Joonsang Yoo1,2, Young Dae Kim1, Hyungjong Park1,3, Byung Moon Kim4, Oh Young Bang5, Hyeon Chang Kim6, Euna Han7, Dong Joon Kim4, Joonnyung Heo1, Minyoung Kim1, Jin Kyo Choi1, Kyung-Yul Lee8, Hye Sun Lee9, Dong Hoon Shin10, Hye-Yeon Choi11, Sung-Il Sohn3, Jeong-Ho Hong1,3, Jong Yun Lee12, Jang-Hyun Baek12,13, Gyu Sik Kim14, Woo-Keun Seo5, Jong-Won Chung5, Seo Hyun Kim15, Tae-Jin Song16, Sang Won Han17, Joong Hyun Park17, Jinkwon Kim2,18, Yo Han Jung8,19, Han-Jin Cho20, Seong Hwan Ahn21, Sung Ik Lee22, Kwon-Duk Seo14,22, Ji Hoe Heo, Hyo Suk Nam1. 1. Department of Neurology (J.Y., Y.D.K., H.P., J.H., M.K., J.K.C., J.H.H., H.S.N.), Yonsei University College of Medicine, Seoul, Korea. 2. Department of Neurology, Yongin Severance Hospital (J.Y., J.K.), Yonsei University College of Medicine, Seoul, Korea. 3. Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea (H.P., S.-I.S., J.-H.H.). 4. Department of Radiology (B.M.K., D.J.K.), Yonsei University College of Medicine, Seoul, Korea. 5. Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (O.Y.B., W.-K.S., J.-W.C.). 6. Department of Preventive Medicine (H.C.K.), Yonsei University College of Medicine, Seoul, Korea. 7. College of Pharmacy, Yonsei Institute for Pharmaceutical Research, Yonsei University, Incheon, South Korea (E.H.). 8. Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research (K.-Y.L., Y.H.J.), Yonsei University College of Medicine, Seoul, Korea. 9. Biostatistics Collaboration Unit, Department of Research Affairs (H.S.L.), Yonsei University College of Medicine, Seoul, Korea. 10. Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea (D.H.S.). 11. Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea (H.-Y.C.). 12. Department of Neurology, National Medical Center, Seoul, Korea (J.Y.L., J.-H.B.). 13. Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-H.B.). 14. Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea (G.S.K., K.-D.S.). 15. Department of Neurology, Yonsei University Wonju College of Medicine, Korea (S.H.K.). 16. Department of Neurology, Seoul Hospital, College of Medicine, Ewha Woman's University, Korea (T.-J.S.). 17. Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea (S.W.H., J.H.P.). 18. Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (J.K.). 19. Department of Neurology, Changwon Fatima Hospital, Korea (Y.H.J.). 20. Department of Neurology, Pusan National University School of Medicine, Busan, Korea (H.-J.C.). 21. Department of Neurology, Chosun University School of Medicine, Gwangju, Korea (S.H.A.). 22. Department of Neurology, Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea (S.I.L., K.-D.S.).
Abstract
Background and Purpose: Patients with acute stroke are often accompanied by comorbidities, such as active cancer. However, adequate treatment guidelines are not available for these patients. The purpose of this study was to evaluate the association between cancer and the outcomes of reperfusion therapy in patients with stroke. Methods: We compared treatment outcomes in patients who underwent reperfusion therapy, using a nationwide reperfusion therapy registry. We divided the patients into 3 groups according to cancer activity: active cancer, nonactive cancer, and without a history of cancer. We investigated reperfusion processes, 24-hour neurological improvement, adverse events, 3-month functional outcome, and 6-month survival and related factors after reperfusion therapy. Results: Among 1338 patients who underwent reperfusion therapy, 62 patients (4.6%) had active cancer, 78 patients (5.8%) had nonactive cancer, and 1198 patients (89.5%) had no history of cancer. Of the enrolled patients, 969 patients received intravenous thrombolysis and 685 patients underwent endovascular treatment (316 patients received combined therapy). Patients with active cancer had more comorbidities and experienced more severe strokes; however, they showed similar 24-hour neurological improvement and adverse events, including cerebral hemorrhage, compared with the other groups. Although the functional outcome at 3 months was poorer than the other groups, 36.4% of patients with active cancer showed functional independence. Additionally, 52.9% of the patients with determined stroke etiology showed functional independence despite active cancer. During the 6-month follow-up, 46.6% of patients with active cancer died, and active cancer was independently associated with poor survival (hazard ratio, 3.973 [95% CI, 2.528–6.245]). Conclusions: In patients with active cancer, reperfusion therapy showed similar adverse events and short-term outcomes to that of other groups. While long-term prognosis was worse in the active cancer group than the nonactive cancer groups, not negligible number of patients had good functional outcomes, especially those with determined stroke mechanisms.
Background and Purpose: Patients with acute stroke are often accompanied by comorbidities, such as active cancer. However, adequate treatment guidelines are not available for these patients. The purpose of this study was to evaluate the association between cancer and the outcomes of reperfusion therapy in patients with stroke. Methods: We compared treatment outcomes in patients who underwent reperfusion therapy, using a nationwide reperfusion therapy registry. We divided the patients into 3 groups according to cancer activity: active cancer, nonactive cancer, and without a history of cancer. We investigated reperfusion processes, 24-hour neurological improvement, adverse events, 3-month functional outcome, and 6-month survival and related factors after reperfusion therapy. Results: Among 1338 patients who underwent reperfusion therapy, 62 patients (4.6%) had active cancer, 78 patients (5.8%) had nonactive cancer, and 1198 patients (89.5%) had no history of cancer. Of the enrolled patients, 969 patients received intravenous thrombolysis and 685 patients underwent endovascular treatment (316 patients received combined therapy). Patients with active cancer had more comorbidities and experienced more severe strokes; however, they showed similar 24-hour neurological improvement and adverse events, including cerebral hemorrhage, compared with the other groups. Although the functional outcome at 3 months was poorer than the other groups, 36.4% of patients with active cancer showed functional independence. Additionally, 52.9% of the patients with determined stroke etiology showed functional independence despite active cancer. During the 6-month follow-up, 46.6% of patients with active cancer died, and active cancer was independently associated with poor survival (hazard ratio, 3.973 [95% CI, 2.528–6.245]). Conclusions: In patients with active cancer, reperfusion therapy showed similar adverse events and short-term outcomes to that of other groups. While long-term prognosis was worse in the active cancer group than the nonactive cancer groups, not negligible number of patients had good functional outcomes, especially those with determined stroke mechanisms.