Stroke Rate Increases Around the Time of Cancer Diagnosis

Wei, Yu‐Ching; Chen, Kuan Fu; Wu, Chia Lun; Lee, Tay Wey; Liu, Chi‐Hung; Shyu, Yu-Chiau; Lin, Ching Po

doi:10.3389/fneur.2019.00579

Cited by 21 publications

(28 citation statements)

References 61 publications

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“…Next, we examined the frequency of ischaemic stroke adjusted by the number of cancer survivors. In accordance with the previous report, 17 the event rate of ischaemic stroke remained nested around the time of cancer diagnosis ( Supplementary Fig. 1B ).…”

Section: Resultssupporting

confidence: 93%

High neutrophil/lymphocyte ratio at cancer diagnosis predicts incidence of stroke in cancer patients

Kawano

Sasaki

Gon

et al. 2021

Brain Communications

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Although cancer increases the incidence and severity of ischemic stroke, there is no reliable method for predicting ischemic stroke in cancer patients. To evaluate the prognostic capacity of the neutrophil-to-lymphocyte ratio at cancer diagnosis for predicting the incidence of ischemic stroke, we used a hospital-based cancer registry that contained clinical data from all patients treated for cancer at Osaka University Hospital between 2007 and 2015. The neutrophil-to-lymphocyte ratio was calculated after dividing absolute neutrophil counts by absolute lymphocyte counts. These counts were obtained within 1 month after cancer diagnosis. The primary endpoint was new-onset ischemic stroke within 2 years after cancer diagnosis. Of the 18,217 included cancer patients (median age: 65.2 years), 69 (0.38%) had ischemic stroke. Unadjusted Cox regression analysis stratified by cancer site demonstrated that each 1-unit increase in the neutrophil-to-lymphocyte ratio was associated with a significant 7.2% increase in the risk of an ischemic stroke event (95% confidence interval 1.041–1.103, P<0.001). Survival tree analysis and the Kaplan–Meier method suggested that patients with and without atrial fibrillation who had increased neutrophil-to-lymphocyte ratios had a higher risk of ischemic stroke. Multivariate Cox proportional hazard models, adjusted for cancer site and stage, revealed that patients with high neutrophil-to-lymphocyte ratios (>15) had higher ischemic stroke risk than patients with low neutrophil-to-lymphocyte ratios (<5). This was true among cancer patients both with (hazard ratio 11.598; 95% confidence interval 0.953–141.181) and without (hazard ratio 7.877; 95% confidence interval 2.351–26.389) atrial fibrillation. The neutrophil-to-lymphocyte ratio at cancer diagnosis is associated with the incidence of ischemic stroke among cancer patients and might thus be useful for identifying patients at high risk of ischemic stroke, allowing us to guide future preventive interventions. Kawano et al. report that the elevated neutrophil-to-lymphocyte ratio at cancer diagnosis is associated with the incidence of ischemic stroke within 2 years after cancer diagnosis, suggesting that neutrophil-to-lymphocyte ratio at cancer diagnosis might be useful for identifying patients at high risk of ischemic stroke.

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Section: Resultssupporting

confidence: 93%

High neutrophil/lymphocyte ratio at cancer diagnosis predicts incidence of stroke in cancer patients

Kawano

Sasaki

Gon

et al. 2021

Brain Communications

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“…21,29 One study reported cancer types stratified by time after stroke and showed that esophageal cancer may be diagnosed later after stroke (mean, 2.3 years) than other cancer types (overall mean, 0.4 years). 35…”

Section: Diagnostic Interval Between Ischemic Stroke and New Cancermentioning

confidence: 99%

Frequency and predictors of occult cancer in ischemic stroke: A systematic review and meta-analysis

