Nezu Tomohisa, Hosomi Naohisa, Naito Hiroyuki, Aoki Shiro, Torii Tsuyoshi, Kurashige Takashi, Sugiura Tomohito, Kuzume Daisuke, Morimoto Yuko, Yoshida Takeshi, Yagita Yoshiki, Oyama Naoki, Shiga Yuji, Kinoshita Naoto, Kamimura Teppei, Ueno Hiroki, Ohshita Tomohiko, Maruyama Hirofumi
Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Neurology, Chikamori Hospital, Kochi, Japan.
Intern Emerg Med. 2022 Apr;17(3):735-741. doi: 10.1007/s11739-021-02862-1. Epub 2021 Oct 1.
Cancer-associated ischemic stroke (CAS) refers to a hypercoagulation disorder related to malignant tumors, especially adenocarcinoma. Carbohydrate antigen (CA) 125 is a mucinous serum marker that might reflect hypercoagulation status, but the association between CA 125 and CAS is unclear across various types of cancer. The aim of this study was to investigate the associations among tumor markers, coagulation markers, and clinical factors in acute ischemic stroke (AIS) patients with active cancer. Consecutive AIS patients with active cancer (a diagnosis or ongoing active therapy for cancer within 6 months) were prospectively enrolled at four hospitals. D-dimer, C-reactive protein (CRP), carcinoembryonic antigen (CEA), CA19-9, and CA 125 levels were measured. Of 120 AIS patients with active cancer, 47 were diagnosed with CAS. CA 125 had the strongest correlations with D-dimer and CRP (ρ = 0.543, p < 0.001 and ρ = 0.452, p < 0.001, respectively). The areas under the receiver-operating characteristic curves for the diagnosis of CAS were 0.812 (95% CI 0.718-0.878) for CA 125, 0.714 (95% CI 0.602-0.801) for CEA, and 0.663 (95% CI 0.552-0.759) for CA 19-9. Multivariable analysis revealed that CA 125 levels in the highest quartile (OR 2.91, 95% CI 1.68-5.53), multiple lesions in multiple vascular territories observed on diffusion-weighted imaging, the absence of dyslipidemia, and the absence of atrial fibrillation were independently associated with CAS. Increased CA 125 levels, which indicate hypercoagulability, were useful for diagnosing CAS in AIS patients with active cancer.
癌症相关缺血性卒中（CAS）是指一种与恶性肿瘤尤其是腺癌相关的高凝状态紊乱疾病。糖类抗原（CA）125是一种黏液性血清标志物，可能反映高凝状态，但CA 125与CAS在各类癌症中的关联尚不清楚。本研究旨在探讨活动性癌症急性缺血性卒中（AIS）患者肿瘤标志物、凝血标志物与临床因素之间的关联。在四家医院前瞻性纳入了连续性的活动性癌症AIS患者（6个月内有癌症诊断或正在进行积极治疗）。检测了D-二聚体、C反应蛋白（CRP）、癌胚抗原（CEA）、CA19-9和CA 125水平。在120例活动性癌症AIS患者中，47例被诊断为CAS。CA 125与D-二聚体和CRP的相关性最强（分别为ρ = 0.543，p < 0.001和ρ = 0.452，p < 0.001）。CA 125诊断CAS的受试者工作特征曲线下面积为0.812（95%CI 0.718 - 0.878），CEA为0.714（95%CI 0.602 - 0.801），CA 19-9为0.663（95%CI 0.552 - 0.759）。多变量分析显示，最高四分位数的CA 125水平（OR 2.91，95%CI 1.68 - 5.53）、弥散加权成像上观察到多个血管区域有多处病变、无血脂异常以及无房颤与CAS独立相关。提示高凝状态的CA 125水平升高，有助于诊断活动性癌症的AIS患者中的CAS。
