Internal Medicine, Ospedale S.Antonio Abate, ASST Valle Olona, Gallarate, Italy.
Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy.
Thromb Res. 2018 May;165:33-37. doi: 10.1016/j.thromres.2018.03.011. Epub 2018 Mar 15.
The association between stroke and cancer is well-known but insufficiently investigated. Aim of this multicentre retrospective cohort study was to estimate the prevalence of cancer-associated ischemic stroke, describe clinical outcomes in patients with cancer-associated ischemic stroke and investigate independent factors associated with active cancer.
Consecutive adult patients admitted for acute ischemic stroke were included. Included patients were admitted in the Stroke Unit of the Hospital of Perugia, Italy, from March 2005 to March 2015, and in a medical unit of the Hospital of Varese, Italy, from January 2010 till December 2011. Clinical and laboratory data of patients with and without active cancer were collected. Multivariate logistic regression analysis was performed to identify independent factors associated with active cancer.
A total of 2209 patients admitted with acute ischemic stroke were included with a median hospital stay of 9 days (interquartile range 5.75-14). Mean age was 72.7 years (standard deviation +/- 13); 55% patients were male and 4.4% had active cancer. Factors significantly associated with the presence of active cancer were age > 65 years (odds ratio [OR] 3.34; 95% confidence interval [CI] 1.64-6.81), occurrence of venous thromboembolism [VTE] (OR 2.84; 95% CI 1.12-7.19), low-density lipoprotein (LDL) cholesterol level < 70 mg/dL (OR 1.92; 95% CI 1.06-3.47), cryptogenic stroke subtype (OR 1.93; 95% CI 1.22-3.04). Overall mortality rate during hospital stay was greater in patients with active cancer (21.5% vs. 10% P < 0.05).
Older age, occurrence of VTE, low LDL level, and cryptogenic stroke subtype, are independently associated with active cancer. Overall, our findings suggest a possible prevalent role of hypercoagulability in the pathogenesis of cancer-associated ischemic stroke.
卒中与癌症之间的关联广为人知，但研究尚不充分。本多中心回顾性队列研究旨在评估癌症相关缺血性卒中的患病率，描述癌症相关缺血性卒中患者的临床结局，并探讨与活动性癌症相关的独立因素。
连续纳入因急性缺血性卒中住院的成年患者。纳入的患者于 2005 年 3 月至 2015 年 3 月在意大利佩鲁贾医院卒中病房，以及 2010 年 1 月至 2011 年 12 月在意大利瓦雷泽医院内科病房接受治疗。收集有和无活动性癌症患者的临床和实验室数据。采用多变量逻辑回归分析确定与活动性癌症相关的独立因素。
共纳入 2209 例因急性缺血性卒中住院的患者，中位住院时间为 9 天（四分位间距 5.75-14）。平均年龄为 72.7 岁（标准差+/-13）；55%的患者为男性，4.4%有活动性癌症。与存在活动性癌症显著相关的因素为年龄＞65 岁（比值比 [OR] 3.34；95%置信区间 [CI] 1.64-6.81）、发生静脉血栓栓塞症 [VTE]（OR 2.84；95% CI 1.12-7.19）、低密度脂蛋白（LDL）胆固醇水平＜70mg/dL（OR 1.92；95% CI 1.06-3.47）、隐源性卒中亚型（OR 1.93；95% CI 1.22-3.04）。住院期间的总死亡率在有活动性癌症的患者中更高（21.5% vs. 10%，P＜0.05）。
年龄较大、发生 VTE、LDL 水平较低和隐源性卒中亚型与活动性癌症独立相关。总的来说，我们的研究结果提示高凝状态可能在癌症相关缺血性卒中的发病机制中起重要作用。
