Insights into cancer–associated stroke through database research

Abstract

Cancer patients have an increased risk of ischemic stroke compared to the general population, presenting unique clinical features related to cancer–induced coagulation activation. Since 2015, we have been working to elucidate the mechanisms behind cancer–associated stroke using various databases (DBs) ranging from a single hospital–based stroke registry to large–scale epidemiological DBs.

We found that coagulation activation in advanced cancer patients is a key determinant of both ischemic stroke onset and long–term prognosis. The AHANDS score–consisting of six parameters at cancer diagnosis : Age, Hypertension, Atrial fibrillation, Neutrophil–to–lymphocyte ratio, D–dimer levels, and advanced cancer Stage– is useful for identifying patients at high risk for cancer–associated stroke. Furthermore, analyses of large–scale epidemiological DBs revealed that the mortality rate in patients with cancer–associated stroke varies significantly by cancer site.

Conventionally, cancer and ischemic stroke have been managed as an independent clinical entity. However, it is now understood that there is a bidirectional interaction between cancer and ischemic stroke. At present, standardized prevention and treatment strategies for cancer–associated stroke have yet to be established, and numerous unresolved issues persist. Therefore, further elucidation of the pathogenesis is warranted.