Peng Chi, Yang Fan, Peng Liwei, Zhang Chenxu, Lin Zhen, Chen Chenxin, Gao Huachen, He Jia, Jin Zhichao
Department of Health Statistics, Naval Medical University, Shanghai, China.
Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University) and Key Laboratory of Tumor Immunopathology, Ministry of Education of China, Chongqing, China.
Eur J Neurol. 2023 Apr;30(4):951-962. doi: 10.1111/ene.15699. Epub 2023 Feb 14.
The aim was to evaluate the temporal trends, characteristics and in-hospital outcomes of patients hospitalized with acute ischaemic stroke (AIS) between those with and without current or historical malignancies.
Adult hospitalizations with a primary diagnosis of AIS were identified from the National Inpatient Sample database 2007-2017. Logistic regression was used to compare the differences in the utilization of AIS interventions and in-hospital outcomes. For further analysis, subgroup analyses were performed stratified by cancer subtypes.
There were 892,862 hospitalizations due to AIS, of which 108,357 (12.14%) had a concurrent diagnosis of current cancer (3.41%) or historical cancer (8.72%). After adjustment for confounders, patients with current malignancy were more likely to have worse clinical outcomes. The presence of historical cancers was not associated with an increase in poor clinical outcomes. Additionally, AIS patients with current malignancy were less likely to receive intravenous thrombolysis (adjusted odds ratio 0.66, 95% confidence interval 0.63-0.71). Amongst the subgroups of AIS patients treated with intravenous thrombolysis or mechanical thrombectomy, outcomes varied by cancer types. Notably, despite these acute stroke interventions, outcome remains poor in AIS patients with lung cancer.
Although AIS patients with malignancy generally have worse in-hospital outcomes versus those without, there were considerable variations in these outcomes according to different cancer types and the use of AIS interventions. Finally, treatment of these AIS patients with a current or historical cancer diagnosis should be individualized.
旨在评估患有急性缺血性卒中（AIS）的住院患者中，有或无当前或既往恶性肿瘤患者的时间趋势、特征及院内结局。
从2007 - 2017年国家住院患者样本数据库中识别出以AIS为主要诊断的成人住院病例。采用逻辑回归比较AIS干预措施使用情况及院内结局的差异。为进一步分析，按癌症亚型进行亚组分析。
因AIS住院的病例有892,862例，其中108,357例（12.14%）同时诊断有当前癌症（3.41%）或既往癌症（8.72%）。在对混杂因素进行调整后，患有当前恶性肿瘤的患者更有可能出现较差的临床结局。既往有癌症与不良临床结局增加无关。此外，患有当前恶性肿瘤的AIS患者接受静脉溶栓治疗的可能性较小（调整后的优势比为0.66，95%置信区间为0.63 - 0.71）。在接受静脉溶栓或机械取栓治疗的AIS患者亚组中，结局因癌症类型而异。值得注意的是，尽管采取了这些急性卒中干预措施，但肺癌合并AIS患者的结局仍然较差。
尽管与无恶性肿瘤的AIS患者相比，有恶性肿瘤的AIS患者通常院内结局较差，但根据不同癌症类型和AIS干预措施的使用情况，这些结局存在相当大的差异。最后，对这些有当前或既往癌症诊断的AIS患者的治疗应个体化。
