Predictors of survival in patients with ischemic stroke and active cancer: A prospective, multicenter, observational study
Authors: Gon Yasufumi , Sakaguchi Manabu , Yamagami Hiroshi , Abe Soichiro , Hashimoto Hiroyuki , Ohara Nobuyuki , Takahashi Daisuke , Abe Yuko , Takahashi Tsutomu , Kitano Takaya , Okazaki Shuhei , Todo Kenichi , Sasaki Tsutomu , Hattori Satoshi , Mochizuki Hideki 
Published: May 2023

Background

Patients with ischemic stroke and active cancer have a poor prognosis; however, supporting evidence remains limited.

Methods

We conducted a prospective, multicenter, observational study in Japan including patients with acute ischemic stroke and active cancer to investigate the prognostic factors. We followed up the patients for 1 year after stroke onset. The patients were divided into two groups according to cryptogenic stroke and known etiologies (small vessel occlusion, large artery atherosclerosis, cardioembolism, other determined etiology) and survival was compared. The hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were calculated using Cox regression models.

Results

We identified 135 eligible patients (39% women; median age, 75 years). Of these, 51% had distant metastasis. A total of 65 (48%) and 70 (52%) patients had cryptogenic stroke and known etiologies, respectively. Patients with cryptogenic stroke had significantly shorter survival than those with known etiologies (HR [95% CI], 3.11 [1.82–5.25]). The multivariate Cox regression analysis revealed that distant metastasis, plasma D-dimer levels, deep venous thrombosis and/or pulmonary embolism complications at stroke onset were independent predictors of mortality after adjusting for potential confounders. Cryptogenic stroke was associated with prognosis in univariate analysis but not significant in multivariate analysis. The plasma D-dimer levels stratified the prognosis of patients with ischemic stroke and active cancer.

Conclusions

The prognosis of patients with acute ischemic stroke and active cancer varies considerably depending on stroke mechanism, distant metastasis, and coagulation abnormalities. Coagulation abnormalities are crucial in determining the prognosis of such patients.

What Is New?

We conducted a prospective, multicenter, observational study in Japan to determine the prognostic survival factors in patients with acute ischemic stroke and active cancer.

Distant metastasis, plasma D-dimer levels, deep venous thrombosis and/or pulmonary embolism were independent predictors of mortality after adjusting for potential confounders.

Patients with known stroke etiologies and mild coagulation abnormalities had a favorable prognosis, whereas those with cryptogenic stroke and severe coagulation abnormalities had a poor outcome.

What Are the Clinical Implications?

The prognosis of patients with acute ischemic stroke and active cancer varies considerably depending on stroke mechanism, distant metastasis, and coagulation abnormalities.

Patients with known stroke etiologies and mild coagulation abnormalities often have a favorable prognosis; therefore, we should not stop stroke therapy because of active cancer.

Patients with cryptogenic stroke and severe coagulation abnormalities often have poor outcomes; consequently, we should thoroughly discuss with the oncologist to determine a treatment plan.