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Cancer in Young Adults With Ischemic Stroke

Journal article
Authors K. Aarnio
H. Joensuu
E. Haapaniemi
S. Melkas
M. Kaste
Turgut Tatlisumak
J. Putaala
Published in Stroke
Volume 46
Issue 6
Pages 1601-+
ISSN 0039-2499
Publication year 2015
Published at Institute of Neuroscience and Physiology
Pages 1601-+
Language en
Links dx.doi.org/10.1161/strokeaha.115.00...
Keywords outcome, MANIFESTATION, ASSOCIATION, PREVENTION, MORTALITY, REGISTRY, THERAPY, PATTERN, EVENTS, Clinical Neurology, Peripheral Vascular Disease
Subject categories Neurosciences, Neurology

Abstract

Background and Purpose-Cancer is a risk factor for ischemic stroke. Little is known about cancer among young adults with ischemic stroke. We studied the frequency of cancer and its association with long-term risk of death among young patients with first-ever ischemic stroke. Methods-1002 patients aged 15 to 49 years, registered in the Helsinki Young Stroke Registry, and with a median follow-up of 10.0 years (interquartile range 6.5-13.8) after stroke were included. Historical and follow-up data were derived from the Finnish Care Register and Statistics Finland. Survival between groups was compared with the Kaplan-Meier life-table method, and Cox proportional hazard models were used to identify factors associated with mortality. Results-One or more cancer diagnosis was made in 77 (7.7%) patients, of whom 39 (3.9%) had cancer diagnosed prestroke. During the poststroke follow-up, 41 (53.2%) of the cancer patients died. Median time from prestroke cancer to stroke was 4.9 (1.0-9.5) years and from stroke to poststroke cancer was 6.7 (2.7-10.9) years. Poststroke cancer was associated with age >40 years, heavy drinking, and cigarette smoking. The cumulative mortality was significantly higher among the cancer patients (68.6%, 95% confidence interval 52.0%-85.3%) compared with patients without cancer (19.7%, 95% confidence interval 16.3%-23.2%). Active cancer at index stroke, melanoma, and lung/respiratory tract cancer had the strongest independent association with death during the follow-up when adjusted for known poststroke mortality prognosticators. Conclusions-Cancer, and especially active cancer and no other apparent cause for stroke, is associated with unfavorable survival among young stroke patients.

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