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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Diagnosis of Incident Cancer After Cryptogenic Stroke: An Exploratory Analysis of the ARCADIA Randomized Trial
Babak B Navi1, Cenai Zhang1, Benjamin R Miller1
1From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY.
Objectives:
The objective of this study was to estimate the incidence, timing, and type of new cancer diagnosis among patients with cryptogenic stroke.
Methods:
We used data from the ARCADIA trial, which enrolled patients with cryptogenic stroke and atrial cardiopathy. Participants were prospectively followed, and serious adverse events were assessed every 3 months or sooner if investigators were alerted between visits to an event. Kaplan-Meier statistics were used to estimate the cumulative incidence of a cancer diagnosis within the first year after randomization.
Results:
Among 878 participants without baseline history of cancer, 13 (1.5%) were diagnosed with incident cancer in the year after randomization, comprising 12 solid cancers (3 prostate, 2 breast, 2 gastrointestinal, and 5 other primary sites) and 1 hematologic cancer (non-Hodgkin lymphoma). The cumulative incidences of a cancer diagnosis were 0% at 3 months, 0.6% (95% CI 0.2%-1.5%) at 6 months, and 2.0% (95 CI 1.1%-3.4%) at 1 year. The median time from index stroke to cancer diagnosis was 261 days (interquartile range 183-358).
Discussion:
In a multicenter cryptogenic stroke cohort with prospective follow-up, the 1-year cumulative incidence of a cancer diagnosis was 2%. This rate may be an underestimation because of the clinical trial population and exclusion of cancers diagnosed immediately after stroke.
Trial Registration Information:
ClinicalTrials.gov Identifier: NCT03192215. Registered June 20, 2017. First patient enrolled February 1, 2018.

