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Abstract
Background and Objectives Patients with a new diagnosis of cancer carry an increased risk of acute ischemic stroke (AIS), and this risk varies depending on age, cancer type, stage, and time from diagnosis. Whether patients with AIS with a new diagnosis of neoplasm represent a distinct subset from those with a previously known active malignancy remains unclear. We aimed to estimate the rate of stroke in patients with newly diagnosed cancer (NC) and previously known active cancer (KC) and to compare the demographic and clinical features, stroke mechanisms, and long-term outcomes between groups.
Methods Using 2003–2021 data from the Acute STroke Registry and Analysis of Lausanne registry, we compared patients with KC with patients with NC (cancer identified during AIS hospitalization or within the following 12 months). Patients with inactive and no history of cancer were excluded. Outcomes were the modified Rankin scale (mRS) score at 3 months and mortality and recurrent stroke at 12 months. We used multivariable regression analyses to compare outcomes between groups while adjusting for important prognostic variables.
Results Among 6,686 patients with AIS, 362 (5.4%) had active cancer (AC), including 102 (1.5%) with NC. Gastrointestinal and genitourinary cancers were the most frequent cancer types. Among all patients with AC, 152 (42.5%) AISs were classified as cancer related, with nearly half of these cases attributed to hypercoagulability. In multivariable analysis, patients with NC had less prestroke disability (adjusted odds ratio [aOR] 0.62, 95% CI 0.44–0.86) and fewer prior stroke/transient ischemic attack events (aOR 0.43, 95% CI 0.21–0.88) than patients with KC. Three-month mRS scores were similar between cancer groups (aOR 1.27, 95% CI 0.65–2.49) and were predominantly driven by the presence of newly diagnosed brain metastases (aOR 7.22, 95% CI 1.49–43.17) and metastatic cancer (aOR 2.19, 95% CI 1.22–3.97). At 12 months, mortality risk was higher in patients with NC vs patients with KC (hazard ratio [HR] 2.11, 95% CI 1.38–3.21), while recurrent stroke risk was similar between groups (adjusted HR 1.27, 95% CI 0.67–2.43).
Discussion In a comprehensive institutional registry spanning nearly 2 decades, 5.4% of patients with AIS had AC, a quarter of which were diagnosed during or within 12 months after the index stroke hospitalization. Patients with NC had less disability and prior cerebrovascular disease, but a higher 1-year risk of subsequent death than patients with KC.
Glossary
- AC=
- active cancer;
- aHR=
- adjusted hazard ratio;
- AIS=
- acute ischemic stroke;
- aOR=
- adjusted odds ratio;
- ASTRAL=
- Acute STroke Registry and Analysis of Lausanne;
- ESUS=
- embolic stroke of undetermined source;
- EVT=
- endovascular thrombectomy;
- HRA=
- Human Rights Act;
- HRO=
- Human Research Ordinance;
- IQR=
- interquartile range;
- IVT=
- IV thrombolysis;
- KC=
- known active cancer;
- MDS=
- myelodysplastic syndrome;
- mRS=
- modified Rankin scale;
- NC=
- newly diagnosed cancer;
- NIHSS=
- NIH Stroke Scale;
- PFO=
- patent foramen ovale;
- TOAST=
- Trial of Org 10172 in Acute Stroke Treatment
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Editor-in-Chief José Merino, MD, MPhil, FAAN.
- Received November 8, 2022.
- Accepted in final form March 9, 2023.
- © 2023 American Academy of Neurology
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