癌症与肿瘤相关的儿童卒中：国际儿童卒中研究结果

Cancer and Tumor-Associated Childhood Stroke: Results From the International Pediatric Stroke Study.

作者信息

Sun Lisa R, Linds Alexandra, Sharma Mukta, Rafay Mubeen, Vadivelu Sudhakar, Lee Sarah, Brandão Leonardo R, Appavu Brian, Estepp Jeremie H, Hukin Juliette, Hassanein Sahar M A, Chan Anthony, Beslow Lauren A

机构信息

Division of Pediatric Neurology, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Cerebrovascular Neurology, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland.

Division of Neurology, Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada.

出版信息

Pediatr Neurol. 2020 Oct;111:59-65. doi: 10.1016/j.pediatrneurol.2020.06.002. Epub 2020 Jun 10.

DOI:10.1016/j.pediatrneurol.2020.06.002

PMID:32951663

Abstract

BACKGROUND

The prevalence of cancer among children with stroke is unknown. This study sought to evaluate cancer- and tumor-associated childhood ischemic stroke in a multinational pediatric stroke registry.

METHODS

Children aged 29 days to less than 19 years with arterial ischemic stroke or cerebral sinovenous thrombosis enrolled in the International Pediatric Stroke Study between January 2003 and June 2019 were included. Data including stroke treatment and recurrence were compared between subjects with and without cancer using Wilcoxon rank sum and chi-square tests.

RESULTS

Cancer or tumor was present in 99 of 2968 children (3.3%) with arterial ischemic stroke and 64 of 596 children (10.7%) with cerebral sinovenous thrombosis. Among children in whom cancer type was identified, 42 of 88 arterial ischemic stroke cases (48%) had brain tumors and 35 (40%) had hematologic malignancies; 45 of 58 cerebral sinovenous thrombosis cases (78%) had hematologic malignancies and eight (14%) had brain tumors. Of 54 cancer-associated arterial ischemic stroke cases with a known cause, 34 (63%) were due to arteriopathy and nine (17%) were due to cardioembolism. Of 46 cancer-associated cerebral sinovenous thrombosis cases with a known cause, 41 (89%) were related to chemotherapy-induced or other prothrombotic states. Children with cancer were less likely than children without cancer to receive antithrombotic therapy for arterial ischemic stroke (58% vs 80%, P = 0.007) and anticoagulation for cerebral sinovenous thrombosis (71% vs 87%, P = 0.046). Recurrent arterial ischemic stroke (5% vs 2%, P = 0.04) and cerebral sinovenous thrombosis (5% vs 1%, P = 0.006) were more common among children with cancer.

CONCLUSIONS

Cancer is an important risk factor for incident and recurrent childhood stroke. Stroke prevention strategies for children with cancer are needed.

摘要

背景

中风儿童中癌症的患病率尚不清楚。本研究旨在通过一个跨国儿科中风登记系统评估与癌症和肿瘤相关的儿童缺血性中风。

方法

纳入2003年1月至2019年6月期间参加国际儿科中风研究的年龄在29天至19岁以下、患有动脉缺血性中风或脑静脉窦血栓形成的儿童。使用Wilcoxon秩和检验和卡方检验比较有癌症和无癌症受试者之间包括中风治疗和复发情况的数据。

结果

在2968例动脉缺血性中风儿童中有99例（3.3%）患有癌症或肿瘤，在596例脑静脉窦血栓形成儿童中有64例（10.7%）患有癌症或肿瘤。在已确定癌症类型的儿童中，88例动脉缺血性中风病例中有42例（48%）患有脑肿瘤，35例（40%）患有血液系统恶性肿瘤；58例脑静脉窦血栓形成病例中有45例（78%）患有血液系统恶性肿瘤，8例（14%）患有脑肿瘤。在54例已知病因的与癌症相关的动脉缺血性中风病例中，34例（63%）是由于动脉病变，9例（17%）是由于心源性栓塞。在46例已知病因的与癌症相关的脑静脉窦血栓形成病例中，41例（89%）与化疗诱导或其他血栓前状态有关。与无癌症的儿童相比，患有癌症的儿童接受动脉缺血性中风抗栓治疗的可能性较小（58%对80%，P = 0.007），接受脑静脉窦血栓形成抗凝治疗的可能性较小（71%对87%，P = 0.046）。复发性动脉缺血性中风（5%对2%，P = 0.04）和脑静脉窦血栓形成（5%对1%，P = 对0.006）在患有癌症的儿童中更为常见。