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A nationwide population-based retrospective cohort study: decreased risk of stroke in cervical cancer patients after receiving treatment

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To evaluate risk of stroke in patients with cervical cancer using population-based data.

Methods

Claims collected in the Taiwan National Health Insurance database were used to identify 20,286 cervical cancer patients receiving diagnosis and treatment during 2000–2008. A reference group of 81,144 non-cancer participants, matched for age, cervical cancer-month and cervical cancer-year, was used for comparison. Risk of stroke was further assessed at follow-up until the end of 2009.

Results

Patients with cervical cancer had a 42 % lower risk of developing stroke compared with the cancer-free reference population. Increased risk of stroke was observed in patients receiving radiotherapy compared with the surgery treatment group (HR = 1.88, 95 % CI = 1.52–2.32).

Conclusion

Results from this large retrospective cohort study indicate a lower risk of developing stroke in cervical cancer patients after receiving treatment compared with a reference population free of cancer after adjusted for age, sex, urbanization level, and stroke risk factors including hypertension and diabetes. Supplementation of estrogen after cancer treatment could explain this finding. Further prospective randomized controlled analysis is needed to confirm these findings and to elucidate the underlying biological mechanisms.

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References

  1. Graus F, Rogers LR, Posner JB (1985) Cerebrovascular complications in patients with cancer. Medicine (Baltimore) 64:16–35

    CAS  Google Scholar 

  2. Rogers LR (2003) Cerebrovascular complications in cancer patients. Neurol Clin 21:167–192

    Article  PubMed  Google Scholar 

  3. Green JA, Kirwan JM, Tierney JF, Symonds P, Fresco L, Collingwood M, Williams CJ (2001) Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet 358:781–786

    Article  PubMed  CAS  Google Scholar 

  4. Chen PC, Muo CH, Lee YT, Yu YH, Sung FC (2011) Lung cancer and incidence of stroke: a population-based cohort study. Stroke 42:3034–3039

    Article  PubMed  Google Scholar 

  5. Chu CN, Chen SW, Bai LY, Mou CH, Hsu CY, Sung FC (2011) Increase in stroke risk in patients with head and neck cancer: a retrospective cohort study. Br J Cancer 105:1419–1423

    Article  PubMed  Google Scholar 

  6. Liang JA, Sun LM, Yeh JJ, Sung FC, Chang SN, Kao CH (2011) The association between malignancy and end-stage renal disease in Taiwan. Jpn J Clin Oncol 41:752–757

    Article  PubMed  Google Scholar 

  7. Liang JA, Sun LM, Muo CH, Sung FC, Chang SN, Kao CH (2011) The analysis of depression and subsequent cancer risk in Taiwan. Cancer Epidemiol Biomarkers Prev 20:473–475

    Article  PubMed  Google Scholar 

  8. Sun LM, Liang JA, Chang SN, Sung FC, Muo CH, Kao CH (2011) Analysis of Parkinson’s disease and subsequent cancer risk in Taiwan: a nationwide population-based cohort study. Neuroepidemiology 37:114–119

    Article  PubMed  Google Scholar 

  9. Kim SG, Hong JM, Kim HY, Lee J, Chung PW, Park KY, Kim GM, Lee KH, Chung CS, Bang OY (2010) Ischemic stroke in cancer patients with and without conventional mechanisms: a multicenter study in Korea. Stroke 41:798–801

    Article  PubMed  Google Scholar 

  10. Seok JM, Kim SG, Kim JW, Chung CS, Kim GM, Lee KH, Bang OY (2010) Coagulopathy and embolic signal in cancer patients with ischemic stroke. Ann Neurol 68:213–219

    PubMed  Google Scholar 

  11. Sun LM, Liang JA, Chang SN, Sung FC, Muo CH, Kao CH (2012) Estrogen decrease coronary artery disease risk in patients with cervical cancer after treatment. Gynecol Oncol 127(1):186–190

    Article  PubMed  CAS  Google Scholar 

  12. Tsai SJ, Huang YS, Tung CH, Lee CC, Lee MS, Chiou WY, Lin HY, Hsu FC, Tsai CH, Su YC, Hung SK (2013) Increased risk of ischemic stroke in cervical cancer patients: a nationwide population-based study. Radiat Oncol 8(1):41

    Article  PubMed  Google Scholar 

  13. Rocca WA, Shuster LT, Brown RD (2012) Could estrogen protect younger menopausal women from stroke? Expert Rev Neurother 12:363–365

    Article  PubMed  CAS  Google Scholar 

  14. Petrovska S, Dejanova B, Jurisic V (2012) Estrogens: mechanisms of neuroprotective effects. J Physiol Biochem 68(3):455–460

    Google Scholar 

  15. Maduro JH, den Dekker HA, Pras E, de Vries EG, van der Zee AG, Klokman WJ, Reyners AK, van Leeuwen FE, Langendijk JA, de Bock GH, Gietema JA (2010) Cardiovascular morbidity after radiotherapy or chemoradiation in patients with cervical cancer. Int J Radiat Oncol Biol Phys 78:1337–1344

    Article  PubMed  Google Scholar 

  16. Rymer MM (2011) Hemorrhagic stroke: intracerebral hemorrhage. Mo Med 108:50–54

    PubMed  Google Scholar 

  17. Phillips LH, Whisnant JP, Reagan TJ (1977) Sudden death from stroke. Stroke 8:392–395

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was partly supported by grants from the study hospital (DMR-101-061 and DMR-100-076), Taiwan Department of Health Clinical Trial and Research Center for Excellence (DOH102-TD-B-111-004), and Taiwan Department of Health Cancer Research Center for Excellence (DOH102-TD-C-111-005).

Conflict of interest

All authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan, China

    Wei-Chun Chang, Yen-Jung Chang & Chia-Hung Kao

  2. Institute of Environmental Health, College of Public Health, China Medical University, Taichung, Taiwan, China

    Chih-Hsin Muo, Shih-Ni Chang & Fung-Chang Sung

  3. Department of Gynecology and Obstetrics, China Medical University Hospital, Taichung, Taiwan, China

    Wei-Chun Chang

  4. Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan, China

    Chia-Hung Kao

  5. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, China

    Chih-Hsin Muo, Shih-Ni Chang, Fung-Chang Sung & Yen-Jung Chang

Authors
  1. Wei-Chun Chang
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  2. Chih-Hsin Muo
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  3. Shih-Ni Chang
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  4. Fung-Chang Sung
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  5. Yen-Jung Chang
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  6. Chia-Hung Kao
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Corresponding authors

Correspondence to Yen-Jung Chang or Chia-Hung Kao.

Additional information

W.-C. Chang and C.-H. Muo contributed equally to this work.

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Chang, WC., Muo, CH., Chang, SN. et al. A nationwide population-based retrospective cohort study: decreased risk of stroke in cervical cancer patients after receiving treatment. Arch Gynecol Obstet 288, 867–871 (2013). https://doi.org/10.1007/s00404-013-2827-7

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  • DOI: https://doi.org/10.1007/s00404-013-2827-7

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