Immediate and Long-Term Outcomes of Reperfusion Therapy in Patients with Cancer

Joonsang Yoo, Young Dae Kim, Hyungjong Park, Byung Moon Kim, Oh Young Bang, Hyeon Chang Kim, Euna Han, Dong Joon Kim, Joonnyung Heo, Minyoung Kim, Jin Kyo Choi, Kyung Yul Lee, Hye Sun Lee, Dong Hoon Shin, Hye Yeon Choi, Sung Il Sohn, Jeong Ho Hong, Jong Yun Lee, Jang Hyun Baek, Gyu Sik KimWoo Keun Seo, Jong Won Chung, Seo Hyun Kim, Tae Jin Song, Sang Won Han, Joong Hyun Park, Jinkwon Kim, Yo Han Jung, Han Jin Cho, Seong Hwan Ahn, Sung Ik Lee, Kwon Duk Seo, Ji Hoe Heo, Hyo Suk Nam

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1 Scopus citations

Abstract

Background and Purpose: Patients with acute stroke are often accompanied by comorbidities, such as active cancer. However, adequate treatment guidelines are not available for these patients. The purpose of this study was to evaluate the association between cancer and the outcomes of reperfusion therapy in patients with stroke. Methods: We compared treatment outcomes in patients who underwent reperfusion therapy, using a nationwide reperfusion therapy registry. We divided the patients into 3 groups according to cancer activity: active cancer, nonactive cancer, and without a history of cancer. We investigated reperfusion processes, 24-hour neurological improvement, adverse events, 3-month functional outcome, and 6-month survival and related factors after reperfusion therapy. Results: Among 1338 patients who underwent reperfusion therapy, 62 patients (4.6%) had active cancer, 78 patients (5.8%) had nonactive cancer, and 1198 patients (89.5%) had no history of cancer. Of the enrolled patients, 969 patients received intravenous thrombolysis and 685 patients underwent endovascular treatment (316 patients received combined therapy). Patients with active cancer had more comorbidities and experienced more severe strokes; however, they showed similar 24-hour neurological improvement and adverse events, including cerebral hemorrhage, compared with the other groups. Although the functional outcome at 3 months was poorer than the other groups, 36.4% of patients with active cancer showed functional independence. Additionally, 52.9% of the patients with determined stroke etiology showed functional independence despite active cancer. During the 6-month follow-up, 46.6% of patients with active cancer died, and active cancer was independently associated with poor survival (hazard ratio, 3.973 [95% CI, 2.528-6.245]). Conclusions: In patients with active cancer, reperfusion therapy showed similar adverse events and short-term outcomes to that of other groups. While long-term prognosis was worse in the active cancer group than the nonactive cancer groups, not negligible number of patients had good functional outcomes, especially those with determined stroke mechanisms.

Original languageEnglish
Pages (from-to)2026-2034
Number of pages9
JournalStroke
DOIs
StateAccepted/In press - 2021

Keywords

  • ischemic stroke
  • neoplasms
  • registries
  • reperfusion
  • thrombectomy

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