活動性担癌患者における脳梗塞発症後の死亡関連因子に関する検討
【背景および目的】脳梗塞を発症した担癌患者の生存率に影響する因子として，複数の因子が報告されているが，深部静脈血栓症（DVT）については検討が不十分である．本研究では，活動性担癌患者の脳梗塞発症後の死亡に関連する因子について，DVT の影響を含め検討した．【方法】当院に入院した急性期脳梗塞患者のうち，癌を合併し，脳梗塞後の経過を 6 カ月間観察することのできた 94 例を対象とし，脳梗塞発症後の死亡イベントに対する各因子の関連性について，ロジスティック回帰分析にて多変量解析を行った．【結果】脳梗塞後の 6 カ月以内に死亡した症例は 40 例であり， D-dimer 高値，DVT ありが独立した...
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| Published in | 脳卒中 Vol. 44; no. 3; pp. 252 - 258 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中学会
2022
日本脳卒中学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0912-0726 1883-1923 |
| DOI | 10.3995/jstroke.10968 |
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| Abstract | 【背景および目的】脳梗塞を発症した担癌患者の生存率に影響する因子として，複数の因子が報告されているが，深部静脈血栓症（DVT）については検討が不十分である．本研究では，活動性担癌患者の脳梗塞発症後の死亡に関連する因子について，DVT の影響を含め検討した．【方法】当院に入院した急性期脳梗塞患者のうち，癌を合併し，脳梗塞後の経過を 6 カ月間観察することのできた 94 例を対象とし，脳梗塞発症後の死亡イベントに対する各因子の関連性について，ロジスティック回帰分析にて多変量解析を行った．【結果】脳梗塞後の 6 カ月以内に死亡した症例は 40 例であり， D-dimer 高値，DVT ありが独立した死亡関連因子であることが示され，D-dimer≥4.1 mg/dl 群で死亡を多く認めた．【結論】D-dimer 高値あるいは DVT を合併した担癌脳梗塞患者は，死亡リスクが高い可能性が示唆された． |
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| AbstractList | 要旨: 【背景および目的】脳梗塞を発症した担癌患者の生存率に影響する因子として, 複数の因子が報告されているが, 深部静脈血栓症(DVT)については検討が不十分である. 本研究では, 活動性担癌患者の脳梗塞発症後の死亡に関連する因子について, DVTの影響を含め検討した. 【方法】当院に入院した急性期脳梗塞患者のうち, 癌を合併し, 脳梗塞後の経過を6カ月間観察することのできた94例を対象とし, 脳梗塞発症後の死亡イベントに対する各因子の関連性について, ロジスティック回帰分析にて多変量解析を行った. 【結果】脳梗塞後の6カ月以内に死亡した症例は40例であり, D-dimer高値, DVTありが独立した死亡関連因子であることが示され, D-dimer≧4.1mg/dl群で死亡を多く認めた. 【結論】D-dimer高値あるいはDVTを合併した担癌脳梗塞患者は, 死亡リスクが高い可能性が示唆された. 【背景および目的】脳梗塞を発症した担癌患者の生存率に影響する因子として，複数の因子が報告されているが，深部静脈血栓症（DVT）については検討が不十分である．本研究では，活動性担癌患者の脳梗塞発症後の死亡に関連する因子について，DVT の影響を含め検討した．【方法】当院に入院した急性期脳梗塞患者のうち，癌を合併し，脳梗塞後の経過を 6 カ月間観察することのできた 94 例を対象とし，脳梗塞発症後の死亡イベントに対する各因子の関連性について，ロジスティック回帰分析にて多変量解析を行った．【結果】脳梗塞後の 6 カ月以内に死亡した症例は 40 例であり， D-dimer 高値，DVT ありが独立した死亡関連因子であることが示され，D-dimer≥4.1 mg/dl 群で死亡を多く認めた．【結論】D-dimer 高値あるいは DVT を合併した担癌脳梗塞患者は，死亡リスクが高い可能性が示唆された． |
| Author | 長谷川, 泰弘 今井, 健 清水, 高弘 土橋, 瑶子 赤須, 友香利 秋山, 久尚 山内, 淳司 山野, 嘉久 |
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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 |
| 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 |
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| Snippet | 【背景および目的】脳梗塞を発症した担癌患者の生存率に影響する因子として，複数の因子が報告されているが，深部静脈血栓症（DVT）については検討が不十分である．本研... 要旨: 【背景および目的】脳梗塞を発症した担癌患者の生存率に影響する因子として, 複数の因子が報告されているが, 深部静脈血栓症(DVT)については検討が不十分である. 本研... |
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| SubjectTerms | cancer D-dimer deep venous thrombosis ischemic stroke |
| Title | 活動性担癌患者における脳梗塞発症後の死亡関連因子に関する検討 |
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| ispartofPNX | 脳卒中, 2022, Vol.44(3), pp.252-258 |
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