急性梗塞性腦中風癌症患者短期預後分析

研究目的:癌症和腦中風，各居台灣2022年國民前十大死因的第一名和第五名。這兩類疾病除了對病患的存活造成威脅，同時也是造成病患失能的常見原因。綜觀過去的研究，我們已知癌症患者比一般族群有較高的腦中風。現今也有許多臨床研究積極探討這兩者疾病之間於病生理學的關聯。考量癌症和腦中風兩者的交互關係，本文聚焦於有癌症病史的梗塞性腦中風患者在急性腦中風的短期預後表現，以及潛在可能影響這一族群患者中風預後的危險因子分析。研究方法及資料:本研究設計為一回溯性研究，資料來源為台中市中山醫學大學附設醫院腦中風中心針對全院腦血管疾病患者的登錄資料庫。研究期間設定為2018年到2023年六月，研究主體為因急性梗塞性腦中風住院合併癌症病史的患者，排除因癌症導致腦部轉移的患者。我們蒐集了病人基本資料、腦中風危險因子、癌症種類和腦部梗塞分佈以藉由SPSS IBM Statistic 20軟體分析。研究欲分析研究期間內有癌症病史的腦中風患者的發生率、又這些併癌症病史的中風患者於中風治療出院後第三個月的活動功能狀態，以及後續追蹤至第六個月後的死亡率。研究結果:全部1727位梗塞性腦中風患者裡，有癌症共病腦中風患者共有190位，約占整體11%。男性107人，女性83人，平均年紀為71.34歲，年紀分布 44-97歲。這190位患者中又有79位為正在接受腫瘤治療的活動性癌症狀態，約占41.6%。這些患者在傳統腦中風危險因子的表現與一般梗塞性腦中風患者並無顯著差異。約52.6%的患者在中風後三個月可獨立生活或輔助行走，追蹤到第六個月的死亡人數為17人(8.94%)。癌症的類型對於病患在本研究中風後三個月的短期功能表現沒有統計上的意義，然而病患年紀、活動性癌症和腦部影像呈多處梗塞的情況對病人在第六個月的存活有影響程度。結論與建議:由於癌症患者的臨床症狀多變和複雜的病生理機轉，對於臨床醫師在中風治療決策上總是具備挑戰需要更全面多方地考量。根據本篇文章的結論，有癌症病史的梗塞性腦中風患者仍有超過一半的患者在中風後三個月能夠回復到獨立生活功能。或許與人民對腦中風症狀的認知與急性腦中風的治療進步有關。於傳統腦中風風險因子分析上，共存癌症史的腦中風患者和非癌中風病人沒有顯著的群體差異。然而，活動性癌症狀態卻與中風後六個月的死亡率相關。這暗示了臨床醫師除了要針對癌症患者進行常見腦中風危險因子篩檢和積極控制心血管危險因子，同時也需要鼓勵病患積極面對癌症治療以期降低腦血管事件。對於反覆中風又沒有明顯心腦血管危險因子的患者，或是異常的高凝血狀態也需要警覺這類患者是否有尚未診斷的癌症。

Objective: Cancer is the first leading cause of death in the past four decades, with a tendency to rise in incidence rate annually, and stroke is the fifth leading cause of death, according to the ranking of the causes of death in Taiwan in 2022. Nowadays, many clinical studies reveal the association between cancer and cerebrovascular events. Both stroke and cancer are common causes of disability worldwide. We aim to observe the incidence of stroke patients with comorbid cancer, the short-term prognosis of acute ischemic stroke patients with cancer, and to evaluate if there are any risk factors that may affect the functional outcome among these patients.Methods and Materials: This is a retrospective study based on the registry data from the Stroke Center at Chung-Shan Medical University Hospital, Taichung, Taiwan. SPSS IBM Statistic 20.0 software was used for statistical analysis. A total of 1727 consecutive acute ischemic stroke patients admitted from 2018 to June 2023 were recruited. Patient's basic information, traditional stroke risk factors, and cancer types were recorded for further analysis to determine whether any of them would affect the functional status of this group of patients at 3 months after stroke and the 6-month mortality rate.Results: All 1727 acute-ischemic stroke patients were included. Of them, 11% had comorbid cancer, and 46% were classified as having active cancer status based on any concurrent anti-neoplastic treatment. Our study showed no significant difference in the performance of traditional stroke risk factors in these patients from that of the general population of non-cancer comorbidity ischemic stroke patients. At 3 months after stroke, about 52.6% of patients were able to live independently or walk with assistance. The number of deaths in the sixth month after a stroke was 17 (8.94%). The type of cancer did not have a statistically significant influence on short-term functional performance three months after stroke, according to our study observation. However, patient age and active cancer has an impact on the 6-month mortality rate.Conclusions and Suggestions: Clinical management of stroke patients with cancer is quite challenging for neurologists, particularly in terms of stroke prevention in a specific patient group with comorbid cancer history. According to the conclusions of this article, more than half of patients with infarct stroke who have comorbid cancer can still return to favorable independent daily activities three months after stroke. Although there are no significant group differences in traditional stroke risk factors among patients with comorbid cancer compared to the general population of stroke patients, clinicians are still encouraged to screen those well-known stroke risk factors for early prevention and intervention as well as keep patients on track for anti-cancer treatment in order to reduce cerebrovascular events.