Risk of ischemic stroke in patients with ovarian cancer: A nationwide population-based study

Ai Seon Kuan; Chung Jen Teng; Hua Hsi Wu; Vincent Yi Fong Su; Yung Tai Chen; Sheng Hsuan Chien; Chiu Mei Yeh; Li Yu Hu; Tzeng Ji Chen; Cheng Hwai Tzeng; Chia Jen Liu

doi:10.1186/1741-7015-12-53

Risk of ischemic stroke in patients with ovarian cancer: A nationwide population-based study

Ai Seon Kuan, Chung Jen Teng, Hua Hsi Wu, Vincent Yi Fong Su, Yung Tai Chen, Sheng Hsuan Chien, Chiu Mei Yeh, Li Yu Hu, Tzeng Ji Chen, Cheng Hwai Tzeng, Chia Jen Liu^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

42 Scopus citations

Abstract

Background: Cancer patients are at risk of thromboembolism. However, studies investigating the relationship between ovarian cancer and ischemic stroke are lacking. The objectives of this study were to assess the association between ovarian cancer and ischemic stroke, and to determine the predictive risk factors. Methods: Ovarian cancer patients aged 20 years and older without antecedent cerebrovascular events and who were followed up for more than 1 year between 1 January 2003 and 31 December 2011 were recruited from the Taiwan National Health Insurance database. Hazard ratios (HRs) of stroke risk for ovarian cancer patients compared with an age- and comorbidity-matched cohort were calculated by Cox proportional regression analysis. The difference in cumulative ischemic stroke incidence between ovarian cancer patients and the matched cohort was analyzed with the Kaplan-Meier method and tested with the log-rank test. Results: Each cohort (ovarian cancer and matched cohort) consisted of 8,810 individuals, with a median age of 49 years. After a median follow-up of 2.68 and 3.85 years, respectively, the ischemic stroke incidence was 1.38-fold higher in the ovarian cancer cohort than in the comparison cohort (9.4 versus 6.8 per 1,000 person-years), with an age- and comorbidity-adjusted HR of 1.49 (P <0.001). The ischemic stroke risk imposed by ovarian cancer was more prominent in patients under 50 years old (HR 2.28; P <0.001) compared with patients 50 years and older (HR 1.33; P = 0.005). Significant risk factors predicting stroke development were age 50 years and older (HR 2.21; P <0.001), hypertension (HR 1.84; P <0.001), diabetes mellitus (HR 1.71; P <0.001), and treatment with chemotherapy (HR 1.45; P = 0.017), especially platinum-based regimens. Conclusions: Ovarian cancer patients were at an increased risk of developing ischemic stroke. Age, hypertension, diabetes, and chemotherapy treatment were independent risk factors.

Original language	English
Article number	53
Journal	BMC Medicine
Volume	12
Issue number	1
DOIs	https://doi.org/10.1186/1741-7015-12-53
State	Published - 25 Mar 2014

Keywords

Chemotherapy
Ischemic stroke
Ovarian cancer
Platinum
Population-based study

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/1741-7015-12-53

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@article{268818221b49418682d6bfe2e11c0b80,

title = "Risk of ischemic stroke in patients with ovarian cancer: A nationwide population-based study",

