Lun Ronda, Roy Danielle Carole, Hao Yu, Deka Rishi, Huang Wen-Kuan, Navi Babak B, Siegal Deborah M, Ramsay Tim, Fergusson Dean, Shorr Risa, Dowlatshahi Dar
Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
School of Epidemiology, University of Ottawa, Ottawa, ON, Canada.
Front Neurol. 2022 Sep 20;13:966190. doi: 10.3389/fneur.2022.966190. eCollection 2022.
Patients newly diagnosed with cancer represent a population at highest risk for stroke. The objective of this systematic review and meta-analysis was to estimate the incidence of stroke in the first year following a new diagnosis of cancer.
We searched MEDLINE and EMBASE from January 1980 to June 2021 for observational studies that enrolled adults with a new diagnosis of all cancers excluding non-melanoma skin cancer, and that reported the incidence of stroke at 1 year. PRISMA guidelines for meta-analyses were followed. Two reviewers independently extracted data and appraised risk of bias. We used the Dersimonian and Laird random effects method to pool cumulative incidences after logit transformation, and reported pooled proportions as percentages. Statistical heterogeneity was assessed using the statistic.
A total of 12,083 studies were screened; 41 studies were included for analysis. Data from 2,552,121 subjects with cancer were analyzed. The cumulative incidence of total stroke at 1 year was 1.4% (95% CI 0.9-2.2%), while the pooled incidence of ischemic stroke was 1.3% (95% CI 1.0-1.8%) and 0.3% (95% CI 0.1-0.9%) for spontaneous intracerebral hemorrhage (ICH), with consistently high statistical heterogeneity (>99% ).
The estimated incidence of stroke during the first year after a new diagnosis of cancer is 1.4%, with a higher risk for ischemic stroke than ICH. Cancer patients should be educated on the risk of stroke at the time of diagnosis. Future studies should evaluate optimal primary prevention strategies in this high-risk group of patients.
新诊断为癌症的患者是中风风险最高的人群。本系统评价和荟萃分析的目的是估计癌症新诊断后第一年中风的发生率。
我们检索了1980年1月至2021年6月期间的MEDLINE和EMBASE数据库，以查找纳入新诊断为所有癌症（不包括非黑色素瘤皮肤癌）的成年人的观察性研究，并报告1年时中风的发生率。遵循PRISMA荟萃分析指南。两名审阅者独立提取数据并评估偏倚风险。我们使用Dersimonian和Laird随机效应方法在对数优势比转换后汇总累积发生率，并将汇总比例报告为百分比。使用I²统计量评估统计异质性。
共筛选了12083项研究；纳入41项研究进行分析。分析了来自2552121名癌症患者的数据。1年时总中风的累积发生率为1.4%（95%CI 0.9-2.2%），而缺血性中风的汇总发生率为1.3%（95%CI 1.0-1.8%），自发性脑出血（ICH）的发生率为0.3%（95%CI 0.1-0.9%），统计异质性始终很高（>99%）。
癌症新诊断后第一年中风的估计发生率为1.4%，缺血性中风的风险高于脑出血。应在诊断时对癌症患者进行中风风险教育。未来的研究应评估这一高危患者群体的最佳一级预防策略。
