Analysis of Prognostic Factors for Survival in Patients with Trousseau Syndrome Initially Presenting with Acute Ischemic Stroke.

Introduction: Trousseau syndrome (TS) represents a significant vascular thromboembolic event in cancer patients and has progressively gained attention as a critical clinical concern in recent years. The aim of this study is to investigate the survival status and prognostic factors in patients with TS whose initial clinical manifestation was acute ischemic stroke (AIS).

Methods: A retrospective analysis was conducted on 24 TS patients hospitalized at the Affiliated Hospital of Jiangsu University between 2018 and 2024. Data collected included demographic characteristics, tumor staging, complete blood count, C-reactive protein (CRP), coagulation function, blood biochemistry analyses, tumor markers, National Institutes of Health Stroke Scale (NIHSS) scores, Modified Rankin Scale (mRS), and treatment regimen. Based on the temporal sequence of AIS onset relative to tumor diagnosis, patients were categorized into two groups: the AIS-TS (AIS as initial symptom with Trousseau syndrome, n = 9) group and the NAIS-TS (AIS was not as initial symptom with Trousseau syndrome, n = 15) group. Survival follow-up was performed via outpatient visits and telephone interviews. Kaplan-Meier survival analysis was used to compare survival rates between the two groups with Log-rank tests for statistical comparisons. Univariate Cox regression analysis was initially conducted to screen potential prognostic factors, followed by multivariate Cox regression analysis for variables with P < 0.1.

Results: Kaplan-Meier survival analysis revealed that the overall survival rate of the AIS-TS group was significantly lower than that of the NAIS-TS group (Log-rank χ² = 5.07, P = 0.024). Multivariate Cox regression analysis indicated that after adjusting for confounding factors, D-dimer index (DDI) (HR = 1.17, 95% CI 1.05 - 1.31, P = 0.004), carcinoembryonic antigen (CEA) (HR = 1.04, 95% CI 1.02 - 1.06, P = 0.001) and female gender (HR = 4.80, 95% CI 1.42 - 16.23, P = 0.012), were independent risk factors for all-cause mortality in TS patients.

Conclusion: TS patients presenting with AIS as the initial symptom exhibited shorter survival time and poorer prognoses. Female gender, elevated DDI and elevated CEA levels were identified as significant prognostic indicators influencing poor survival and prognosis in TS patients, potentially establishing a foundation for future prognostic evaluations in TS patients.