A risk model for prediction of diagnosis of cancer after ischemic stroke

Abstract

It remains controversial which characteristics may predict occult cancer in stroke patients. Characteristics of patients with ischemic stroke registered in the Zurich Swiss Stroke Registry (2014 to 2016) were tested for associations with cancer diagnosis after stroke with consideration of death as competing risk for cancer diagnosis. Among 1157 patients, 34 (3%) and 55 patients (5%) were diagnosed with cancer within 1 and 3 years after stroke. Levels of white blood cells (WBC) > 9,600/µl (subdistribution hazard ratio (SHR) 3.68, p = 0.014), platelets > 400,000/µl (SHR 7.71, p = 0.001), and d-dimers ≥ 3 mg/l (SHR 3.67, p = 0.007) were independently associated with cancer diagnosis within 1 year after stroke. Occurrence of ischemic lesions in ≥ 2 vascular territories not attributed to cardioembolic etiology was associated with cancer diagnosed within 1 year after stroke in univariable analysis (SHR 3.69, p = 0.001). The area under the curve of a score from these parameters (score sum 0–4) was 0.73. A score of ≥ 2 had a sensitivity of 43% and specificity of 92% for prediction of cancer diagnosis within 1 year after stroke. We suggest further validation of a score of WBC, platelets, d-dimers and multiple ischemic lesions without cardioembolic stroke etiology for prediction of cancer diagnosis after stroke.

Cancer-associated ischemic stroke: current knowledge and future directions

“…A risk prediction model was developed to identify patients at the highest risk for occult cancer diagnosis after ischemic stroke. 49 The incidence of a new occult cancer diagnosis was 3% at 1 year (34/1157) and 5% at 3 years (55/1158). The independent predictors of cancer included levels of white blood cells >9,600/μl [subdistribution (SHR) 3.68, P=0.014, platelets >400,000/μl (SHR 7.71, P=0.001), and D-dimer ≥3 mg/l (SHR 3.67, P=0.007); ischemic strokes in ≥2 vascular territories not attributed to a cardioembolic etiology was associated with cancer diagnosed within 1 year after stroke only in univariate analysis (SHR 3.69, P=0.001).…”