Ischemic Stroke (IS) has been related to cancer in postmortem studies of oncologic patients and as being the first expression of an occult neoplasm, probably because of hypercoagulability attributed to cancer. The aim of the study was to detect an association between cancer and IS, and possible predictors of cancer among these patients.
Nine hundred seventeen patients with IS were retrospectively collected from January 2012 to December 2014 in our hospital with a following time of 18 months. Patients with active or previous cancer within 5 years, TIA or cerebral hemorrhage, inability to follow-up or absence of complementary study of IS were excluded. Detection of cancer divided the patients in two cohorts. Demographical, clinical, analytical and prognostic characteristics were collected and subsequently compared between patients with development of tumor (Cancer Patients -CP-) and those free of malignancy (No Cancer Patients -NCP-).
Cancer were detected in 29 out of 381 IS patients who finally met criteria (7.61%), instead of the 17 patients expected, according to cancer incidence in general population. The mean time from IS onset to cancer diagnosis was 6 months, with 44.83% of the diagnoses within the first 6 months after IS. The most frequent locations were colon (24%), lung and prostate (14%). 62% of CP presented metastatic or locally advanced desease. Older age (p = 0.003), previous cancer >5 years (p = 0.042), higher fibrinogen (p = 0.019) and lower hemoglobin (Hb) values (p = 0.004) were predictors of occult neoplasm. No differences were found in other analytical parameters, thromboembolic risk factors, nor with the etiology and clinical manifestations of the stroke.
In our study IS is associated with cancer, based on the fact that the incidence is almost twice that of general population. The diagnosis of cancer was mainly in advanced stages and within 6 months from IS. It suggests the presence of cancer at the diagnosis of IS due to prothrombotic effect of cancer, without being atributted, therefore, to a greater medical control than general population. Older age, previous cancer, fibrinogen and Hb values were related to the diagnosis of cancer after IS, being potential predictors in this group of patients.
Clinical trial identification
Legal entity responsible for the study
Servicio de Oncología Médica, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa
All authors have declared no conflicts of interest.