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Clinical characteristics and tumor markers in ischemic stroke patients with active cancer

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Abstract

Cancer-associated ischemic stroke (CAS) refers to a hypercoagulation disorder related to malignant tumors, especially adenocarcinoma. Carbohydrate antigen (CA) 125 is a mucinous serum marker that might reflect hypercoagulation status, but the association between CA 125 and CAS is unclear across various types of cancer. The aim of this study was to investigate the associations among tumor markers, coagulation markers, and clinical factors in acute ischemic stroke (AIS) patients with active cancer. Consecutive AIS patients with active cancer (a diagnosis or ongoing active therapy for cancer within 6 months) were prospectively enrolled at four hospitals. D-dimer, C-reactive protein (CRP), carcinoembryonic antigen (CEA), CA19-9, and CA 125 levels were measured. Of 120 AIS patients with active cancer, 47 were diagnosed with CAS. CA 125 had the strongest correlations with D-dimer and CRP (ρ = 0.543, p < 0.001 and ρ = 0.452, p < 0.001, respectively). The areas under the receiver-operating characteristic curves for the diagnosis of CAS were 0.812 (95% CI 0.718–0.878) for CA 125, 0.714 (95% CI 0.602–0.801) for CEA, and 0.663 (95% CI 0.552–0.759) for CA 19-9. Multivariable analysis revealed that CA 125 levels in the highest quartile (OR 2.91, 95% CI 1.68–5.53), multiple lesions in multiple vascular territories observed on diffusion-weighted imaging, the absence of dyslipidemia, and the absence of atrial fibrillation were independently associated with CAS. Increased CA 125 levels, which indicate hypercoagulability, were useful for diagnosing CAS in AIS patients with active cancer.

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The data that support the findings of this study are available from the corresponding author on reasonable request.

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Acknowledgements

We express our gratitude to Mayumi Oda at Chikamori Hospital, Mari Okamoto at Kawasaki Medical School, and Makiko Miyamoto at National Hospital Organization Kure Medical Center and Chugoku Cancer Center for their secretarial assistance. This study was supported by a research grant from the Japan Society for the Promotion of Science KAKENHI (grant numbers 17K17907 and 20K16579).

Funding

This study was supported by a research grant from the Japan Society for the Promotion of Science KAKENHI (grant numbers 17K17907 and 20K16579).

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Authors and Affiliations

  1. Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Tomohisa Nezu, Hiroyuki Naito, Shiro Aoki, Yuji Shiga, Naoto Kinoshita, Teppei Kamimura, Hiroki Ueno, Tomohiko Ohshita & Hirofumi Maruyama

  2. Department of Neurology, Chikamori Hospital, Kochi, Japan

    Naohisa Hosomi, Daisuke Kuzume & Yuko Morimoto

  3. Department of Disease Model, Research Institute of Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Naohisa Hosomi

  4. Department of Neurology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan

    Tsuyoshi Torii, Takashi Kurashige & Tomohito Sugiura

  5. Department of Rheumatology, Chikamori Hospital, Kochi, Japan

    Takeshi Yoshida

  6. Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan

    Yoshiki Yagita & Naoki Oyama

Authors
  1. Tomohisa Nezu
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  2. Naohisa Hosomi
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  8. Daisuke Kuzume
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  9. Yuko Morimoto
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  11. Yoshiki Yagita
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  12. Naoki Oyama
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  13. Yuji Shiga
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  14. Naoto Kinoshita
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  15. Teppei Kamimura
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  16. Hiroki Ueno
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  17. Tomohiko Ohshita
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  18. Hirofumi Maruyama
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Contributions

TN: drafted and revised the manuscript for intellectual content, and collected data. NH, HN, SA, TT, TK, TS, DK, YM, TY, YY, NO, YS, NK, TK, HU, TO, and HM: revised the manuscript for intellectual content, and collected data.

Corresponding author

Correspondence to Tomohisa Nezu.

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Conflict of interest

Hirofumi Maruyama received grants from Daiichi Sankyo Co., Ltd.; these grants are unrelated to the submitted work. All other authors declare that they have no conflicts of interest.

Ethical approval

This study complies with the Declaration of Helsinki guidelines for investigations involving humans, and the study protocol was approved by the Ethics Committees of each hospital (Hiroshima University Hospital; E-608, National Hospital Organization Kure Medical Center; 29–01, Kawasaki Medical School Hospital; 2621, and Chikamori Hospital; 223). As this study used clinical records, it was performed under the opt-out method.

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Informed consent for participation was not obtained from the participants.

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Nezu, T., Hosomi, N., Naito, H. et al. Clinical characteristics and tumor markers in ischemic stroke patients with active cancer. Intern Emerg Med 17, 735–741 (2022). https://doi.org/10.1007/s11739-021-02862-1

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  • DOI: https://doi.org/10.1007/s11739-021-02862-1

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