The Risk of Ischemic and Hemorrhagic Stroke in Head and Neck Cancer: A Longitudinal Cohort Study

Kim, Chulho; Yu, Hyunjae; Kim, Dong Kyu

doi:10.3390/cancers15133503

Cited by 5 publications

(8 citation statements)

References 31 publications

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“…Furthermore, nasopharyngeal carcinoma was excluded from their main analysis. We also note that the cohorts in the studies by Yeh et al and Kim et al predominately represented oral subsites (approximately 95% and 72%, respectively). In comparison, our cohort comprised of 48% nasopharyngeal, 18% oral cavity, and 13% laryngeal tumors.…”

Section: Discussionmentioning

confidence: 51%

“…Moreover, different summary measures were used to quantify stroke risk in these studies. Some studies used incidence rate ratios, while some used hazard ratios derived from Cox proportional hazards regression model . Furthermore, most studies reported an increased risk in the overall HNC cohort, without providing detailed information about the risks in subpopulations.…”

Section: Introductionmentioning

confidence: 99%

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Stroke Risk in Survivors of Head and Neck Cancer

Yip,

Zheng,

Cheo

et al. 2024

JAMA Netw Open

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ImportanceSurvivors of head and neck cancers (HNC) have increased risk of stroke. A comprehensive report using standardized methods is warranted to characterize the risk and to inform on survivorship strategy.ObjectiveTo determine the stroke risk in subpopulations of survivors of HNC in Singapore.Design, Setting, and ParticipantsThis national, registry-based, cross-sectional study aimed to estimate stroke risk in subgroups of the HNC population between January 2005 and December 2020. Participants were identified from the Singapore Cancer Registry, the Singapore Stroke Registry, and the Registry of Birth and Deaths using relevant International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes. HNC subgroups were defined based on patient demographic, disease, and treatment factors. Data were analyzed from September 2022 to September 2023.ExposureDiagnosis of HNC.Main Outcomes and MeasuresBoth ischemic and hemorrhagic stroke were studied. The age-standardized incidence rate ratio (SIRR) and age-standardized incidence rate difference (SIRD) were reported. The Singapore general population (approximately 4 million) served as the reference group for these estimations.ResultsA total of 9803 survivors of HNC (median [IQR] age at diagnosis, 58 [49-68] years; 7166 [73.1%] male) were identified. The most common HNC subsites were nasopharynx (4680 individuals [47.7%]), larynx (1228 individuals [12.5%]), and tongue (1059 individuals [10.8%]). A total of 337 individuals (3.4%) developed stroke over a median (IQR) follow-up of 42.5 (15.0-94.5) months. The overall SIRR was 2.46 (95% CI, 2.21-2.74), and the overall SIRD was 4.11 (95% CI, 3.37-4.85) strokes per 1000 person-years (PY). The cumulative incidence of stroke was 3% at 5 years and 7% at 10 years after HNC diagnosis. The SIRR was highest among individuals diagnosed at younger than 40 years (SIRR, 30.55 [95% CI, 16.24-52.35]). All population subsets defined by age, sex, race and ethnicity, HNC subsites (except tongue), stage, histology, and treatment modalities had increased risk of stroke compared with the general population. The SIRR and SIRD were significantly higher among individuals who had a primary radiation treatment approach (SIRR, 3.01 [95% CI, 2.64-3.43]; SIRD, 5.12 [95% CI, 4.18-6.29] strokes per 1000 PY) compared with a primary surgery approach (SIRR, 1.64 [95% CI, 1.31-2.05]; SIRD, 1.84 [95% CI, 0.923.67] strokes per 1000 PY).Conclusions and RelevanceIn this cross-sectional study of survivors of HNC, elevated stroke risks were observed across different age, subsites, and treatment modalities, underscoring the importance of early screening and intervention.

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Section: Discussionmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Stroke Risk in Survivors of Head and Neck Cancer

Yip,

Zheng,

Cheo

et al. 2024

JAMA Netw Open

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“…The cohort dataset used in this study consisted of a representative sample of 1,025,340 adults, which is approximately 2.2% of the population of the Republic of Korea. Its excellent reliability has already been proven through a reliability verification study and several previous publications [ 15 , 16 , 17 , 18 ].…”

Section: Methodsmentioning

confidence: 87%

Exploring the Link between Head and Neck Cancer and Elevated Risk of Rheumatoid Arthritis: A National Population-Based Cohort Study

