Clinical Features and Influencing Factors for Prognosis of Ischemic Stroke in Cancer Patients

doi:10.3969/j.issn.1673-5765.2021.02.005

Abstract

Abstract:

Objective To analyze the clinical and imaging features of ischemic stroke in cancer patients, and the factors influencing the prognosis. Methods A retrospective analysis was performed for the data of ischemic stroke patients with cancer who admitted to Department of Neurology, the First Affiliated Hospital of China Medical University between October 2015 to June 2020. According to the mRS score at 90 days from discharge, they were divided into the groups of good prognosis (mRS≤2) or poor prognosis (mRS>2). Multivariate logistic regression analysis was used to analyze the factors influencing the prognosis. Results A total of 51 patients were included, with a mean age of 65.2±9.3 years and 38 males (74.5%). 14 cases had good prognosis, and 37 cases had poor prognosis. 33 cases (64.7%) developed cerebral multi-infarction, and 31 cases (60.8%) developed bihemispheric infarction. Multivariate analysis showed that higher hemoglobin level was an independent protective factor for the prognosis (OR 0.925, 95%CI 0.859-0.994), while higher D-dimer level (OR 5.124, 95%CI 1.289-20.373) and bihemispheric infarction (OR 11.533, 95%CI 1.151-115.542) were independent risk factors for the prognosis. Conclusions The imaging features of cerebral infarction in cancer patients were multiple ischemic lesions and multiple-vascular-territory distribution. Higher hemoglobin level was a protective factor for prognosis of ischemic stroke in cancer patients, while higher D-dimer level and bihemispheric infarction were risk factors for prognosis.

Key words: Cerebral infarction; Cancer; Prognosis; Clinical feature; Risk factor

摘要：

目的分析合并恶性肿瘤的脑梗死患者的临床特征及影像学特点，探讨影响患者预后的相关因素。方法回顾性分析2015年10月-2020年6月于中国医科大学附属第一医院神经内科收治的合并恶性肿瘤的脑梗死患者的临床资料，根据患者出院90 d时mRS评分将其分为预后良好组（mRS 0～2分）和预后不良组（mRS＞2分）。采用多因素logistic回归模型分析影响合并恶性肿瘤的脑梗死患者预后的相关因素。结果共纳入51例患者，平均年龄65.2±9.3岁，男性38例（74.5%）；预后良好组14例，预后不良组 37例。多发性梗死33例（64.7%），双侧半球梗死31例（60.8%）。多因素分析结果显示，高血红蛋白水平为合并恶性肿瘤的脑梗死患者预后独立保护性因素（OR 0.925，95%CI 0.859～0.994），而高D- 二聚体水平（OR 5.124，95%CI 1.289～20.373）及双侧半球梗死（OR 11.533，95%CI 1.151～115.542）为合并恶性肿瘤的脑梗死患者预后独立危险因素。结论合并恶性肿瘤的脑梗死患者影像学以多病灶、多血管支配区域受累为特点。高血红蛋白水平为合并恶性肿瘤的脑梗死患者预后保护性因素，而高D-二聚体水平及双侧半球梗死为预后危险因素。

关键词: 脑梗死; 恶性肿瘤; 预后; 临床特点; 危险因素

WANG Ji-Rui,LIN Mei-Qing, ZHAO Jiu-Han, SHANG Xiu-Li. Clinical Features and Influencing Factors for Prognosis of Ischemic Stroke in Cancer Patients[J]. Chinese Journal of Stroke, 2021, 16(02): 136-140.

王继蕊，林梅青，赵久晗，商秀丽. 合并恶性肿瘤的脑梗死的临床特点及影响预后的相关因素分析[J]. 中国卒中杂志, 2021, 16(02): 136-140.

References

[1] ABUBAKAR I，TILLMANN T，BANERJEE A.

Global，regional，and national age-sex specific allcause

and cause-specific mortality for 240 causes

of death，1990-2013：a systematic analysis for the

Global Burden of Disease Study 2013[J]. Lancet，

2015，385（9963）：117-171.

[2] 中华医学会，中华医学会肿瘤学分会. 中华医学会

肺癌临床诊疗指南（2019版）[J]. 肿瘤研究与临床，

2020，32（4）：217-249.

[3] 程雪娇，伊然，董齐，等. Trousseau综合征的研究进

展[J]. 中国临床神经科学，2019，27（1）：98-120.

[4] KNEIHSL M，ENZINGER C，WÜNSCH G，et al.

Poor short-term outcome in patients with ischaemic

stroke and active cancer[J]. J Neurol，2016，263（1）：

150-156.

[5] 中华医学会神经病学分会，中华医学会神经病学分

会脑血管病学组. 中国急性缺血性脑卒中诊治指南

2018[J]. 中华神经科杂志，2018，51（9）：666-682.

