Babore Alejandro Daniel, Tybjerg Anne Julie, Andersen Klaus Kaae, Olsen Tom Skyhoj
Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark.
Danish Cancer Society Research Center, Copenhagen, Denmark.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105023. doi: 10.1016/j.jstrokecerebrovasdis.2020.105023. Epub 2020 Jun 18.
Lung cancer and stroke share smoking as a major cause of disease. We investigated prevalence and risk of occult lung cancer with manifestation during the first year after stroke.
All patients >40 years of age with incident stroke in Denmark 2003-2015 were identified through the Danish Stroke Registry (n=85,893) and matched 1:10 on age and sex to the Danish background population without a history of stroke (n=858,740). Linking data to the Danish Cancer Registry we determined prevalence of occult primary lung cancer defined as the event of previously unknown lung cancer during a one-year follow-up in the stroke and the background population. Cox regression models with adjustments for demographics, co-morbidities and stroke risk factors were used to study risk compared to the background population.
Prevalence (per 1000 person-years) of occult lung cancer in the stroke cohort was 5.3; in the background cohort 2.6. Prevalence separately for current smokers (n=26,055) was 9.6; ex-smokers (n=20,035) 6.5; never-smokers (n=27,268) 1.4. Risk of occult lung cancer (adjusted) was increased HR 1.95 in the stroke population. In the stroke population adjusting for stroke risk factors age (HR 1.24 per 10 years) and smoking (HR 7.1 in current smokers; HR 1.6 in ex-smokers) were the only significant risk factors for occult lung cancer.
Occult lung cancer is rarely found in stroke patients who have never smoked. It is not uncommon in smokers in whom 1% of current smokers had occult lung cancer that became manifest within the first year after stroke.
肺癌和中风都将吸烟作为主要致病因素。我们调查了中风后第一年出现症状的隐匿性肺癌的患病率和风险。
通过丹麦中风登记处识别出2003年至2015年丹麦所有40岁以上的中风患者（n = 85,893），并按年龄和性别以1:10的比例与无中风病史的丹麦背景人群（n = 858,740）进行匹配。将数据与丹麦癌症登记处关联后，我们确定了隐匿性原发性肺癌的患病率，其定义为中风人群和背景人群在一年随访期间发生的先前未知的肺癌事件。使用对人口统计学、合并症和中风风险因素进行调整的Cox回归模型来研究与背景人群相比的风险。
中风队列中隐匿性肺癌的患病率（每1000人年）为5.3；背景队列中为2.6。当前吸烟者（n = 26,055）的患病率分别为9.6；既往吸烟者（n = 20,035）为6.5；从不吸烟者（n = 27,268）为1.4。中风人群中隐匿性肺癌的风险（调整后）增加，风险比（HR）为1.95。在中风人群中，调整中风风险因素后，年龄（每10岁HR为1.24）和吸烟（当前吸烟者HR为7.1；既往吸烟者HR为1.6）是隐匿性肺癌的仅有的显著风险因素。
从不吸烟的中风患者中很少发现隐匿性肺癌。在吸烟者中并不罕见，其中1%的当前吸烟者患有隐匿性肺癌，且在中风后的第一年内出现症状。
