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Predictors of unknown cancer in patients with ischemic stroke

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Abstract

Stroke is the second most frequent neurologic finding in postmortem studies of cancer patients. It has also been described as the first expression of an occult cancer. We have studied patients diagnosed with cancer after an ischemic stroke (IS) and we analyze differences with non-tumor patients. Single cohort longitudinal retrospective study of patients admitted to our center with IS diagnosis from 1 January 2012 to 12 December 2014. All patients were followed for 18 months. Patients with transient ischemic infarction or cerebral hemorrhage, active cancer or in the last 5 years, inability to follow-up or absence of complete complementary study (holter-EKG, echocardiogram, and dupplex/angiography-CT) were excluded. Demographic, clinical, analytical and prognostic characteristics were compared between both subgroups. From a total of 381 IS patients with no history of cancer, 29 (7.61%) were diagnosed with cancer. The mean time from stroke onset to cancer diagnosis was 6 months. The most frequent location was colon (24%). 35% were diagnosed in a metastatic stage. Older age (p = 0.003), previous cancer (p = 0.042), chronic kidney disease (CKD) (p = 0.006) and lower hemoglobin (p = 0.004) and fibrinogen (p = 0.019) values were predictors of occult neoplasm. No differences were found in other biochemical or epidemiological parameters, prognosis, etiology or clinical manifestations of the IS. In our study, older age, CKD, previous cancer and hemoglobin and fibrinogen values were related to the diagnosis of cancer after IS. More studies are needed to determine which patients could benefit from a larger study on admission that might allow an earlier diagnosis of the underlying neoplasm.

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This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Author notes

  1. Sonia Quintas and Jacobo Rogado have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Hospital Universitario de La Princesa, Calle Diego de León, 62, Secretaría de Neurología, 28006, Madrid, Spain

    Sonia Quintas, Julio Dotor García-Soto, Gemma Reig-Roselló & Jose Vivancos

  2. Department of Oncology, Hospital Universitario de La Princesa, Madrid, Spain

    Jacobo Rogado, Vilma Pacheco-Barcia, Rebeca Mondéjar & Ramón Colomer

  3. Institute of Health Carlos III, National School of Public Health, Madrid, Spain

    Pedro Gullón

Authors
  1. Sonia Quintas
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  2. Jacobo Rogado
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Correspondence to Sonia Quintas.

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Quintas, S., Rogado, J., Gullón, P. et al. Predictors of unknown cancer in patients with ischemic stroke. J Neurooncol 137, 551–557 (2018). https://doi.org/10.1007/s11060-017-2741-0

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  • DOI: https://doi.org/10.1007/s11060-017-2741-0

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