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Predictors of survival for patients with cancer after cryptogenic stroke

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Abstract

Patients with active cancer experience ischemic stroke via cryptogenic mechanisms, with cancer-associated hypercoagulability being considered a major contributor to such strokes. Despite the remarkably shortened survival of these patients, the clinical predictors of survival are poorly understood. We determined the clinical factors including D-dimer levels serving as the predictors of overall survival in these patients. Retrospective study was conducted on cancer patients who visited our hospital for acute ischemic stroke with cryptogenic mechanisms from April 2012 through November 2014. Demographics, clinical characteristics, imaging and laboratory results including coagulation markers were collected, and overall survival was calculated from the patient medical records and a governmental national database. A high D-dimer level was defined as a D-dimer level exceeding the median value from the study population (>5.50 μg/ml). A total of 93 patients were identified, with a median survival of 62 days (interquartile range 32–223 days). A high D-dimer level (p = 0.004; hazard ratio [HR] 2.01, 95 % confidence interval [CI] 1.26–3.21), systemic metastases (p = 0.02; HR 2.08, 95 % CI 1.11–3.90), and diabetes mellitus (p = 0.03; HR 1.78, 95 % CI 1.03–3.10) were identified as independent predictors of poor overall survival using multivariate Cox proportional hazard analysis. Most of the patients (87 %) were primarily treated with low-molecular-weight heparin (dalteparin, n = 49; enoxaparin, n = 32). The type of low-molecular-weight heparin had no association with survival. A high D-dimer level, systemic metastases, and diabetes are independent predictors of poor survival in cancer patients with cryptogenic stroke.

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Acknowledgments

This study was supported by Grants from the Korean Health Technology R&D Project (A121911, A121660), Ministry of Health & Welfare, Republic of Korea. Yong-Won Shin and Soon-Tae Lee were supported by Lee Sueng Moon Research Fund of Seoul National University Hospital (2015-2848).

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Authors and Affiliations

  1. Department of Neurology, Seoul National University Hospital, Seoul, South Korea

    Yong-Won Shin, Soon-Tae Lee, Keun-Hwa Jung, Do-Yong Kim, Kon Chu & Sang Kun Lee

  2. Integrated Cancer Care Center, Seoul National University Cancer Hospital, Seoul, South Korea

    Soon-Tae Lee

  3. Nohwa Branch of Public Health Center, Seoul, Jeollanam-do, South Korea

    Yong-Won Shin

  4. Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea

    Chul-Kee Park

  5. Department of Internal Medicine, Cancer Research Institute, Seoul National University Hospital, Seoul, South Korea

    Tae Min Kim

  6. Department of Radiology, Seoul National University Hospital, Seoul, South Korea

    Seung Hong Choi

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  1. Yong-Won Shin
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Correspondence to Soon-Tae Lee.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Shin, YW., Lee, ST., Jung, KH. et al. Predictors of survival for patients with cancer after cryptogenic stroke. J Neurooncol 128, 277–284 (2016). https://doi.org/10.1007/s11060-016-2106-0

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  • DOI: https://doi.org/10.1007/s11060-016-2106-0

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