Development of a Score for Prediction of Occult Malignancy in Stroke Patients (Occult-5 Score)

Beyeler, Morin; Birner, Barbara; Branca, Mattia; Meinel, Thomas; Vynckier, Jan; Buffle, Eric; Scutelnic, Adrian; Heldner, Mirjam R; Bücke, Philipp; Seiffge, David J; Mordasini, Pascale; Dobrocky, Tomas; Piechowiak, Eike Immo; Kaesmacher, Johannes; Gralla, Jan; Mattle, Heinrich; Arnold, Marcel; Fischer, Urs; Pabst, Thomas; Berger, Martin D.; Jung, Simon

doi:10.1016/j.jstrokecerebrovasdis.2022.106609

Cited by 16 publications

(19 citation statements)

References 32 publications

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“…2, S1) while a study of patients with active cancer diagnosed prior to stroke suggested an association of fibrinogen levels higher than 4.0 g/l 27 , identical with the cut-off used here. Previous studies suggested an association of cryptogenic stroke and ischemic lesions in multiple vascular territories 14,25 with occult cancer while others did not 7,17 . Here, the occurrence of ischemic lesions in ≥ 2 vascular territories was associated with risk of cancer diagnosis within 1 year after stroke if stroke was not attributed to a concurrent cardioembolic etiology (Table S1.…”

Section: Discussionmentioning

confidence: 93%

“…2 c,d). Based on previous studies suggesting higher cut-off values of d-dimers, among them 0.82 mg/l 14 , 1.2 mg/l 15 , and 3 mg/l 6 to be associated with occult cancer, we added analyses with these cut-offs and observed that levels of d-dimers ≥ 3 mg/l ( p = 0.002 and p = 0.009, Fig. 2 c,d) were associated with cancer diagnosed within 1 year and 3 years after stroke in our cohort while levels of d-dimers higher than 0.82 mg/l or higher than 1.2 mg/l as suggested before did not show differences between groups (data not shown).…”

Section: Resultsmentioning

confidence: 99%

“…Here, the occurrence of ischemic lesions in ≥ 2 vascular territories was associated with risk of cancer diagnosis within 1 year after stroke if stroke was not attributed to a concurrent cardioembolic etiology (Table S1 . Elevated levels of d-dimers have been related to occult cancer, however with variable cut-offs 6 , 14 , 15 , 25 , 26 . We confirmed the role of different cut-offs in this context with levels of d-dimers ≥ 3 mg/l 6 associated with cancer diagnosed after stroke while this was not significant when chosing the ULN (0.5 mg/l) as cut-off (Fig.…”

Section: Discussionmentioning

confidence: 99%

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

Seystahl

Gramatzki

Wanner

et al. 2023

Sci Rep

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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.

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Section: Discussionmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Seystahl

Gramatzki

Wanner

et al. 2023

Sci Rep

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“…Even if an interaction with ESUS was significant, the association between SVS and occult cancer remained statistically insignificant in the subgroup analysis. In patients with occult cancer, compared to patients with active known cancer, the impact of paraneoplastic hypercoagulability may be smaller as markers of coagulation (D-dimer) and inflammation (CRP and Hb) tend to be less altered at admission in the first group ( 20 ). This may influence the thrombus composition and consequently change the thrombus imaging characterization.…”

Section: Discussionmentioning

confidence: 99%

“…Active cancer was identified according to the definition from the Haemostasis and Malignancy Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis ( 18 , 19 ). Newly diagnosed cancer within one year after the index stroke was defined as “occult cancer” at the time of stroke and considered an active cancer for the purposes of this study ( 4 , 20 , 21 ). As defined previously, patients with focal non-melanoma skin cancer and those treated with prophylactic hormone therapy for prior breast cancer were classified as not having active cancer ( 14 , 22 , 23 ).…”

Section: Methodsmentioning

confidence: 99%

Absence of susceptibility vessel sign and hyperdense vessel sign in patients with cancer-related stroke

et al. 2023

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Background and aimIdentification of paraneoplastic hypercoagulability in stroke patients helps to guide investigations and prevent stroke recurrence. A previous study demonstrated an association between the absence of the susceptibility vessel sign (SVS) on brain MRI and active cancer in patients treated with mechanical thrombectomy. The present study aimed to confirm this finding and assess an association between the absence of the hyperdense vessel sign (HVS) on head CT and active cancer in all stroke patients.MethodsSVS and HVS status on baseline imaging were retrospectively assessed in all consecutive stroke patients treated at a comprehensive stroke center between 2015 and 2020. Active cancer, known at the time of stroke or diagnosed within 1 year after stroke (occult cancer), was identified. Adjusted odds ratios (aOR) and their 95% confidence interval (CI) for the association between the thrombus imaging characteristics and cancer were calculated using multivariable logistic regression.ResultsOf the 2,256 patients with thrombus imaging characteristics available at baseline, 161 had an active cancer (7.1%), of which 36 were occult at the time of index stroke (1.6% of the total). The absence of SVS was associated with active cancer (aOR 3.14, 95% CI 1.45–6.80). No significance was reached for the subgroup of occult cancer (aOR 3.20, 95% CI 0.73–13.94). No association was found between the absence of HVS and active cancer (aOR 1.07, 95% CI 0.54–2.11).ConclusionThe absence of SVS but not HVS could help to identify paraneoplastic hypercoagulability in stroke patients with active cancer and guide patient care.

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