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. 2023 Sep;8(3):792-801.
doi: 10.1177/23969873231181628. Epub 2023 Jun 15.

The crosstalk between Stroke and Cancer: Incidence of cancer after a first-ever cerebrovascular event in a population-based study

Catarina Guedes Vaz  1   2 , Jéssica Rodrigues  3 , Diogo Pereira  1 , Ilda Matos  4 , Carla Oliveira  5   6 , Maria José Bento  2   3 , Rui Magalhães  2 , Manuel Correia  1   2 , Luis F Maia  1   2   5
Affiliations

The crosstalk between Stroke and Cancer: Incidence of cancer after a first-ever cerebrovascular event in a population-based study

Catarina Guedes Vaz et al. Eur Stroke J. 2023 Sep.

Abstract

Objectives: To determine the cancer incidence after the first-ever cerebrovascular event (CVE) and compare it to the cancer incidence in the population from the same region.

Methods: We evaluated 1069 patients with a first-ever CVE (Ischaemic or haemorrhagic stroke and Transient Ischaemic Attack) from a prospective population registry of stroke and transient focal neurological attacks, diagnosed between 2009 and 2011. We conducted a structured search to identify cancer-related variables and case-fatality for a period of 8 years following CVE. Cancer incidence in CVE patients was compared to the North Region Cancer Registry (RORENO).

Results: We found that 90/1069 (8.4%) CVE patients developed cancer after a first-ever CVE. Overall cancer annual incidence rate was higher after a CVE (820/100,000, 95%CI: 619-1020) than in general population (513/100,000, 95%CI: 508-518). In the 45-54 age group cancer incidence post-CVE was 3.2-fold (RR, 95%CI: 1.6-6.4) higher compared to the general population, decreasing gradually in older age-groups. Median time between CVE and cancer was 3.2 years (IQR = 1.4-5.2). Lower respiratory tract and colorectal were the most frequent cancer types. In univariable models, male sex (sHR = 1.78, 95%CI: 1.17-2.72, p = 0.007), tobacco use (sHR = 2.04, 95%CI: 1.31-3.18, p = 0.002) and peripheral artery disease (sHR = 2.37, 95%CI: 1.10-5.13, p = 0.028) were associated to higher cancer risk after CVE. After adjustment, tobacco use (sHR = 1.84, 95%CI: 1.08-3.14, p = 0.026) remained associated to a higher risk of cancer.

Conclusions: At the population level, patients presenting a first-ever CVE have higher cancer incidence, that is particularly prominent in younger age-groups. Higher cancer incidence, delayed cancer diagnosis and increased mortality post-CVE warrants further research on long-term cancer surveillance in first-ever CVE survivors.

Keywords: Stroke; Transient Ischaemic Attack; cancer; incidence; population study.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart describing study design and patient selection.
Figure 2.
Figure 2.
Cumulative incidence functions for all possible outcomes (Cancer or Death) taking competing risks into account: (a) including stroke-mortality (⩽30 days), n = 1069 and (b) excluding stroke-mortality, n = 984.
Figure 3.
Figure 3.
Sex-specific annual incidence rates for Cancer in ACIN2 patients and RORENO population. In green cancer incidence in the general population (RORENO); In Blue cancer incidence in Ischaemic strokes and TIAs; In Grey cancer incidence in all strokes and TIAs.
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