Stroke in Patients with Unresectable Pancreatic Cancer Undergoing Chemotherapy: Clinical Characteristics and Risk Assessment

Ischemic stroke is one of the most serious complications in pancreatic cancer patients. In this study, we examined the clinical characteristics and risk factors for stroke in patients with unresectable pancreatic cancer receiving chemotherapy. We conducted a retrospective cohort study of 343 consecutive patients with recurrent or unresectable pancreatic cancer with chemotherapy started between April 2017 and December 2022. We investigated the clinical characteristics of stroke and risk factors for stroke within 180 days after starting chemotherapy and during the entire follow-up period. Stroke occurred in 11 patients (3.2%) within the first 180 days. Although five patients were treated with anticoagulants and/or mechanical thrombectomy, only two patients were able to continue chemotherapy after the stroke. The median survival time after stroke was 28 days. Elevated D-dimer (≥2.9 μg/mL) and CA19-9 (≥1621 U/mL) values at the start of chemotherapy were significant independent risk factors for stroke within 180 days. The combined score calculated with these two factors stratified the stroke risk within 180 days and during the entire follow-up period of a median of 11.3 months and as long as 58.7 months. Stroke within 180 days occurred in 3.2% of patients and was commonly associated with discontinuation of chemotherapy and short survival. The combined score calculated with D-dimer and CA 19-9 levels predicted the stroke risk in pancreatic cancer patients receiving chemotherapy.