Rioux

Touma

Nehme

et al. 2020

International Journal of Stroke

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Background The optimal approach for cancer screening after an ischemic stroke remains unclear. Aims We sought to summarize the existing evidence regarding the frequency and predictors of cancer after an ischemic stroke. Summary of review We searched seven databases from January 1980 to September 2019 for articles reporting malignant tumors and myeloproliferative neoplasms diagnosed after an ischemic stroke (PROSPERO protocol: CRD42019132455). We screened 15,400 records and included 51 articles. The pooled cumulative incidence of cancer within one year after an ischemic stroke was 13.6 per thousand (95% confidence interval [CI], 5.6–24.8), higher in studies focusing on cryptogenic stroke (62.0 per thousand; 95% CI, 13.6–139.3 vs 9.6 per thousand; 95% CI, 4.0–17.3; p = 0.02) and those reporting cancer screening (39.2 per thousand; 95% CI, 16.4–70.6 vs 7.2 per thousand; 95% CI, 2.5–14.1; p = 0.003). Incidence of cancer after stroke was generally higher compared to people without stroke. Most cases were diagnosed within the first few months after stroke. Several predictors of cancer were identified, namely older age, smoking, and involvement of multiple vascular territories as well as elevated C-reactive protein and d-dimers. Conclusions The frequency of incident cancer after an ischemic stroke is low, but higher in cryptogenic stroke and after cancer screening. Several predictors may increase the yield of cancer screening after an ischemic stroke. The pooled incidence of post-stroke cancer is likely underestimated, and larger studies with systematic assessment of cancer after stroke are needed to produce more precise and valid estimates.

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“…Our study focused on breast cancer and stroke and found that the time from the breast cancer diagnosis to the occurrence of stroke was approximately 6 years. According to Wei et al [18], the highest risk of stroke was found in patients with malignant brain tumors, followed by those with gastric cancer, prostate cancer, urogenital cancer, lung cancer, and leukemia. These cancer types conferred a higher risk of stroke than breast cancer, and their time from the diagnosis of cancer to the occurrence stroke was shorter.…”

Section: Breast Cancer and Strokementioning

confidence: 99%

“…Studies have shown that stroke occurs more frequently in cancer patients than in the general population and can present as the first sign of cancer, leading to its detection [17]. Wei et al [18] found that the risk of stroke was highest between 0.5 years before and after a diagnosis of cancer, with a steep-sided bell curve.…”

Section: Breast Cancer and Strokementioning

confidence: 99%

Risk of Stroke in Patients with Breast Cancer and Sleep Disorders

et al. 2021

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Breast cancer and stroke were leading cause of cancer-related mortality in the world. Stroke is the second leading cause of death. Previous studies showed that patients with breast cancer had a relatively higher risk of sleep disorders. Sleep disorders increased the risk of stroke. The aim of our study was to examine the risk of stroke after a breast cancer with sleep disorder among women in Taiwan. The Taiwan Cancer Registry was used to identify patients with breast cancer. Patients with new-onset breast cancer from January 2007 to December 2015 were selected for this study and followed until December 31, 2017. Patients who were diagnosed with sleep disorders were set as the case group, and the controls were those without sleep disorders. We enrolled 5256 patients with sleep disorders and 10,512 patients without sleep disorders. There were 121 (2.30%) patients with ischemic stroke among the breast cancer patients with sleep disorders. The mean time from the diagnosis of breast cancer to the occurrence of ischemic stroke was 6.29±2.59 years for breast cancer patients with sleep disorders and 6.00±2.76 years for those without sleep disorders (p < 0.0001). After matching by age and index year, breast patients with sleep disorders had a 1.31-fold higher risk (95% confidence interval: 1.03-1.66; p-value=0.026) of ischemic stroke than those without sleep disorders, after adjustment for comorbidities, cancer clinical stage, and treatment types. In conclusion, Breast cancer patients with sleep disorders have an increased risk of stroke.

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Stroke Rate Increases Around the Time of Cancer Diagnosis

Cited by 21 publications

References 61 publications

High neutrophil/lymphocyte ratio at cancer diagnosis predicts incidence of stroke in cancer patients

High neutrophil/lymphocyte ratio at cancer diagnosis predicts incidence of stroke in cancer patients

Frequency and predictors of occult cancer in ischemic stroke: A systematic review and meta-analysis

Risk of Stroke in Patients with Breast Cancer and Sleep Disorders

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