Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511, Japan.
Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kanagawa, Japan.
J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105365. doi: 10.1016/j.jstrokecerebrovasdis.2020.105365. Epub 2020 Oct 16.
While the intravenous recombinant tissue plasminogen activator (rt-PA) therapy for acute ischemic stroke patients with cancer is recommended when survival of ≥ 6 months is expected, the risk factors for death and stroke recurrence within 6 months after stroke are not well known. Thus, we aimed to identify markers for death and recurrence risks within six months from stroke onset in patients with cancer.
In a retrospective cohort study, the subjects comprised acute ischemic stroke patients with cancer hospitalized at St. Marianna University hospital from 2008 through 2019. To evaluate the associations between the clinical factors within 24 h of the initial stroke and death or stroke recurrence events within 6 months from stroke onset, Logistic analysis and Cox proportional hazards regression analysis was used respectively. Next, the optimal cutoff point of markers for different mortality groups was determined using the receiver operating characteristic curve analysis and cumulative outcome rate of each group was compared using the Kaplan-Meier method.
Among 194 patients with cancer who developed acute stroke, 167 were ultimately selected for analysis. 47 subjects (28.14%) passed away within 6 months following stroke onset, and 20 subjects (11.98%) had stroke recurrence. High D-dimer levels, low fibrinogen levels, high Glasgow prognostic scores (GPS), and multiple vascular territory infarctions was independently associated with death, where higher death rate was significantly confirmed in the group with D-dimer levels of ≥3.95 mg/dl, fibrinogen levels <277.5 mg/dl and GPS scores of 2. Low fibrinogen level, lack of antithrombotic therapy, and the presence of metastasis were associated with stroke recurrence.
When patients with cancer suffer stroke, D-dimer levels, fibrinogen levels, GPS, and multiple vascular territory infarctions would be associated with the risk of death within 6 months. Low fibrinogen levels, lack of antithrombotic therapy, and the presence of metastasis correlated with high risk of stroke recurrence.
对于预计生存时间≥6 个月的急性缺血性脑卒中合并癌症患者，推荐静脉重组组织型纤溶酶原激活剂（rt-PA）治疗。然而，脑卒中后 6 个月内死亡和卒中复发的风险因素尚不清楚。因此，我们旨在确定癌症患者脑卒中发病后 6 个月内死亡和复发风险的标志物。
在一项回顾性队列研究中，研究对象为 2008 年至 2019 年在圣玛丽安娜大学医院住院的急性缺血性脑卒中合并癌症患者。为了评估初始脑卒中后 24 小时内的临床因素与脑卒中发病后 6 个月内的死亡或卒中复发事件之间的关系，分别进行了 Logistic 分析和 Cox 比例风险回归分析。接下来，使用受试者工作特征曲线分析确定不同死亡率组标志物的最佳截断点，并使用 Kaplan-Meier 方法比较每组的累积结局率。
在 194 例患有癌症的急性脑卒中患者中，最终有 167 例被纳入分析。47 例（28.14%）患者在脑卒中发病后 6 个月内死亡，20 例（11.98%）患者发生卒中复发。高 D-二聚体水平、低纤维蛋白原水平、高格拉斯哥预后评分（GPS）和多血管区域梗死与死亡独立相关，D-二聚体水平≥3.95mg/dl、纤维蛋白原水平<277.5mg/dl 和 GPS 评分 2 的患者死亡率显著升高。低纤维蛋白原水平、缺乏抗血栓治疗以及存在转移与卒中复发相关。
癌症患者发生脑卒中时，D-二聚体水平、纤维蛋白原水平、GPS 和多血管区域梗死与 6 个月内死亡风险相关。低纤维蛋白原水平、缺乏抗血栓治疗和存在转移与卒中复发风险增加相关。
