Incidence and risk factors for ischemic stroke in patients with cancer: A retrospective observational study
Hiroaki Terada a 1, Kenji Nakamura a 1, Shoto Fujita a, Yasufumi Gon b c, Tomohiro Kawano b, Takaya Kitano b, Junji Takasugi b, Hideaki Kanki b, Ling Zha d, Masayo Komatsu d, Tetsuhisa Kitamura d, Tsutomu Sasaki b e
a) Faculty of Medicine, The University of Osaka, Japan
b) Department of Neurology, Graduate School of Medicine, The University of Osaka, Japan
c) Department of Medical Innovation, Academic Clinical Research Center, The University of Osaka Hospital, Japan
d) Department of Social Medicine, Environmental Medicine and Population Science, Graduate School of Medicine, The University of Osaka, Japan
e) StemRIM Institute of Regeneration-inducing Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Abstract
Background
Patients with cancer have an elevated risk of ischemic stroke, which can interrupt cancer treatment and worsen survival outcomes. However, epidemiological data on stroke incidence and risk factors in this population remain limited.
Methods
We conducted a retrospective observational study of 35,862 patients with cancer registered at the University of Osaka Hospital between 2007 and 2020. Patients were followed for one year after cancer diagnosis to evaluate the cumulative incidence of ischemic stroke, accounting for death as a competing risk. Risk factors were assessed using the Fine and Gray competing risk model, with subdistribution hazard ratios (SHRs) and their 95 % confidence intervals (CIs) calculated.
Results
During the study period, 188 patients experienced a stroke. Of these, ischemic stroke was the most common type, occurring in 143 patients (76.1 %), followed by intracerebral hemorrhage in 38 patients (20.2 %) and subarachnoid hemorrhage in 7 patients (3.7 %). The 1-year cumulative incidence of ischemic stroke was 0.42 %. In multivariable analysis, independent risk factors for ischemic stroke included older age (adjusted SHR, 1.01; 95 % CI, 1.00–1.03), hypertension (1.59; 95 % CI, 1.10–2.30), dyslipidemia (1.60; 95 % CI, 1.09–2.36), atrial fibrillation (2.42; 95 % CI, 1.54–3.81), and advanced stages (1.74; 95 % CI, 1.12–2.70). Elevated leukocyte count (≥11,000/μL) and platelet count (≥350,000/μL) at cancer diagnosis were also independent predictors of ischemic stroke.
Conclusion
Our findings suggest that older age, hypertension, dyslipidemia, atrial fibrillation, advanced stages, and elevated leukocyte and platelet count could represent potential risk factors for ischemic stroke in patients with cancer.