Costamagna Gianluca, Navi Babak B, Beyeler Morin, Hottinger Andreas F, Alberio Lorenzo, Michel Patrik
Stroke Unit, Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York, New York.
Semin Thromb Hemost. 2024 Apr;50(3):342-359. doi: 10.1055/s-0043-1771270. Epub 2023 Jul 28.
Ischemic stroke is an important cause of morbidity and mortality in cancer patients. The underlying mechanisms linking cancer and stroke are not completely understood. Long-standing and more recent evidence suggests that cancer-associated prothrombotic states, along with treatment-related vascular toxicity, such as with chemotherapy and immunotherapy, contribute to an increased risk of ischemic stroke in cancer patients. Novel biomarkers, including coagulation, platelet and endothelial markers, cell-free DNA, and extracellular vesicles are being investigated for their potential to improve risk stratification and patient selection for clinical trials and to help guide personalized antithrombotic strategies. Treatment of cancer-related stroke poses unique challenges, including the need to balance the risk of recurrent stroke and other thromboembolic events with that of bleeding associated with antithrombotic therapy. In addition, how and when to restart cancer treatment after stroke remains unclear. In this review, we summarize current knowledge on the mechanisms underlying ischemic stroke in cancer, propose an etiological classification system unique to cancer-related stroke to help guide patient characterization, provide an overview of promising biomarkers and their clinical utility, and discuss the current state of evidence-based management strategies for cancer-related stroke. Ultimately, a personalized approach to stroke prevention and treatment is required in cancer patients, considering both the underlying cancer biology and the individual patient's risk profile.
缺血性中风是癌症患者发病和死亡的重要原因。癌症与中风之间的潜在机制尚未完全明确。长期以来以及最近的证据表明，癌症相关的血栓前状态，以及与化疗和免疫治疗等治疗相关的血管毒性，会增加癌症患者发生缺血性中风的风险。新型生物标志物，包括凝血、血小板和内皮标志物、游离DNA和细胞外囊泡，正在被研究，以评估其改善风险分层和临床试验患者选择的潜力，并帮助指导个性化抗血栓策略。癌症相关中风的治疗带来了独特的挑战，包括需要平衡复发性中风和其他血栓栓塞事件的风险与抗血栓治疗相关的出血风险。此外，中风后如何以及何时重新开始癌症治疗仍不明确。在这篇综述中，我们总结了目前关于癌症患者缺血性中风潜在机制的知识，提出了一种癌症相关中风特有的病因分类系统，以帮助指导患者特征描述，概述了有前景的生物标志物及其临床应用，并讨论了癌症相关中风循证管理策略的现状。最终，考虑到潜在的癌症生物学特性和个体患者的风险概况，癌症患者需要个性化的中风预防和治疗方法。
