Long-Term Outcomes and Predictors in Cancer-Related Stroke Using the Linked Data Set

Data on long-term prognostic factors in patients with cancer-related stroke are limited. The purpose of this study was to evaluate long-term outcomes and investigate prognostic factors of cancer-related stroke using a linked data set.

Between January 2008 and December 2014, patients with cancer-related stroke (n=690) were included in a linked data set comprising the Health Insurance Review and Assessment Service claims database and the Clinical Research Center for Stroke registry data. Outcomes were long-term mortality, major bleeding including intracerebral hemorrhage and gastrointestinal bleeding, and recurrent ischemic stroke after ischemic stroke. Clinical factors related to outcomes after ischemic stroke, including vascular risk factors, acute stroke management, and types of cancer, were evaluated.

Of the 690 patients with cancer-related stroke (mean age, 68.5 years and 61.7% male) during a median 1.7 year period, 401 (58.1%) patients died during follow-up duration. Multivariate Cox regression analysis revealed that old age (hazard ratio [HR], 1.30 per 10 years [95% CI, 1.17-1.45]), stroke severity (HR, 1.05 [95% CI, 1.03-1.06]), anticoagulation at discharge (HR, 1.67 [95% CI, 1.02-2.74]), and types of cancer, such as pancreatic (HR, 3.73 [95% CI, 2.70-5.16]), hepatobiliary (HR, 2.31 [95% CI, 1.78-3.00]), and lung cancers (HR, 1.73 [95% CI, 1.33-2.25]), were significantly associated with long-term mortality. Major bleeding occurred in 42 patients (6.1%), and recurrent ischemic stroke was observed in 89 patients (12.9%) during the follow-up period.

Long-term outcomes of cancer-related stroke are poor. Treatment at discharge and cancer type are crucial factors associated with long-term mortality.