Kim,

Yu,

Kim

2024

Cancers

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An increased risk of cancer among patients with rheumatoid arthritis (RA) has been reported. However, the risk of RA events among patients with head and neck cancer (HNC) is unknown. Therefore, we investigated the incidence and risk of RA among patients with HNC. This study was based on a cohort dataset. Overall, 2824 individuals without HNC and 706 patients with HNC were selected using propensity score matching. The overall RA event rate was 12.19 for patients with HNC and 7.60 for those without HNC. A significantly increased risk of developing RA was also observed among patients with HNC. The risk of developing RA over time was relatively high within the first year after HNC diagnosis; further, it increased significantly during the follow-up period. Moreover, middle-aged male patients with HNC exhibited an increased risk of developing RA compared with the controls; however, no significant difference was noted among female patients or other age groups. Notably, subgroup analysis according to cancer subtype revealed that only oral cancer survivors had an increased risk of developing RA. These results underscore the importance of vigilant monitoring by clinicians to promptly identify the onset of RA in patients with HNC.

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“…Although IS commonly occurs in patients who have received RT, few studies have examined the etiology and vascular territory of IS. [6][7][8][9][10] Moreover, CAS is also a common complication after RT. [14][15][16][17][18][19] In general population, the annual IS risk was 0.4% and 0.5% for patients with 50% to 99% and 70% to 99% in asymptomatic CAS.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Ischemic stroke (IS) is a common post-RT complication that occurs at a rate of 17.32 per 1,000 person-years, with an incidence rate ranging from 10% to 34% among HNC survivors after RT. [6][7][8][9][10] Studies have reported that compared with the general population, patients with HNC had a standardized stroke incidence ratio of 1.37 7 and had a relative risk of IS ranging from 2.09 over a 5-year follow-up period to 10.1 over a 7-year follow-up period after RT. 8,9 .…”

Section: Introductionmentioning

confidence: 99%

Vertebral and Carotid Artery Stenosis after Irradiation Both Raise Ischemic Stroke Risk in Head and Neck Cancer Patients

Jiang,

Chang,

Huang

et al. 2024

Preprint

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Purpose: To study the risk of ischemic stroke (IS) following carotid (CAS) or vertebral artery stenosis (VAS) in head and neck cancer (HNC) patients after radiation therapy (RT). Methods: We included HNC patients who received RT between 2010 and 2023. They underwent regular head and neck imaging monitoring to evaluate cancer recurrence at the department of radiation-oncology and vascular examinations at the department of neurology. Patients were initially divided into nasopharyngeal carcinoma (NPC) and non-NPC groups. The primary outcome was the occurrence of IS after RT, and the secondary outcomes included the development of >50% CAS or >50% VAS after RT. Cox regression and Kaplan?Meier analyses were conducted to compare the outcomes of the study groups. Further analysis was conducted based on the presence or absence of >50% CAS or >50% VAS during the follow-up period. Results: Of the 1,423 HNC patients, 19%, 6.8%, and 2.3% developed >50% CAS, >50% VAS, and IS during a 58-month follow-up. Compared with the NPC group, the non-NPC group exhibited a higher incidence of >50% CAS (25.4% vs. 10.7%, p<0.001) and >50% VAS (8.8% vs. 4.3%, p<0.001), but similar risks of IS. In patients with HNC, >50% CAS (adjusted hazard ratio [HR]=3.21, 95% confidence interval [CI]=1.53-6.71), and >50% VAS (adjusted HR=2.89, 95% CI=1.28-6.53) were both the independent predictors of IS. In the patients with NPC, >50% CAS was an independent predictor of anterior circulation IS (adjusted HR=4.39, 95% CI=1.17-16.47). By contrast, >50% VAS emerged as a predictor of posterior circulation IS in both the NPC (adjusted HR=15.02, 95% CI=3.76-60.06) and non-NPC groups (adjusted HR=13.59, 95% CI=2.21-83.46). Conclusion: HNC patients with >50% CAS or >50% VAS after RT had an increased risk of IS within their corresponding vascular territory. CAS is a major predictor of IS in NPC patients, whereas VAS is a major predictor of IS in both NPC and non-NPC patients.

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The Risk of Ischemic and Hemorrhagic Stroke in Head and Neck Cancer: A Longitudinal Cohort Study

Cited by 5 publications

References 31 publications

Stroke Risk in Survivors of Head and Neck Cancer

Stroke Risk in Survivors of Head and Neck Cancer

Exploring the Link between Head and Neck Cancer and Elevated Risk of Rheumatoid Arthritis: A National Population-Based Cohort Study

Vertebral and Carotid Artery Stenosis after Irradiation Both Raise Ischemic Stroke Risk in Head and Neck Cancer Patients

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