abstract = "Background: Cancer patients are at risk of thromboembolism. However, studies investigating the relationship between ovarian cancer and ischemic stroke are lacking. The objectives of this study were to assess the association between ovarian cancer and ischemic stroke, and to determine the predictive risk factors. Methods: Ovarian cancer patients aged 20 years and older without antecedent cerebrovascular events and who were followed up for more than 1 year between 1 January 2003 and 31 December 2011 were recruited from the Taiwan National Health Insurance database. Hazard ratios (HRs) of stroke risk for ovarian cancer patients compared with an age- and comorbidity-matched cohort were calculated by Cox proportional regression analysis. The difference in cumulative ischemic stroke incidence between ovarian cancer patients and the matched cohort was analyzed with the Kaplan-Meier method and tested with the log-rank test. Results: Each cohort (ovarian cancer and matched cohort) consisted of 8,810 individuals, with a median age of 49 years. After a median follow-up of 2.68 and 3.85 years, respectively, the ischemic stroke incidence was 1.38-fold higher in the ovarian cancer cohort than in the comparison cohort (9.4 versus 6.8 per 1,000 person-years), with an age- and comorbidity-adjusted HR of 1.49 (P <0.001). The ischemic stroke risk imposed by ovarian cancer was more prominent in patients under 50 years old (HR 2.28; P <0.001) compared with patients 50 years and older (HR 1.33; P = 0.005). Significant risk factors predicting stroke development were age 50 years and older (HR 2.21; P <0.001), hypertension (HR 1.84; P <0.001), diabetes mellitus (HR 1.71; P <0.001), and treatment with chemotherapy (HR 1.45; P = 0.017), especially platinum-based regimens. Conclusions: Ovarian cancer patients were at an increased risk of developing ischemic stroke. Age, hypertension, diabetes, and chemotherapy treatment were independent risk factors.",

keywords = "Chemotherapy, Ischemic stroke, Ovarian cancer, Platinum, Population-based study",

author = "Kuan, {Ai Seon} and Teng, {Chung Jen} and Wu, {Hua Hsi} and Su, {Vincent Yi Fong} and Chen, {Yung Tai} and Chien, {Sheng Hsuan} and Yeh, {Chiu Mei} and Hu, {Li Yu} and Chen, {Tzeng Ji} and Tzeng, {Cheng Hwai} and Liu, {Chia Jen}",

note = "Funding Information: This study is supported in part by a grant from Taipei Veterans General Hospital (V103B-022 and V103E10-001). The supporting sources have no role in the study design or conduct, or in the decision to submit for publication. The study is based on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance (BNHI), Department of Health, Executive Yuan, Taiwan and managed by National Health Research Institutes (NHRI), Taiwan. We express our particular gratitude to the government organization BNHI and the non-profit foundation NHRI.",

year = "2014",

month = mar,

day = "25",

doi = "10.1186/1741-7015-12-53",

language = "English",

volume = "12",

journal = "BMC Medicine",

issn = "1741-7015",

publisher = "BioMed Central Ltd.",

number = "1",

}

TY - JOUR

T1 - Risk of ischemic stroke in patients with ovarian cancer

T2 - A nationwide population-based study

AU - Kuan, Ai Seon

AU - Teng, Chung Jen

AU - Wu, Hua Hsi

AU - Su, Vincent Yi Fong

AU - Chen, Yung Tai

AU - Chien, Sheng Hsuan

AU - Yeh, Chiu Mei

AU - Hu, Li Yu

AU - Chen, Tzeng Ji

AU - Tzeng, Cheng Hwai

AU - Liu, Chia Jen

N1 - Funding Information: This study is supported in part by a grant from Taipei Veterans General Hospital (V103B-022 and V103E10-001). The supporting sources have no role in the study design or conduct, or in the decision to submit for publication. The study is based on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance (BNHI), Department of Health, Executive Yuan, Taiwan and managed by National Health Research Institutes (NHRI), Taiwan. We express our particular gratitude to the government organization BNHI and the non-profit foundation NHRI.

