Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
Eur J Neurol. 2018 Jan;25(1):128-134. doi: 10.1111/ene.13456. Epub 2017 Oct 16.
Patients with cancer have been reported to have poorer outcomes following intracerebral hemorrhage (ICH) than those without cancer, but the findings were not consistent between studies. The aim of this study was to test the hypothesis that cancer is associated with poor outcomes following ICH.
In all, 3137 consecutive patients admitted to the stroke unit of Osaka University Hospital were reviewed. Patients diagnosed with ICH were extracted and divided into two groups according to the presence of cancer. ICH characteristics were compared between the groups. The outcomes were measured using the 30-day and 90-day modified Rankin Scale (mRS).
Amongst the 399 ICH patients (37.1% women; median age 66 years), the frequency of cancer was 15.3%. Of these, 70.5% of patients had distant metastatic cancers. Compared to controls, cancer patients were comparable in the Glasgow Coma Scale, hematoma volume and the frequency of infratentorial location and intraventricular hemorrhage extension, but had poorer outcomes following ICH. Ordinal logistic regression analysis revealed that cancer was independently associated with poor outcomes following ICH (odds ratio 5.14; 95% confidence interval 2.63-10.06). Adjustment was made for the covariates age, sex, time from onset to admission, prior use of antithrombotic agents, pre-stroke mRS, Glasgow Coma Scale, hematoma volume, infratentorial location and intraventricular hemorrhage extension. When the analysis was performed using data from individuals with localized cancer, the effect remained significant after assessment with 90-day mRS but not after that with 30-day mRS.
The results suggest that cancer, especially distant metastatic cancer, is an independent predictor of poorer outcomes following ICH.
据报道，癌症患者发生脑出血（ICH）后的预后比非癌症患者差，但研究结果并不一致。本研究旨在验证癌症与 ICH 后不良预后相关的假设。
回顾性分析了大阪大学医院卒中单元收治的 3137 例连续患者。提取诊断为 ICH 的患者，并根据是否存在癌症将其分为两组。比较两组患者的 ICH 特征。采用 30 天和 90 天改良 Rankin 量表（mRS）评估预后。
399 例 ICH 患者中（女性占 37.1%；中位年龄 66 岁），癌症的发生率为 15.3%。其中，70.5%的患者为远处转移性癌症。与对照组相比，癌症患者的格拉斯哥昏迷量表评分、血肿体积以及幕下位置和脑室内出血扩展的发生率相当，但 ICH 后预后较差。有序逻辑回归分析显示，癌症是 ICH 后不良预后的独立预测因素（优势比 5.14；95%置信区间 2.63-10.06）。调整了年龄、性别、发病至入院时间、抗血栓药物使用史、卒中前 mRS、格拉斯哥昏迷量表评分、血肿体积、幕下位置和脑室内出血扩展等混杂因素。当使用局限性癌症患者的数据进行分析时，90 天 mRS 评估后仍有显著效果，但 30 天 mRS 评估后无显著效果。
研究结果表明，癌症，特别是远处转移性癌症，是 ICH 后不良预后的独立预测因素。
