Predictors of Survival in Patients With Ischemic Stroke and Active Cancer: A Prospective, Multicenter, Observational Study

Background: Patients with ischemic stroke and active cancer have a poor prognosis; however, supporting evidence remains limited. Methods: We conducted a prospective, multicenter, observational study in Japan including patients with acute ischemic stroke and active cancer to investigate the prognostic factors. We followed up the patients for 1 year after stroke onset. The patients were divided into two groups according to cryptogenic stroke and known etiologies (small vessel occlusion, large artery atherosclerosis, cardioembolism, other determined etiology) and survival was compared. The hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were calculated using Cox regression models. Results: We identified 135 eligible patients (39% women; median age, 75 years). Of these, 51% had distant metastasis. A total of 65 (48%) and 70 (52%) patients had cryptogenic stroke and known etiologies, respectively. Patients with cryptogenic stroke had significantly shorter survival than those with known etiologies (HR [95% CI], 3.11 [1.82-5.25]). The multivariate Cox regression analysis revealed that distant metastasis, plasma D-dimer levels, deep venous thrombosis and/or pulmonary embolism complications at stroke onset were independent predictors of mortality after adjusting for potential confounders. Cryptogenic stroke was associated with prognosis in univariate analysis but not significant in multivariate analysis. The plasma D-dimer levels stratified the prognosis of patients with ischemic stroke and active cancer. Conclusions: The prognosis of patients with acute ischemic stroke and active cancer varies considerably depending on stroke mechanism, distant metastasis, and coagulation abnormalities. Coagulation abnormalities are crucial in determining the prognosis of such patients.