From the Department of Neurology, Keimyung University School of Medicine, Daegu, Korea (J.Y.).
Department of Neurology (J.Y., H.S.N., Y.D.K., J.H.H.), Yonsei University College of Medicine, Seoul, Korea.
Stroke. 2019 Feb;50(2):507-511. doi: 10.1161/STROKEAHA.118.023044.
Background and Purpose- Recent guidelines have suggested the potential benefit of intravenous thrombolysis in stroke patients with systemic malignancy who have a reasonable life expectancy of >6 months. However, it is difficult to determine which patients with cancer will have a life expectancy of >6 months. Therefore, we identified the factors associated with 6-month mortality in patients with acute ischemic stroke and systemic malignancy. Methods- Consecutive stroke patients with systemic malignancy were retrospectively analyzed. We classified the patients into 3 groups: the nonactive cancer, active nonmetastatic cancer, and metastatic cancer groups. We compared the baseline characteristics and 6-month survival rates. Results- Of the 468 ischemic stroke patients with systemic malignancy during an 8-year period, 223 patients had nonactive cancer, 105 patients had active nonmetastatic cancer, and 140 patients had metastasis. During the 6-month follow-up, 122 patients (26.1%) died (nonactive cancer group [7.2%, 16/223], active nonmetastatic cancer group [11.4%, 12/105], and metastatic cancer group [67.1%, 94/140]). Multivariate Cox regression analysis revealed that the presence of metastasis (hazard ratio, 4.527; 95% CI, 2.175-9.422) was independently associated with 6-month mortality. However, the active nonmetastatic cancer group exhibited similar 6-month mortality to the nonactive cancer group (hazard ratio, 0.711; 95% CI, 0.282-1.795). Gastric/esophageal cancer and pancreatic cancer were also independently associated with 6-month mortality (hazard ratio, 2.068 and 2.389, respectively). Conclusions- In stroke patients with active cancer, the presence of metastasis and the cancer type were crucial factors associated with 6-month mortality.
背景与目的- 最近的指南建议，对于预期寿命大于 6 个月的伴有系统性恶性肿瘤的卒中患者，静脉溶栓可能有益。然而，确定哪些癌症患者的预期寿命大于 6 个月是困难的。因此，我们确定了伴有急性缺血性卒中合并系统性恶性肿瘤患者 6 个月死亡率的相关因素。方法- 回顾性分析连续的伴有系统性恶性肿瘤的卒中患者。我们将患者分为 3 组：非活动性癌症组、活动性非转移性癌症组和转移性癌症组。比较了各组的基线特征和 6 个月生存率。结果- 在 8 年期间，468 例伴有系统性恶性肿瘤的缺血性卒中患者中，223 例为非活动性癌症，105 例为活动性非转移性癌症，140 例为转移性癌症。在 6 个月的随访期间，122 例患者（26.1%）死亡（非活动性癌症组[7.2%，16/223]、活动性非转移性癌症组[11.4%，12/105]和转移性癌症组[67.1%，94/140]）。多变量 Cox 回归分析显示，存在转移（风险比，4.527；95%置信区间，2.175-9.422）与 6 个月死亡率独立相关。然而，活动性非转移性癌症组的 6 个月死亡率与非活动性癌症组相似（风险比，0.711；95%置信区间，0.282-1.795）。胃癌/食管癌和胰腺癌也与 6 个月死亡率独立相关（风险比分别为 2.068 和 2.389）。结论- 在伴有活动性癌症的卒中患者中，转移的存在和癌症类型是与 6 个月死亡率相关的关键因素。
