Ischemic stroke in patients with unresectable pancreatic and gastric cancer

Thromboembolism, including ischemic stroke and venous thromboembolism (VTE), is a critical complication in patients with advanced cancer. Pancreatic cancer and gastric cancer are classified as "very high risk" cancers based on the Khorana score, a risk model for VTE. However, the cumulative incidence of ischemic stroke in patients with unresectable pancreatic and gastric cancers has not been elucidated. This study evaluated the incidence and mortality of ischemic stroke in patients with unresectable pancreatic and gastric cancer.

This retrospective, single-center cohort study included patients diagnosed with unresectable pancreatic or gastric cancer between January 2009 and December 2021.

Among 276 patients, ischemic stroke occurred in 18 patients. All 18 patients were categorized into cancer-associated stroke (CAS), including cancer-related coagulopathy, by a board certified fellow. The 1-year cumulative incidence rates were 10.2% in patients with unresectable pancreatic cancer and 5.8% in patients with unresectable gastric cancer (P = 0.22). The median survival time after stroke was significantly shorter for patients with unresectable pancreatic cancer than for patients with unresectable gastric cancer (41 days vs 116 days, P < 0.05). In contrast, no significant difference was observed in overall survival (OS) between patients with and without ischemic stroke (244 days vs 221 days, P = 0.66).

This study's findings indicated that CAS accounts for most ischemic stroke in patients with unresectable pancreatic and gastric cancers. Moreover, the prognosis after ischemic stroke was significantly worse in patients with unresectable pancreatic cancer. However, ischemic stroke itself may not influence OS in patients with unresectable pancreatic or gastric cancer.