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Authors
Advisor(s)
Abstract(s)
Introdução: A doença cerebrovascular é a segunda complicação neurológica mais comum que
ocorre nos doentes com cancro, e o próprio Acidente Vascular Cerebral (AVC) pode ser a
primeira manifestação de uma neoplasia oculta. Clinicamente, estes eventos vasculares
cerebrais não diferem entre os pacientes oncológicos e a população em geral. Por outro lado,
é difícil estabelecer-se, com clareza, se a relação entre estas duas patologias é causal, ou
meramente casual. Existem estudos que indicam uma prevalência superior de AVC em
pacientes com cancro. O envelhecimento da população e o avanço nas terapias antitumorais,
com a melhoria na sobrevida destes doentes, faz prever um aumento de casos com ambos os
distúrbios, o que torna imperativa a melhoria da sua compreensão.
Objetivos: Pretendeu-se determinar a prevalência de cancro nos doentes internados por AVC
e identificar os principais tipos de neoplasia presentes. Colocou-se a hipótese de que o
eventual contributo etiológico da doença maligna levasse à existência de um padrão típico
nestes doentes, relativamente a dados demográficos, fatores de risco vascular, parâmetros
analíticos e mecanismos de AVC. Do mesmo modo, previu-se que o cancro influenciaria
negativamente o prognóstico destes doentes. O propósito final deste estudo reside no auxílio
para o desenvolvimento de medidas preventivas e abordagens terapêuticas mais adaptadas às
necessidades das populações.
Métodos: O presente estudo retrospetivo analisou os pacientes admitidos na Unidade de AVC,
do Centro Hospitalar Cova da Beira, entre 2008 e 2011, e incluiu os que tinham diagnóstico de
cancro no grupo de casos. O grupo controlo foi definido pelos doentes não oncológicos, cuja
hospitalização decorreu no ano de 2008. Foram acedidas variáveis demográficas, fatores de
risco vascular, parâmetros laboratoriais, escalas de avaliação funcional, dados de
mortalidade, mecanismos de AVC, tipos de cancro, data do diagnóstico oncológico e
tratamentos antitumorais já efetuados.
Resultados: Foram internados 1054 doentes, 48 dos quais com cancro (4,55%), sendo que os
mais frequentes foram o cancro colorrectal (14), mama (8) e próstata (7). Os pacientes
oncológicos tiveram maior proporção de AVC de mecanismo idiopático, comparativamente aos
controlos. A análise estatística univariável revelou níveis mais elevados de Proteína C Reativa
(em AVC hemorrágicos) e D-dímeros (em AVC isquémicos), e níveis mais baixos de HDL e
hematócrito (em AVC isquémicos) nos pacientes com cancro. Contudo, apenas os D-dímeros
apresentaram uma relação independente na análise multivariável. A dependência funcional
parece ser influenciada negativamente pela idade, presença de fibrilhação auricular e AVC de
tipo hemorrágico. Curiosamente, o cancro não influenciou o prognóstico.
Conclusões: A proporção aumentada de AVC por mecanismos não-convencionais alerta para o
potencial contributo dos distúrbios de coagulação subjacentes à condição oncológica de base. As neoplasias mais comuns são as mesmas que afetam a população portuguesa, ou seja, a sua ocorrência não pode contribuir para aumentar o grau de suspeição quanto a um eventual AVC. São necessários mais estudos para consolidar os achados laboratoriais e para esclarecer importância do cancro no prognóstico, através de um acompanhamento além do internamento. Até lá, uma vez que a triagem oncológica de todos os doentes com AVC não é exequível, recomenda-se a avaliação crítica destes quatro parâmetros (D-dímeros, proteína C reativa, HDL e hematócrito), com o intuito de se fazer a seleção dos pacientes que devem ser investigados quanto à possível existência de uma neoplasia oculta.
