Department of Neurosciences, 5622University of Montreal, Montreal, Canada.
Centre hospitalier de l'Université de Montréal, Montreal, Canada.
Int J Stroke. 2021 Jan;16(1):12-19. doi: 10.1177/1747493020971104. Epub 2020 Nov 16.
The optimal approach for cancer screening after an ischemic stroke remains unclear.
We sought to summarize the existing evidence regarding the frequency and predictors of cancer after an ischemic stroke.
We searched seven databases from January 1980 to September 2019 for articles reporting malignant tumors and myeloproliferative neoplasms diagnosed after an ischemic stroke (PROSPERO protocol: CRD42019132455). We screened 15,400 records and included 51 articles. The pooled cumulative incidence of cancer within one year after an ischemic stroke was 13.6 per thousand (95% confidence interval [CI], 5.6-24.8), higher in studies focusing on cryptogenic stroke (62.0 per thousand; 95% CI, 13.6-139.3 vs 9.6 per thousand; 95% CI, 4.0-17.3; p = 0.02) and those reporting cancer screening (39.2 per thousand; 95% CI, 16.4-70.6 vs 7.2 per thousand; 95% CI, 2.5-14.1; p = 0.003). Incidence of cancer after stroke was generally higher compared to people without stroke. Most cases were diagnosed within the first few months after stroke. Several predictors of cancer were identified, namely older age, smoking, and involvement of multiple vascular territories as well as elevated C-reactive protein and d-dimers.
The frequency of incident cancer after an ischemic stroke is low, but higher in cryptogenic stroke and after cancer screening. Several predictors may increase the yield of cancer screening after an ischemic stroke. The pooled incidence of post-stroke cancer is likely underestimated, and larger studies with systematic assessment of cancer after stroke are needed to produce more precise and valid estimates.
缺血性卒中后癌症筛查的最佳方法仍不清楚。
我们旨在总结现有关于缺血性卒中后癌症发生的频率和预测因素的证据。
我们从 1980 年 1 月至 2019 年 9 月在七个数据库中检索了报道缺血性卒中后诊断的恶性肿瘤和骨髓增生性肿瘤的文章（PROSPERO 方案：CRD42019132455）。我们筛选了 15400 条记录，纳入了 51 篇文章。缺血性卒中后一年内癌症的累积发生率为每千人 13.6（95%置信区间 [CI]，5.6-24.8），在关注隐源性卒中的研究中更高（62.0/千；95%CI，13.6-139.3 与 9.6/千；95%CI，4.0-17.3；p=0.02）和报告癌症筛查的研究中更高（39.2/千；95%CI，16.4-70.6 与 7.2/千；95%CI，2.5-14.1；p=0.003）。与无卒中的人相比，卒中后癌症的发生率通常更高。大多数病例在卒中后几个月内确诊。确定了几种癌症的预测因素，即年龄较大、吸烟、多个血管区域受累以及 C 反应蛋白和 D-二聚体升高。
缺血性卒中后癌症的发生率较低，但在隐源性卒中后和癌症筛查后较高。几种预测因素可能会增加缺血性卒中后癌症筛查的检出率。卒中后癌症的累积发病率可能被低估，需要更大规模的研究对卒中后癌症进行系统评估，以得出更准确和有效的估计。
