Independent risk factors and the potential predictors of bladder cancer-related ischemic stroke

Abstract

Objective To investigate the independent risk factors and potential predictors of bladder cancer-related ischemic stroke (BCRIS). Methods This was a multi-center retrospective study including patients with active bladder cancer and acute ischemic stroke without traditional stroke risk factors (BCRIS group), and sex- and age-matched patients with active bladder cancer alone (control group). Data were collected between January 2006 and December 2018. Uni- and multivariate analyses were performed to identify independent risk factors for BCRIS. The predictive performance of these risk factors was assessed using receiver operating characteristic (ROC) curves. Results Records were retrospectively reviewed from 60 BCRIS patients and 120 bladder cancer controls. Univariate analysis revealed that serum D-dimer and carcinoembryonic antigen (CEA) levels and the platelet and neutrophil counts were significantly higher in BCRIS patients compared with controls. Multivariate analysis identified the three above-mentioned variables as independent risk factors for BCRIS. The product of all three factors gave the largest area under the ROC curve. Conclusions Elevated serum D-dimer and CEA levels and increased platelet count were independent risk factors for BCRIS, and the cut-off value based on the product of the three independent risk factors (≥2,640,745.29) could serve as a potential predictor of BCRIS.

Platelet Parameters as Biomarkers for Thrombosis Risk in Cancer: A Systematic Review and Meta-analysis

“…14 35 36 38 39 40 42 43 46 47 51 52 56 70 74 75 77 83 87 Thromboprophylaxis was not reported in 46 studies. 7 26 27 28 29 31 32 34 37 45 48 49 53 54 55 57 58 60 63 64 65 68 69 71 72 76 79 80 82 84 89 93 94 95 96 97 100 102 103 107 110 112 116 120 122 123…”

“…Seven studies rating good or fair found a higher mean platelet count in solid and mixed cancer patients who developed thrombosis versus controls. 29 55 69 82 85 108 112 Six studies had VTE as outcome, 29 55 82 85 108 112 while Quan et al studied ischemic stroke in bladder cancer patients. 69 The study by Khorana et al investigated chemotherapy-related VTE, 112 while Albertin et al and Zhang et al investigated postoperative VTE in gynecological cancer patients undergoing surgery.…”

“…In this review, four studies with ATE as outcome were included, 34,62,69,109 of which three investigated ischemic stroke. 34,62,69 One study on ischemic stroke found a significant association with higher platelet count, 69 and two studies found no association.…”

Trousseau's Syndrome Presenting as Multiple Cerebral Infarctions Caused by Mucin-producing Bladder Micropapillary Urothelial Cancer

“…Trousseau's syndrome in patients with bladder cancer, most of which are transitional cell carcinoma, is considered uncommon. A recent multi-center retrospective study investigated bladder cancer-related ischemic stroke and found that approximately 1.29% of the patients with bladder cancer also had ischemic stroke ( 10 ). In another study, urogenital carcinoma was reported as the fourth-most frequent cancer that presented with stroke ( 11 ).…”

“…Several studies have suggested that serum CA19-9 and CA125 levels may be generally useful predictors of the onset of CI in patients with cancer ( 20 , 21 ). However, a recent study that targeted cases with bladder cancer (including any histopathological type) indicated that an elevated serum CEA level was an independent risk factor of CIs, whereas the serum CA19-9 and CA125 levels showed no significant correlations with the occurrence of CIs ( 10 ). While whether the discrepancy between the results in our case and those in the aforementioned recent study is due to differences in the histopathological type or patient-specific features is unclear, examinations of serum tumor markers, such as CA19-9 and CA125, are not usually performed routinely for cases of bladder cancer (as shown in the Table), so data that might be useful for addressing this topic are still lacking.…”