Introduction: Cerebrovascular disease is the second most common neurological complication that occurs in patients with cancer, and stroke may be the first manifestation of an occult malignancy. Clinically, these cerebrovascular events did not differ between the cancer patients and the general population. On the other hand, it is difficult to establish with clarity if the relationship between these two pathologies is causal, or merely casual. There are studies that indicate a higher prevalence of stroke in patients with cancer. Ageing of the population and advances in antitumour therapies, with improved survival in these patients, does provide an increase in cases with both disorders, which makes it imperative to improve their understanding. Goals: The aim was to determine the prevalence of cancer in patients admitted for stroke and identify the major types of cancer present. It was considered the hypothesis that the possible contribution of malignant disease would lead to the existence of a typical pattern in these patients, for demographic data, vascular risk factors, analytic parameters and mechanisms of stroke. Similarly, it was predicted that cancer would adversely affect the prognosis of these patients. The ultimate purpose of this study is to aid in the development of preventive and therapeutic approaches better adapted to the population needs. Methods: This retrospective study analysed patients admitted to the stroke unit, of Cova da Beira Hospital Centre between 2008 and 2011, and included those who had a diagnosis of cancer in the group of cases. The control group was defined by non-cancer patients whose hospitalization was held in 2008. We had accessed to demographic variables, vascular risk factors, laboratory parameters, functional assessment scales, mortality data, mechanisms of stroke, cancer types, the date of the cancer diagnosis and antitumour treatments already made. Results: 1054 patients, 48 of whom had cancer (4.55%) were hospitalized, and the most common were colorectal cancer (14), breast (8) and prostate (7). The cancer patients had a higher rate of stroke of idiopathic mechanism, compared to controls. The univariate statistical analysis revealed higher levels of C-reactive protein (in hemorrhagic stroke) and D-dimers (in ischemic stroke), and lower HDL levels and haematocrit (in ischemic stroke) in patients with cancer. However, only the D-dimer showed an independent relationship in multivariate analysis. The functional dependence seems to be negatively influenced by age, presence of atrial fibrillation and stroke hemorrhagic type. Interestingly, the cancer did not influence prognosis. Conclusions: Increased proportion of stroke by non-conventional mechanisms alert to the potential contribution of coagulation disorders underlying oncologic condition. The most common cancers are the same that affect the Portuguese population, i.e., their occurrence cannot contribute to increase the level of suspicion regarding a possible stroke. More studies are needed to consolidate the laboratorial findings and to clarify the importance of cancer prognosis by monitoring beyond the hospital. Until then, once the cancer screening of all stroke patients is not feasible, critical evaluation of these four parameters (D-dimers, C-reactive protein, HDL and haematocrit) in patients with cancer, in order to make the selection of patients who should be investigated for the possible existence of a hidden malignancy is recommended.
Introduction: Cerebrovascular disease is the second most common neurological complication that occurs in patients with cancer, and stroke may be the first manifestation of an occult malignancy. Clinically, these cerebrovascular events did not differ between the cancer patients and the general population. On the other hand, it is difficult to establish with clarity if the relationship between these two pathologies is causal, or merely casual. There are studies that indicate a higher prevalence of stroke in patients with cancer. Ageing of the population and advances in antitumour therapies, with improved survival in these patients, does provide an increase in cases with both disorders, which makes it imperative to improve their understanding. Goals: The aim was to determine the prevalence of cancer in patients admitted for stroke and identify the major types of cancer present. It was considered the hypothesis that the possible contribution of malignant disease would lead to the existence of a typical pattern in these patients, for demographic data, vascular risk factors, analytic parameters and mechanisms of stroke. Similarly, it was predicted that cancer would adversely affect the prognosis of these patients. The ultimate purpose of this study is to aid in the development of preventive and therapeutic approaches better adapted to the population needs. Methods: This retrospective study analysed patients admitted to the stroke unit, of Cova da Beira Hospital Centre between 2008 and 2011, and included those who had a diagnosis of cancer in the group of cases. The control group was defined by non-cancer patients whose hospitalization was held in 2008. We had accessed to demographic variables, vascular risk factors, laboratory parameters, functional assessment scales, mortality data, mechanisms of stroke, cancer types, the date of the cancer diagnosis and antitumour treatments already made. Results: 1054 patients, 48 of whom had cancer (4.55%) were hospitalized, and the most common were colorectal cancer (14), breast (8) and prostate (7). The cancer patients had a higher rate of stroke of idiopathic mechanism, compared to controls. The univariate statistical analysis revealed higher levels of C-reactive protein (in hemorrhagic stroke) and D-dimers (in ischemic stroke), and lower HDL levels and haematocrit (in ischemic stroke) in patients with cancer. However, only the D-dimer showed an independent relationship in multivariate analysis. The functional dependence seems to be negatively influenced by age, presence of atrial fibrillation and stroke hemorrhagic type. Interestingly, the cancer did not influence prognosis. Conclusions: Increased proportion of stroke by non-conventional mechanisms alert to the potential contribution of coagulation disorders underlying oncologic condition. The most common cancers are the same that affect the Portuguese population, i.e., their occurrence cannot contribute to increase the level of suspicion regarding a possible stroke. More studies are needed to consolidate the laboratorial findings and to clarify the importance of cancer prognosis by monitoring beyond the hospital. Until then, once the cancer screening of all stroke patients is not feasible, critical evaluation of these four parameters (D-dimers, C-reactive protein, HDL and haematocrit) in patients with cancer, in order to make the selection of patients who should be investigated for the possible existence of a hidden malignancy is recommended.
Description
Keywords
Acidente Vascular Cerebral Cancro Coagulopatia D-Dímeros