Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea.
Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea; Medical Science Research Center, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea.
J Stroke Cerebrovasc Dis. 2021 Jun;30(6):105742. doi: 10.1016/j.jstrokecerebrovasdis.2021.105742. Epub 2021 Mar 26.
While the prevalence of active cancer patients experiencing acute stroke is increasing, the effects of active cancer on reperfusion therapy outcomes are inconclusive. Thus, we aimed to compare the safety and outcomes of reperfusion therapy in acute stroke patients with and without active cancer.
A comprehensive literature search was conducted for studies comparing the effects of intravenous thrombolysis (IVT) or endovascular treatment (EVT) in ischemic stroke patients with and without active cancer. The literature was screened using both a manual and machine learning algorithm approach. The outcomes evaluated were symptomatic intracerebral hemorrhage (sICH), all-type intracerebral hemorrhage (aICH), successful recanalization, favorable outcomes (modified Rankin Scale, 0-2), and mortality. We calculated the pooled odds ratio (OR) and 95% confidence interval (CI) using the random-effects model from the included studies.
Seven studies were analyzed in this meta-analysis. IVT (n = 1012) was associated with an increased risk of sICH (OR, 9.80; 95% CI, 3.19-30.13) in the active cancer group. However, no significant differences in aICH, favorable outcomes, and mortality were found between groups. Although sICH and successful recanalization in the EVT group (n = 2496) were similar, we observed fewer favorable outcomes (OR, 0.55; 95% CI, 0.33-0.93) and a high prevalence of mortality (OR, 2.91; 95% CI, 1.89-4.47) in the active cancer group.
Reperfusion therapy may benefit selected patients with acute ischemic stroke with active cancer, considering the comparable clinical outcomes of IVT and procedure-related outcomes of EVT. These results should be cautiously interpreted and confirmed in future well-designed large-scale studies.
尽管患有活动性癌症的急性脑卒中患者的发病率正在增加，但活动性癌症对再灌注治疗结果的影响尚无定论。因此，我们旨在比较伴有和不伴有活动性癌症的急性脑卒中患者再灌注治疗的安全性和结局。
我们对比较伴有和不伴有活动性癌症的缺血性脑卒中患者静脉溶栓（IVT）或血管内治疗（EVT）效果的研究进行了全面的文献检索。我们使用手动和机器学习算法对文献进行了筛选。评估的结局包括症状性颅内出血（sICH）、全类型颅内出血（aICH）、再通成功、良好结局（改良Rankin 量表，0-2 分）和死亡率。我们使用纳入研究的随机效应模型计算了汇总优势比（OR）和 95%置信区间（CI）。
这项荟萃分析纳入了 7 项研究。IVT（n=1012）组中，活动性癌症与 sICH 风险增加相关（OR，9.80；95%CI，3.19-30.13）。然而，两组间 aICH、良好结局和死亡率无显著差异。尽管 EVT 组（n=2496）的 sICH 和再通成功率相似，但我们观察到良好结局（OR，0.55；95%CI，0.33-0.93）较少，死亡率较高（OR，2.91；95%CI，1.89-4.47）。
考虑到 IVT 的临床结局相似和 EVT 的操作相关结局更优，再灌注治疗可能对伴有急性缺血性脑卒中的特定活动性癌症患者有益。这些结果应在未来设计良好的大规模研究中谨慎解读和证实。
