Incidence and risk factors for ischemic stroke in patients with cancer: A retrospective observational study

Patients with cancer have an elevated risk of ischemic stroke, which can interrupt cancer treatment and worsen survival outcomes. However, epidemiological data on stroke incidence and risk factors in this population remain limited.

We conducted a retrospective observational study of 35,862 patients with cancer registered at the University of Osaka Hospital between 2007 and 2020. Patients were followed for one year after cancer diagnosis to evaluate the cumulative incidence of ischemic stroke, accounting for death as a competing risk. Risk factors were assessed using the Fine and Gray competing risk model, with subdistribution hazard ratios (SHRs) and their 95 % confidence intervals (CIs) calculated.

During the study period, 188 patients experienced a stroke. Of these, ischemic stroke was the most common type, occurring in 143 patients (76.1 %), followed by intracerebral hemorrhage in 38 patients (20.2 %) and subarachnoid hemorrhage in 7 patients (3.7 %). The 1-year cumulative incidence of ischemic stroke was 0.42 %. In multivariable analysis, independent risk factors for ischemic stroke included older age (adjusted SHR, 1.01; 95 % CI, 1.00-1.03), hypertension (1.59; 95 % CI, 1.10-2.30), dyslipidemia (1.60; 95 % CI, 1.09-2.36), atrial fibrillation (2.42; 95 % CI, 1.54-3.81), and advanced stages (1.74; 95 % CI, 1.12-2.70). Elevated leukocyte count (≥11,000/μL) and platelet count (≥350,000/μL) at cancer diagnosis were also independent predictors of ischemic stroke.

Our findings suggest that older age, hypertension, dyslipidemia, atrial fibrillation, advanced stages, and elevated leukocyte and platelet count could represent potential risk factors for ischemic stroke in patients with cancer.