From the Departments of Neurology (A.G., E.L., A.S.) and Pathology (S.C.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Neurology (M.S., M.R., J.D.), University of Pittsburgh Medical Center, PA.
Neurology. 2022 Jul 25;99(4):e393-e401. doi: 10.1212/WNL.0000000000200601.
The aim of this work was to evaluate the influence of solid organ malignancies on the in-hospital outcomes and recurrent strokes among patients hospitalized with acute ischemic stroke (AIS).
Adult hospitalizations with a primary diagnosis of AIS were identified from the Nationwide Readmissions Database from 2016 to 2018. Logistic regression was used to compare the differences in the use of acute stroke interventions and clinical outcomes in patients with and without malignancy. Survival analysis was used to evaluate the risk of readmission due to recurrent stroke after discharge.
There were 1,385,840 hospitalizations due to AIS (mean ± SD age 70.4 ± 14.0 years, female 50.2%). Of these, 50,553 (3.7%) had a concurrent diagnosis of solid organ malignancy. The 5 most common malignancies included lung cancer (24.6%), prostate cancer (13.2%), breast cancer (9.3%), pancreatic cancer (6.5%), and colorectal cancer (6.2%). After adjustment for baseline differences, patients with malignancy were more likely to have intraparenchymal hemorrhage (odds ratio [OR] 1.11, 95% CI 1.04-1.19), in-hospital mortality (OR 2.15, 95% CI 2.04-2.28), and discharge disposition other than to home (OR 1.70, 95% CI 1.64-1.75). Patients with malignancy were less likely to receive IV thrombolysis (tissue plasminogen activator [tPA]) and were more likely to undergo mechanical thrombectomy (MT). Among the subgroups of patients treated with tPA or MT, the outcomes were comparable between patients with and without malignancy, except patients with lung cancer remained at a higher risk of mortality and adverse disposition despite these acute stroke interventions. Patients with malignancy were at a higher risk of readmission due to recurrent AIS within 1 year of discharge (hazards ratio 1.18, 95% CI 1.11-1.25), and this risk was driven specifically by the lung and pancreatic cancers.
While patients with malignancy generally have worse in-hospital outcomes compared to those without, there is considerable variation in these outcomes according to the different cancer types and the use of acute stroke interventions. The use of tPA and MT is generally safe for eligible patients with an underlying malignancy. Patients with lung and pancreatic cancers have a higher early risk of recurrent stroke and might need more intensive surveillance and careful institution of the optimal secondary prevention measures.
本研究旨在评估实体器官恶性肿瘤对急性缺血性脑卒中（AIS）住院患者住院期间结局和复发性脑卒中的影响。
从 2016 年至 2018 年全国再入院数据库中确定了原发性 AIS 住院患者。采用 logistic 回归比较恶性肿瘤患者与无恶性肿瘤患者在急性脑卒中干预措施和临床结局方面的差异。采用生存分析评估出院后因复发性脑卒中而再入院的风险。
共 1385840 例 AIS 住院患者（平均年龄±标准差为 70.4±14.0 岁，女性占 50.2%），其中 50553 例（3.7%）合并实体器官恶性肿瘤诊断。最常见的 5 种恶性肿瘤包括肺癌（24.6%）、前列腺癌（13.2%）、乳腺癌（9.3%）、胰腺癌（6.5%）和结直肠癌（6.2%）。在校正基线差异后，恶性肿瘤患者更有可能发生脑实质内出血（比值比 [OR]1.11，95%CI1.04-1.19）、住院期间死亡率（OR2.15，95%CI2.04-2.28）和出院时非居家安置（OR1.70，95%CI1.64-1.75）。恶性肿瘤患者接受静脉溶栓（组织型纤溶酶原激活物 [tPA]）治疗的可能性较低，而接受机械血栓切除术（MT）的可能性较高。在接受 tPA 或 MT 治疗的亚组患者中，恶性肿瘤患者与无恶性肿瘤患者的结局相似，除了肺癌患者尽管接受了这些急性脑卒中干预措施，但死亡率和不良结局的风险仍然较高。恶性肿瘤患者在出院后 1 年内因复发性 AIS 再入院的风险较高（风险比 1.18，95%CI1.11-1.25），这种风险主要是由肺癌和胰腺癌引起的。
尽管与无恶性肿瘤患者相比，恶性肿瘤患者的住院期间结局通常较差，但根据不同的癌症类型和急性脑卒中干预措施，这些结局存在相当大的差异。对于有潜在恶性肿瘤的合格患者，tPA 和 MT 的使用通常是安全的。患有肺癌和胰腺癌的患者早期复发性脑卒中的风险较高，可能需要更密切的监测，并谨慎实施最佳二级预防措施。