[6] NAITO H，NEZU T，HOSOMI N，et al.

Antithrombotic therapy strategy for cancerassociated

ischemic stroke：a case series of 26

patients[J/OL]. J Stroke Cerebrovasc Dis，2018，27

（9）：e206-e211[2020-11-20]. https：//doi.org/10.

1016/j.jstrokecerebrovasdis.2018.04.021.

[7] TAKANO H，NAKAJIMA K，NAGAYOSHI Y，et

al. Clinical associations of Trousseau’s syndrome

associated with cerebral infarction and ovarian

cancer[J/OL]. J Gynecol Oncol，2018，29（5）：

e67[2020-11-20]. https：//doi.org/10.3802/jgo.2018.29.

e67.

[8] AOYAMA K，TAMURA M，UCHIBORI M，et al.

Trousseau syndrome in a patient with advanced oral

squamous cell carcinoma：a case report[J]. J Med

Case Rep，2019，13（1）：26.

[9] YIGIT M，SOGUT O，YIGIT E，et al. The

relationship between anemia and recurrence

of ischemic stroke in patients with Trousseau’s

syndrome：a retrospective cross-sectional study[J].

Turk J Emerg Med，2016，16（2）：65-68.

[10] 姜季委，高洁，王继蕊，等. 癌症相关缺血性卒中临

床研究[J]. 中国现代神经疾病杂志，2019，19（5）：

354-360.

[11] TSUSHIMA M，METOKI N，HAGII J，et

al. D-dimer and C-reactive protein as potential

biomarkers for diagnosis of Trousseau’s syndrome

in patients with cerebral embolism[J]. J Stroke

Cerebrovasc Dis，2020，29（2）：104534.

[12] CHEN W B，HE Y B，SU Y Y. Multifocal cerebral

infarction as the first manifestation of occult

malignancy：case series of trousseau’s syndrome and literature review[J]. Brain Circ，2018，4（2）：65.

[13] SORGUN M H，KUZU M，OZER I S，et al.

Risk factors，biomarkers，etiology，outcome and

prognosis of ischemic stroke in cancer patients[J].

Asian Pac J Cancer Prev，2018，19（3）：649.

[14] 郭琳佳，刘文宏. 恶性肿瘤合并急性脑梗死的临床

特点及预后分析[J]. 中风与神经疾病杂志，2019，36

（1）：39-44.

[15] NOUH A M，STAFF I，FINELLI P F. Three

territory sign：an MRI marker of malignancy-related

ischemic stroke（Trousseau syndrome）[J]. Neurol

Clin Pract，2019，9（2）：124-128.

[16] CHI X S，ZHAO R L，PEI H T，et al. Diffusionweighted

imaging-documented bilateral small

embolic stroke involving multiple vascular territories

may indicate occult cancer：a retrospective case

series and a brief review of the literature[J]. Aging

Med，2020，3（1）：53-59.

[17] FUJIMOTO S，TOYODA K，JINNOUCHI J，et

al. Differences in diffusion-weighted image and

transesophageal echocardiographical findings in

cardiogenic，paradoxical and aortogenic brain

embolism[J]. Cerebrovasc Dis，2011，32（2）：148-

154.

[18] PARK H Y，LEE H S，CHANG H，et al. Multifocal

strokes as the initial manifestation of metastatic

tumors[J]. Neurologist，2010，16（5）：322-324.

[19] BAO L，ZHANG S Y，GONG X Y，et al. Trousseau

syndrome related cerebral infarction：clinical

manifestations，laboratory findings and radiological

features[J]. J Stroke Cerebrovasc Dis，2020，29（9）：

104891.

[20] ZHANG Y Y，CORDATO D，SHEN Q，et al. Risk

factor，pattern，etiology and outcome in ischemic

stroke patients with cancer：a nested case-control

study[J]. Cerebrovasc Dis，2007，23（2/3）：181-187.

[21] TACCONE F S，JEANGETTE S M，BLECIC S A.

First-ever stroke as initial presentation of systemic

cancer[J]. J Stroke Cerebrovasc Dis，2008，17（4）：

169-174.

[22] SHAO B，WAHRENBROCK M G，YAO L，et al.

Carcinoma mucins trigger reciprocal activation

of platelets and neutrophils in a murine model of

Trousseau syndrome[J]. Blood，2011，118（15）：

4015-4023.

[23] SELVIK H A，THOMASSEN L，BJERKREIM

A T，et al. Cancer-associated stroke：the Bergen

NORSTROKE study[J]. Cerebrovasc Dis Extra，

2015，5（3）：107-113.

[24] SØRENSEN H T，MELLEMKJÆR L，OLSEN J H，

et al. Prognosis of cancers associated with venous

thromboembolism[J]. N Engl J Med，2000，343（25）：

1846-1850.