PY - 2014/3/25

Y1 - 2014/3/25

N2 - Background: Cancer patients are at risk of thromboembolism. However, studies investigating the relationship between ovarian cancer and ischemic stroke are lacking. The objectives of this study were to assess the association between ovarian cancer and ischemic stroke, and to determine the predictive risk factors. Methods: Ovarian cancer patients aged 20 years and older without antecedent cerebrovascular events and who were followed up for more than 1 year between 1 January 2003 and 31 December 2011 were recruited from the Taiwan National Health Insurance database. Hazard ratios (HRs) of stroke risk for ovarian cancer patients compared with an age- and comorbidity-matched cohort were calculated by Cox proportional regression analysis. The difference in cumulative ischemic stroke incidence between ovarian cancer patients and the matched cohort was analyzed with the Kaplan-Meier method and tested with the log-rank test. Results: Each cohort (ovarian cancer and matched cohort) consisted of 8,810 individuals, with a median age of 49 years. After a median follow-up of 2.68 and 3.85 years, respectively, the ischemic stroke incidence was 1.38-fold higher in the ovarian cancer cohort than in the comparison cohort (9.4 versus 6.8 per 1,000 person-years), with an age- and comorbidity-adjusted HR of 1.49 (P <0.001). The ischemic stroke risk imposed by ovarian cancer was more prominent in patients under 50 years old (HR 2.28; P <0.001) compared with patients 50 years and older (HR 1.33; P = 0.005). Significant risk factors predicting stroke development were age 50 years and older (HR 2.21; P <0.001), hypertension (HR 1.84; P <0.001), diabetes mellitus (HR 1.71; P <0.001), and treatment with chemotherapy (HR 1.45; P = 0.017), especially platinum-based regimens. Conclusions: Ovarian cancer patients were at an increased risk of developing ischemic stroke. Age, hypertension, diabetes, and chemotherapy treatment were independent risk factors.

AB - Background: Cancer patients are at risk of thromboembolism. However, studies investigating the relationship between ovarian cancer and ischemic stroke are lacking. The objectives of this study were to assess the association between ovarian cancer and ischemic stroke, and to determine the predictive risk factors. Methods: Ovarian cancer patients aged 20 years and older without antecedent cerebrovascular events and who were followed up for more than 1 year between 1 January 2003 and 31 December 2011 were recruited from the Taiwan National Health Insurance database. Hazard ratios (HRs) of stroke risk for ovarian cancer patients compared with an age- and comorbidity-matched cohort were calculated by Cox proportional regression analysis. The difference in cumulative ischemic stroke incidence between ovarian cancer patients and the matched cohort was analyzed with the Kaplan-Meier method and tested with the log-rank test. Results: Each cohort (ovarian cancer and matched cohort) consisted of 8,810 individuals, with a median age of 49 years. After a median follow-up of 2.68 and 3.85 years, respectively, the ischemic stroke incidence was 1.38-fold higher in the ovarian cancer cohort than in the comparison cohort (9.4 versus 6.8 per 1,000 person-years), with an age- and comorbidity-adjusted HR of 1.49 (P <0.001). The ischemic stroke risk imposed by ovarian cancer was more prominent in patients under 50 years old (HR 2.28; P <0.001) compared with patients 50 years and older (HR 1.33; P = 0.005). Significant risk factors predicting stroke development were age 50 years and older (HR 2.21; P <0.001), hypertension (HR 1.84; P <0.001), diabetes mellitus (HR 1.71; P <0.001), and treatment with chemotherapy (HR 1.45; P = 0.017), especially platinum-based regimens. Conclusions: Ovarian cancer patients were at an increased risk of developing ischemic stroke. Age, hypertension, diabetes, and chemotherapy treatment were independent risk factors.

KW - Chemotherapy

KW - Ischemic stroke

KW - Ovarian cancer

KW - Platinum

KW - Population-based study

UR - http://www.scopus.com/inward/record.url?scp=84899147039&partnerID=8YFLogxK

U2 - 10.1186/1741-7015-12-53

DO - 10.1186/1741-7015-12-53

M3 - Article

C2 - 24661584

AN - SCOPUS:84899147039

SN - 1741-7015

VL - 12

JO - BMC Medicine

JF - BMC Medicine

IS - 1

M1 - 53

ER -

Risk of ischemic stroke in patients with ovarian cancer: A nationwide population-based study

Abstract

Keywords

UN SDGs

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