What is the clinical evidence from this study?

Study design: Cohort. Population: Gastric Cancer (n=45060). Intervention: Gastric cancer vs. Matched non-cancer cohort. Primary outcome: Ischemic stroke (HR 1.11, 95% CI 1.03-1.19, p=0.007).

September 1, 2015Open Access

Risk of Ischemic Stroke in Patients With Gastric Cancer

Key Result

Gastric cancer was associated with a significantly higher risk of subsequent ischemic stroke compared to a matched non-cancer cohort (HR 1.11).

Study Design

Type

Cohort (n=45,060)

Structured PICO

Does gastric cancer increase the risk of ischemic stroke in patients without antecedent stroke?

Population

45,060 adults aged 20 years and older, comprising 22,530 patients with gastric cancer and 22,530 matched non-cancer controls without prior stroke, followed for up to 9 years.

Exposure

Gastric cancer (exposure)

Comparator

Matched non-cancer cohort

Outcome

Ischemic strokehard clinical

Gastric cancer is associated with a significantly increased risk of ischemic stroke, particularly in patients younger than 65, females, and those who have undergone major surgery for their cancer.

Main Result

Hazard Ratio: 1.11 (95% CI 1.03–1.19)

Absolute Event Rate: 22.6% vs 21.4%

p-value: p=0.007

Limitations

Lack of information on lifestyle variables, behavioral factors, and biochemistry profiles (e.g., serum D-dimer level)
Gastric cancer staging data were not available in the database
Information on how participants managed their comorbidities was not analyzed
Information on cause of death was not available, potentially underestimating fatal ischemic strokes outside the hospital

Abstract

Improvements in therapeutic modalities have prolonged the survival of gastric cancer patients. Comorbidities such as thromboembolic events that emerge as a result of disease complexities and/or treatments received have not been considered. The objectives of this study are to examine the relationship between gastric cancer and ischemic stroke, and to determine predictive risk factors. A nationwide population-based cohort study was conducted using data from the Taiwan National Health Insurance database. A total of 45,060 gastric cancer patients and non-cancer counterparts without antecedent stroke were recruited. Hazard ratios (HRs) and the cumulative incidence of ischemic stroke were calculated, and risk factors for ischemic stroke were assessed. Gastric cancer patients were associated with higher risk of ischemic stroke (HR 1.11, 95% confidence interval CI 1.03-1.19, P = 0.007), especially in participants younger than 65 years (HR 1.61, 95% CI 1.39-1.86, P < 0.001) and in female participants (HR 1.30, 95% CI 1.14-1.49; P < 0.001) when compared with the matched cohort. Independent risk factors of ischemic stroke in gastric cancer patients included age, hypertension, atrial fibrillation, dyslipidemia, and having received major surgery for gastric cancer. Our findings suggest the importance of stroke surveillance and prevention strategies in high-risk patients. Having received major surgery for gastric cancer is a significant risk factor in these patients.

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