Rousseau Julien, Wen Patrick Y
Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA, USA.
Curr Neurol Neurosci Rep. 2025 Jul 1;25(1):46. doi: 10.1007/s11910-025-01434-6.
This review explores the complex relationship between cancer and vascular disease. It aims to synthesize current evidence on the epidemiology, mechanisms, management, and outcomes of ischemic stroke, cerebral venous sinus thrombosis (CVST), venous thromboembolism (VTE) in brain tumor patients, and intracranial hemorrhage (ICH), while highlighting the cerebrovascular risks of systemic cancer therapies.
Recent studies reveal that cancer patients are at increased risk for ischemic stroke, often from cancer-specific mechanisms such as hypercoagulability, non-bacterial thrombotic endocarditis, and tumor embolism. VTE is increasingly recognized in patients with primary brain tumors. Emerging data support the safety of direct oral anticoagulants over low-molecular weight heparin in selected patients with brain tumors. Cancer treatments-including immune checkpoint inhibitors (ICIs), hormonal therapies, and radiation-contribute to cerebrovascular risk. Vascular complications are underrecognized yet significant contributors to morbidity and mortality in cancer patients. Multidisciplinary strategies, personalized risk stratification, and targeted research are critical to improving outcomes in this vulnerable population.
本综述探讨癌症与血管疾病之间的复杂关系。其旨在综合关于缺血性卒中、脑静脉窦血栓形成（CVST）、脑肿瘤患者的静脉血栓栓塞（VTE）以及颅内出血（ICH）的流行病学、机制、管理和结局的当前证据，同时强调全身性癌症治疗的脑血管风险。
近期研究表明，癌症患者发生缺血性卒中的风险增加，通常源于癌症特异性机制，如高凝状态、非细菌性血栓性心内膜炎和肿瘤栓塞。原发性脑肿瘤患者中VTE越来越受到关注。新数据支持在部分脑肿瘤患者中，直接口服抗凝剂比低分子量肝素更安全。包括免疫检查点抑制剂（ICIs）、激素疗法和放疗在内的癌症治疗会增加脑血管风险。血管并发症虽未得到充分认识，但却是癌症患者发病和死亡的重要因素。多学科策略、个性化风险分层和针对性研究对于改善这一脆弱人群的结局至关重要。
