Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
CTU Bern, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
J Stroke Cerebrovasc Dis. 2024 Oct;33(10):107899. doi: 10.1016/j.jstrokecerebrovasdis.2024.107899. Epub 2024 Aug 4.
Early diagnosis of previously unknown cancer (i.e., occult cancer) after an acute ischemic stroke (AIS) could result in faster initiation of cancer therapy and potentially improve clinical outcomes. Our study aimed to compare mortality rates between AIS patients with occult cancer diagnosed during the index stroke hospitalization versus those diagnosed after hospital discharge.
Among consecutive AIS patients treated at our stroke center from 2015 through 2020, we identified new cancer diagnoses made within the year after the AIS. We used multivariable Cox regression analyses to evaluate the association between the timing of occult cancer diagnosis (during the AIS hospitalization versus after discharge) and long-term survival.
Of 3894 AIS patients with available long-term follow-up data, 59 (1.5 %) were diagnosed with a new cancer within one year after index stroke. Of these, 27 (46 %) were diagnosed during the index hospitalization and 32 (54 %) were diagnosed after discharge. During a median follow-up of 406 days (interquartile range, 89-1073), 70 % (n = 19) of patients whose cancer was diagnosed during hospitalization had died, compared to 63 % (n = 20) of patients whose cancer was diagnosed after discharge (p= 0.58). In our main multivariable model, there was no difference in long-term mortality between patient groups (adjusted hazard ratio, 1.16; 95 % confidence interval, 0.53-2.52; p= 0.71).
In this analysis, timing of a new cancer diagnosis after AIS did not seem to influence patients' long-term survival. Given the fairly small number of included patients with previously occult cancer, larger multicenter studies are needed to confirm our results.
急性缺血性脑卒中（AIS）后对先前未知的癌症（即隐匿性癌症）进行早期诊断可能会导致更快地开始癌症治疗，并有可能改善临床结局。我们的研究旨在比较在指数性脑卒中住院期间诊断出隐匿性癌症的 AIS 患者与出院后诊断出隐匿性癌症的患者之间的死亡率。
在我们的卒中中心于 2015 年至 2020 年期间连续治疗的 AIS 患者中，我们确定了在 AIS 后一年内新诊断出的癌症。我们使用多变量 Cox 回归分析来评估隐匿性癌症诊断时机（在 AIS 住院期间与出院后）与长期生存之间的关系。
在有长期随访数据的 3894 例 AIS 患者中，有 59 例（1.5%）在指数性脑卒中后一年内被诊断出新发癌症。其中，27 例（46%）在指数性住院期间诊断，32 例（54%）在出院后诊断。在中位数为 406 天（四分位距 89-1073）的随访期间，在住院期间诊断出癌症的患者中，有 70%（n=19）死亡，而在出院后诊断出癌症的患者中，有 63%（n=20）死亡（p=0.58）。在我们的主要多变量模型中，两组患者的长期死亡率无差异（调整后的危险比，1.16；95%置信区间，0.53-2.52；p=0.71）。
在这项分析中，AIS 后新发癌症的诊断时间似乎并未影响患者的长期生存。鉴于隐匿性癌症患者的数量较少，需要更大规模的多中心研究来证实我们的结果。
