Cerebrovasc Dis 46: 46–51, 2018 – reference: 15) McMillan DC: The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer. Cancer Treat Rev 39: 534–540, 2013 – reference: 6) Navi BB, Singer S, Merkler AE, et al.: Recurrent thromboembolic events after ischemic stroke in patients with cancer. Neurology 83: 26–33, 2014 – reference: 19) Uno K, Homma S, Satoh T, et al.: Tissue factor expression as a possible determinant of thromboembolism in ovarian cancer. Br J Cancer 96: 290–295, 2007 – reference: 27) Asakura H, Takahashi H, Uchiyama T, et al.: Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis. Thromb J 14: 42, 2016 – ident: 2 doi: 10.1002/ana.24325 – ident: 21 doi: 10.1111/j.1538-7836.2005.01174.x – ident: 29 doi: 10.1007/s00595-016-1308-6 – ident: 3 doi: 10.1182/blood-2006-10-053736 – ident: 8 doi: 10.1016/j.jstrokecerebrovasdis.2020.105365 – ident: 17 doi: 10.5853/jos.2014.16.2.91 – ident: 14 doi: 10.1001/archinte.166.4.458 – ident: 23 doi: 10.1111/jth.13761 – ident: 6 doi: 10.1212/WNL.0000000000000539 – ident: 22 doi: 10.1253/circj.CJ-17-0445 – ident: 7 doi: 10.1161/STR.0000000000000158 – ident: 4 doi: 10.1007/s10238-013-0230-0 – ident: 13 doi: 10.1038/sj.bjc.6601242 – ident: 9 doi: 10.5853/jos.2016.00570 – ident: 24 doi: 10.1056/NEJM200012213432504 – ident: 15 doi: 10.1016/j.ctrv.2012.08.003 – ident: 26 doi: 10.1159/000491436 – ident: 11 doi: 10.1016/S0140-6736(11)61904-1 – ident: 1 doi: 10.1212/01.WNL.0000129912.56486.2B – ident: 10 doi: 10.1161/STROKEAHA.112.658625 – ident: 16 doi: 10.1373/clinchem.2011.166249 – ident: 20 doi: 10.1200/JCO.2009.22.4584 – ident: 25 doi: 10.1002/ana.22050 – ident: 27 doi: 10.1186/s12959-016-0117-x – ident: 19 doi: 10.1038/sj.bjc.6603552 – ident: 18 doi: 10.1016/j.critrevonc.2003.10.003 – ident: 5 doi: 10.5853/jos.2016.00570 – ident: 28 doi: 10.1016/j.thromres.2011.02.015 – ident: 12 doi: 10.1161/STROKEAHA.118.023044 |
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| Title | Factors affecting post-ischemic stroke mortality in cancer patients |
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