Embolization of tumor cells is rare in patients with systemic cancer and cerebral large vessel occlusion.
cancer
stroke
thrombectomy
thrombus
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
11
05
2020
revised:
27
05
2020
accepted:
27
05
2020
pubmed:
4
6
2020
medline:
30
6
2021
entrez:
4
6
2020
Statut:
ppublish
Résumé
Stroke is a dreaded complication in patients with cancer. Besides paraneoplastic coagulopathy, chemotherapy, radiotherapy and tumor-directed invasive procedures, circulating cancer cells may contribute to thrombus formation and embolic stroke. However, the incidence of tumor cells within the blood clots of cancer patients with stroke is unknown and the role of circulating tumor cells in the formation of cerebrovascular thrombi remains unclear. All patients who had undergone cerebrovascular thrombectomy at the University Hospital Zurich between 2014 and 2017 were screened for history of cancer. Clinical information was retrieved from the local stroke registry and the electronic charts and thrombi underwent a thorough histopathological re-review. Thirty-two of 182 patients (18%) with thrombectomy had a history of cancer. The majority of patients had advanced stage cancer. However, even after extensive histopathological re-review, only one specimen revealed tumor cells in the thrombus: a 75-year-old patient with acute occlusion of the middle cerebral artery who had been diagnosed with non-small-cell lung cancer 8.1 months prior to stroke. The presence of cancer cells in clots from cerebrovascular thrombectomy, indicative of a direct involvement of circulating tumor cells in the causation of stroke, is rare.
Sections du résumé
BACKGROUND AND PURPOSE
Stroke is a dreaded complication in patients with cancer. Besides paraneoplastic coagulopathy, chemotherapy, radiotherapy and tumor-directed invasive procedures, circulating cancer cells may contribute to thrombus formation and embolic stroke. However, the incidence of tumor cells within the blood clots of cancer patients with stroke is unknown and the role of circulating tumor cells in the formation of cerebrovascular thrombi remains unclear.
METHODS
All patients who had undergone cerebrovascular thrombectomy at the University Hospital Zurich between 2014 and 2017 were screened for history of cancer. Clinical information was retrieved from the local stroke registry and the electronic charts and thrombi underwent a thorough histopathological re-review.
RESULTS
Thirty-two of 182 patients (18%) with thrombectomy had a history of cancer. The majority of patients had advanced stage cancer. However, even after extensive histopathological re-review, only one specimen revealed tumor cells in the thrombus: a 75-year-old patient with acute occlusion of the middle cerebral artery who had been diagnosed with non-small-cell lung cancer 8.1 months prior to stroke.
CONCLUSIONS
The presence of cancer cells in clots from cerebrovascular thrombectomy, indicative of a direct involvement of circulating tumor cells in the causation of stroke, is rare.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2041-2046Subventions
Organisme : Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
ID : PP00P3_170683
Pays : International
Organisme : University of Zurich
ID : Clinical Research Priority Program (CRPP) stroke
Pays : International
Organisme : Filling-The-Gap Program
Pays : International
Informations de copyright
© 2020 European Academy of Neurology.
Références
Zoller B, Ji J, Sundquist J, Sundquist K. Risk of coronary heart disease in patients with cancer: a nationwide follow-up study from Sweden. Eur J Cancer. 2012; 48: 121-128.
Navi BB, Iadecola C. Ischemic stroke in cancer patients: a review of an underappreciated pathology. Ann Neurol. 2018; 83: 873-883.
Seebacher NA, Stacy AE, Porter GM, Merlot AM. Clinical development of targeted and immune based anti-cancer therapies. J Exp Clin Cancer Res. 2019; 38: 156.
Dardiotis E, Aloizou AM, Markoula S, et al. Cancer-associated stroke: pathophysiology, detection and management (review). Int J Oncol. 2019; 54: 779-796.
Siravegna G, Marsoni S, Siena S, Bardelli A. Integrating liquid biopsies into the management of cancer. Nat Rev Clin Oncol. 2017; 14: 531-548.
Le Rhun E, Seoane J, Salzet M, Soffietti R, Weller M. Liquid biopsies for diagnosing and monitoring primary tumors of the central nervous system. Cancer Lett. 2020; 480: 24-28.
Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35-41.
Fonkem E, Lok E, Robison D, Gautam S, Wong ET. The natural history of intravascular lymphomatosis. Cancer Med. 2014; 3: 1010-1024.
Stefanou MI, Rath D, Stadler V, et al. Cardiac myxoma and cerebrovascular events: a retrospective cohort study. Front Neurol. 2018; 9: 823.
Zander T, Maynar J, Lopez-Zarraga F, et al. Mechanical thrombectomy in patients with tumour-related ischaemic stroke. Interv Neuroradiol. 2016; 22: 705-708.
Goddard JK, Nussbaum ES, Madison M, et al. Endovascular aspiration to treat acute ischemic stroke caused by embolic carcinoma. Interv Neuroradiol. 2019;25: 403-406.
Dearborn JL, Urrutia VC, Zeiler SR. Stroke and cancer - a complicated relationship. J Neurol Transl Neurosci. 2014; 2: 1039.
Jung S, Jung C, Hyoung Kim J, et al. Procedural and clinical outcomes of endovascular recanalization therapy in patients with cancer-related stroke. Interv Neuroradiol. 2018; 24: 520-528.
Goyal L, Saha SK, Liu LY, et al. Polyclonal secondary FGFR2 mutations drive acquired resistance to FGFR inhibition in patients with FGFR2 fusion-positive cholangiocarcinoma. Cancer Discov. 2017; 7: 252-263.
Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723-1731.
Park H, Kim J, Ha J, et al. Histological features of intracranial thrombi in stroke patients with cancer. Ann Neurol. 2019; 86: 143-149.
Collins RC, Al-Mondhiry H, Chernik NL, Posner JB. Neurologic manifestations of intravascular coagulation in patients with cancer. A clinicopathologic analysis of 12 cases. Neurology 1975; 25: 795-806.