The Effect of Chemotherapy on Stroke Risk in Cancer Patients

Takaya Kitano; Tsutomu Sasaki; Yasufumi Gon; Kenichi Todo; Shuhei Okazaki; Tetsuhisa Kitamura; Yuri Kitamura; Manabu Sakaguchi; Tomotaka Sobue; Yasushi Matsumura; Satoshi Hattori; Hideki Mochizuki

doi:10.1055/s-0040-1708484

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2020; 120(04): 714-723
DOI: 10.1055/s-0040-1708484

Stroke, Systemic or Venous Thromboembolism

Georg Thieme Verlag KG Stuttgart · New York

The Effect of Chemotherapy on Stroke Risk in Cancer Patients

Authors

Takaya Kitano

¹Department of Neurology, Graduate School of Medicine, Osaka University, Osaka, Japan
Tsutomu Sasaki

¹Department of Neurology, Graduate School of Medicine, Osaka University, Osaka, Japan
Yasufumi Gon

¹Department of Neurology, Graduate School of Medicine, Osaka University, Osaka, Japan
Kenichi Todo

¹Department of Neurology, Graduate School of Medicine, Osaka University, Osaka, Japan
Shuhei Okazaki

¹Department of Neurology, Graduate School of Medicine, Osaka University, Osaka, Japan
Tetsuhisa Kitamura

²Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
Yuri Kitamura

²Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
Manabu Sakaguchi

¹Department of Neurology, Graduate School of Medicine, Osaka University, Osaka, Japan
Tomotaka Sobue

²Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
Yasushi Matsumura

³Department of Medical Information Science, Graduate School of Medicine, Osaka University, Osaka, Japan
Satoshi Hattori

⁴Department of Integrated Medicine, Biomedical Statistics, Graduate School of Medicine, Osaka University, Osaka, Japan
Hideki Mochizuki

¹Department of Neurology, Graduate School of Medicine, Osaka University, Osaka, Japan

Abstract

Background Chemotherapy may be a cause of cancer-associated stroke, but whether it increases stroke risk remains uncertain. We investigated how chemotherapy affects stroke risk in cancer patients.

Methods Of 27,932 patients in a hospital-based cancer registry (which contains clinical data on all patients treated for cancer at Osaka University Hospital) screened between 2007 and 2015, medical records of 19,006 patients with complete data were investigated. A validated algorithm was used to identify stroke events within 2 years of cancer diagnosis. Patients were divided based on whether their initial treatment plan included chemotherapy. The association between chemotherapy and stroke was analyzed using the Kaplan–Meier method and stratified Cox regression.

Results Of 19,006 patients, 5,887 (31%) were in the chemotherapy group. Stroke occurred in 44 (0.75%) and 51 (0.39%) patients in the chemotherapy and nonchemotherapy group, respectively. Kaplan–Meier curve analysis showed that patients in the chemotherapy group had a higher stroke risk than those in the nonchemotherapy group (hazard ratio [HR] 1.84; 95% confidence interval [CI] 1.23–2.75). However, this difference was insignificant after adjustment for cancer status using inverse probability of treatment weighting with propensity scores (HR 1.20; 95% CI 0.76–1.91). Similarly, in the stratified Cox regression model, chemotherapy was not associated with stroke after adjustment for cancer status (HR 1.26; 95% CI 0.78–2.03).

Conclusion In our study, the elevated stroke risk in cancer patients who received chemotherapy was presumably due to advanced cancer stage; chemotherapy was not associated with the increased risk of stroke.

Keywords

stroke - cerebral infarction - cerebrovascular disease - neoplasms - cancer

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